Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3A :0 > Womens health > Flashcards

Womens health Flashcards

1
Q

dfferent types of proplase

A

rectocele cystocele and uterine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

risk factors of prolapse

A

multiple vagonal delivers
birth trauma, instramental eliveries
post menopause
chronic coughing
chronic consipatoin caising strianing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

management of proplapse

A

pelciv floor excercises
wight loss
lifestyle change
stress incontinance and antichoinergic
vaginal oetrogen cream

pessary

hysterectomy

lifestyle:
#wight loss
stop somking
avoid straing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are teh tpes of urinary incontiance

A

stress - weak muscels aussif weakness of sphincter muscles and urine incontinace wirh laight/coughing
urge - overactiviy of teh detrusor musle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

test for incontinance

A

asses pelcivic tone - prolapse, atrrophic vaginitis, uretheral diverticulu, ask tehmn to cpugh and squeeze

bladder diary
urine dipstick urodynamic tsting -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

managetment of stress and urge incontinance

A

stress - avoid caffien and diuretics
weight loss
duloxatine
peliv floor excercises

tention free vaginal tape
colposuspension

urge -
anticholinergic medication
bladder retrianin
mirabegron
botox injection
percutatous sacral nerve stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is overreacitve bladder and its causes

A

involentary contraction of the detrussor muscle caused by
brain damafe
diabteies
diuretivs
urethritis
vaginitis #
UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

stmptoms of overreactive bladder

A

urge incontinance
eneurisis
runnig water is a trigger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

teratment of overreactive bladder

A
  • Try a toildel regine o every 4 hours
  • Pads
  • Anticholinergic drugs - reduce activity of autonomic NS
  • Botox of bladder neck
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

different types of vaginal malformations

A
  • Bicornate - can lead to dverse pregancy outcomes
  • Imperforated hymen - if not treated could lad to retrograde menstration leading to endometriosis
  • Transverse vaginal septum- the septum doesn’t recede, it grows sideways. It can causes infertitliy and pregnancy complications. Diagnise via ultradounsl treat with surgery.
  • Vaginal hypoplasia - small vag - use vaginal dialators or surgery
  • Vaginal agensis - no vag
    Potenitlaly have no uters and cervix,
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are tge ages and stages of pubity

A

8-14
breat bugs
pubic hair
period.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

treatment for menohragia/dysmennoreha

A

Tranexamic acid when no associated pain (antifibrinolytic – reduces bleeding)
Mefenamic acid when there is associated pain (NSAID – reduces bleeding and pain)

Contraception:
* Mirena
* Combine oral contraceptive
* Cycle progesterones

* Hysterectomy  Endometrial ablation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

define menopause and perimenopause

A

menopaude - retrospecitve diansis 12 months after teh last period
perimenopause - period before and 12 onths after menopause where ther are symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is classed as premature menopause

A

under 45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

perimonpause symptoms

A

hot flushes
emotional instability
PMS
irregular periods
joint pain
heavier/lighter periods
vadinal dryness and atrophy
reduced libido

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are teh age relates tests for menopause

A
  • Women over 45 with typical symptoms and menopause a diagnosis can be made
  • FSH blood tests in women under 40 with suspected premature menopause
    Women 40-45 with menopausal symptoms or change menstrual cycle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

HRT breakdown

A

must give progesterone if they stillhave a wwomb

progesterone: mirena/miny pill
both:batch/tablet
oestrogen: patch/gel/tablet/spray

dont give if breast cancer or gynea cancer!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

complications of lack of oestrogen

A
  • Cardiovascular disease and stoke
    • Osteoporosis
    • Pelvic organ prolapse
      Urinary inconstancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is adenomyosis

A

endometrial tissue inside of teh myometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

presentaio of adenomosis and testts

A

dysmenorhea
menohradia
dysparanuria
pregnancy complications

ultrasond

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

adenomyosis treatment and complications

A

Tranexamic acid when there is no associated pain (antifibrinolytic – reduces bleeding)
Mefenamic acid when there is associated pain (NSAID – reduces bleeding and pain)
Management when contraception is wanted or acceptable:

Mirena coil (first line)
Combined oral contraceptive pill
Cyclical oral progestogens

* GnRH analouges to cuases a menopause like state 
* Endometrial alation 
* Uterien artery embolisation 
* Hysterectomy
  • Infertility
  • Miscarrige
  • Preterm birth
  • Small for gestational age
  • Need for c section
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is ashermans ad its causes

A

adhesiosn form in teh uterus after damage

pelvic infectios
dilation and cutterage porcedure
uterine surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

test and treatment or ashermans syndrome

A

hysperoscopy
hyterosalpingograohy
sonohystrography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what s ltchen scleross and epdemology

A

chronc nflamatory autoimmune sn condton wth shny porcaln sn

45-60 women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

licehn scleross ey presntatons

A
  • Vulval itching
  • Skin changes
  • Sorness and pain
  • Worse at night
  • Skin tightness
  • Pain during sex
  • Erosions
  • Fissures
  • The koebner phenomen - signs and symotos are mae worse by friction to to the skin.

Skin looks:
* Porcalin white
* Shiny
* Tight
* Thin
* Rainsed
Pauples/plaques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

management and complcatons of lchen scleross

A

potetnt topcal sterod - dermovate
use every day for 4 wees then 2x a wee
emollents

5% develop squamous cell carciomsa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

atrophic vaginosis - define, path and presintationw

A

Dryness and atrophy of the vaginal mucosa due to a lack of oestrogen.

When exposed to oestrogen, the vagina and urinary tract become thicker, more elastic, and produce secretions. As oestrogen falls, its thinner, less elastic and more dry. This causes a tendency towards inflammation. There is also a change in pH and flora which leads to localised infections. Oestrogen also helps to keep connective tissue health and a lack of can lead to pelvic organ prolapse and stress incontinence.

  • Itching
  • Dryness
  • Dyspareunia - pain on sex
  • Bleeding

Also consider it in women presenting with recurrent UTIs, stress incontinence, pelvic organ prolapse.

Examination of vagina:
* Pale mucosa
* Think skin
* Reduced folds
* Erythema and inflammation
* Dryness
* Sparse pubic hair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

atrophic vaginitis management and complications

A
  • Vaginal lubricants
  • Topical oestrogen:

Topical oestrogen has lots of infractions with HRT - breast cancer angina and venous thromboembolism!!
It may also lead to increaed ris pf endometrial hyoerplasia and endometrial cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

vulval cancer pathophysiology

A

squamous cell cercinoma
* Vulval intraepithelial neoplasia is a premalignant condition affection the squamous epithelium
* High grade squamous intraepithelial lesion is associated with HPV infection that occurs in 35-50 YO
Differentiated VIN is associated with lichen sclerosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

key presentation and tests of vulval canccer

A
  • Often incadendl presintaiton during catherisation
  • Lump
  • Ulceration
  • Bleeding
  • Pain
  • Itching
  • Lymphadenopathy of groin
  • Often affects the labia majora - irreguar mass
  • Bleeding #
  • Ulceration
  • Fungating lesion
  • 2 week wait
  • Biopsy of lesion
  • Sentinel node biopsy - demonstarte nodal spread
  • CT abdomen and pelvis for staging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

managemen of vulval cancer

A

For differentiated vulval intraepithelial neoplasia:
* Watch and wait wide local excision
* Imiqimod cream
* Laser ablation

  • Local excisions
  • Goin lymog dissection
  • Checmotherapy
    Radiotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

vaginal cancer risk factors and ke presentations an dtreatment

A

75 YO
HPV infection
lupus

lum in vagina and aroud skin
ulcer
bleeding after menopause
ssmelly discahre
bleeding between preieorsd
itch
pain when peeing

radiotherpy
surgert
vaginal reconstruction
chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

symptoms and testng of cervical cancer

A
  • Asymptomatic
  • Abnormal vaginal bleedig
  • Vaginal dishcccharge
  • Pelvic pain
    Dyspareunia

Examine cervix with speculum
* Smear
* Colpposcopy and 2 week wait referal
* Look for ulceration, inflamation, bleeding, visible tumour
* Don’t use smear tests t exclude cervical cancer

  • Colposcopy - stains such as acetic acid and iodende solution can be used
  • Acetic acid makes the cells appear white (acetowhite) which happens in cells with increased nucleuer to cytoplasmic ratio
  • Schillers iodene test - healthy areas will tuen brown, unhealthyones won stain
    Punch biopsy or lareg loop excision of the transformational zone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

pathophysology of cerviacla cencer

A
  • 80% are squamous cell carcinomas
  • Adenocarcinoma is the second most common
  • Dyskaryosis - cervical scressning test is HPV positive and there are abnormal changes in the cells fo the cervix

HPV chance increase:
* Early sexual activity
* Increased sexua partners
* Nto using condoms

  • Associated with HPV (human papillomavirus) 16 and 18, they are responsible for 70% of cancers
  • Smear tests to screen for precancerous cells
    P53 and pRb are tumour surpressor genes, HPV produces proiens whch inhibit these
  • Not engaging in cervical screening
  • Smoking
  • HIV
  • Combined pill >5 years
  • More full term pregnancies
  • Family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

explan eth cervcal acner screengn process

A
  • Happens every 3 years age 25-49 and every 5 50-64
  • Cervical smear test - the juice is tested for HPV and then microscpoy for precancerous cell changes
  • Women with pevious HIV are screened annually
  • Women with previous CIN may need additional tests
  • The resuts are:
  • Inadequate
  • Normal
  • Boarderline changes
  • Low grade
  • High grade dyskaryosis
  • Possible invasive squamous cell carcinoma

Inadequate sample – repeat the smear after at least three months
HPV negative – continue routine screening
HPV positive with normal cytology – repeat the HPV test after 12 months
HPV positive with abnormal cytology – refer for colposcopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

endometral cancer cell type and rs factor

A

80% are adenocarcinoma

unoposed oestrogen
early menses
no pregannges
obesty
oestrogen only hormoen replacement therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

treatment of cervcal cancer

A

Management and monitoring

Cervical intraepithelial neoplasia and early-stage 1A: LLETZ or cone biopsy
Stage 1B – 2A: Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy
Stage 2B – 4A: Chemotherapy and radiotherapy
Stage 4B: Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care

* 5 year Survuval drops from 98% with 1 to 15% with stage 4
* Bevacizumab - monoclona antibody
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

ey presentaton of endometral cancer

A
  • POST MENOPAUSAL BLEEDING!!!!!!!!!!!!!
  • Post coitao bleeing
  • Intermenstrual bleeding
  • Unusually heavy bleeding
  • Haematuria
  • Abnormal vag discharge
  • Anaemia
    Raised platemelt count
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

tests and manageemtn of endometral cancer

A
  • 2 week wait if post menopausal bleeding (more than 12 months after last mensration
  • Transvaginal ultrasound in over 55 with - unexplained vag discharge, visible haemeaturia
  • Transvaginal ultrasoun for endometrial thickness
  • Pipelle biopsy
  • Hysteroscopy
  • Stages:
    Stage 1: Confined to the uterus
    Stage 2: Invades the cervix
    Stage 3: Invades the ovaries, fallopian tubes, vagina or lymph nodes
    Stage 4: Invades bladder, rectum or beyond the pelvis
  • 1 & 2 - total abdominal hysterectomy with bilateral salpingo-oophorectomy, also known as a TAH and BSO (removal of uterus, cervix and adnexa).
  • Progesterone
  • Chemo
  • Radio
  • Radical hysterectomy inclucing pelvic lymph odes and top of vag
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

endometral polyps - defne and rs factors

A

An abnormal growth containing glands, stroma and blood vessels projecting from the lining of the uterus (endometrium)

  • Taximofen
  • Increased oestrogen levels
  • HRT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

endometral poyps presentaton tets and management

A
  • Bleeding
  • Infertility
  • Malognant transformation
  • Transvaginla ultrasonography
  • Colour flow doppler
  • Sonohysterography
  • Histological diagnosis
  • Hysteroscopy
  • Dilatation and curettage
  • Watch and wait
  • levonorgestrel intrauterine system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

endometeross path and causes

A
  • Some genetic compponenent
  • During mensturaiton it flows backewards (retrograde menstration) leading to te hcells seeding in the pelivs
  • Lymphatic spread
  • Cells change- metaplasia
  • Embryonic cells remain outsied the usterus and the devlop later on in life
  • Pelvic pain
  • The endometrial tissue also bleeds elsewheere wich causes irritation and inflamatin t the tissues elsewhrer,
  • This causes cyclicalm dull, heavy burnig pain
  • It can lead to adhesiosn
  • Reduced fertility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

endometross presentatons

A
  • Some genetic compponenent
  • During mensturaiton it flows backewards (retrograde menstration) leading to te hcells seeding in the pelivs
  • Lymphatic spread
  • Cells change- metaplasia
  • Embryonic cells remain outsied the usterus and the devlop later on in life
  • Pelvic pain
  • The endometrial tissue also bleeds elsewheere wich causes irritation and inflamatin t the tissues elsewhrer,
  • This causes cyclicalm dull, heavy burnig pain
  • It can lead to adhesiosn
  • Reduced fertility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

endometrsos tests

A
  • Pelvic ultrasoubnd - endometromas and chocolate cysts
  • Need gynea referal for laparoscopy
  • Laproscopc sugery s gold standard - biopsy needed. They can also remove bits which can help to relieve symptoms.
    *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

treatment of endometross

A

Management and monitoring

Initial:
* Stablish clear diagnosis
* Provide explanation, build partnership with patient
* Analgesics for pain

Hormonal
* Combined oral contraceptive pill 
* Progesterone only pill 
* Injection 
* Mirena coil 
* Implant 
* GnRH agonists 

Surgical:
* Laparoscopic to excise endometrial issues and remove adhesions 
* Hysterectomy 

* Hormonal medication can stop ovulation and reduce endometrial thickening 
* Induce a menopause  like state - GnRH agonists 
* Infertility can sometimes be treated with surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

defien fibroids and teh different types

A

Benign tumours of the smooth muscle of the uetere.

  • Affect 40-60% of women later on and are oestrogen sensiivt.
  • Intramural - within the myometrium, as they gro they change shape and distory the uterus
  • Subserosal - grow into the absmmoincal cavity
  • Submucosal - just belwo the endometrium
  • Pedunculated - on a stalk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

managament and complicationis of fibroids

A
  • For fibroids less than 3cm, treat the same as heavy menstural bleeding
  • Mirenal coil
  • Tranexamix acid
  • Symtpmatic manegemnt - NSAIDs
  • Combined oral contraceptive
  • Cyclical oral progesterones
  • Endometrial ablation
  • Resection during hysteroscooy
  • Hysterectomy

If over 3cm - refer to gynae -
* Uterine artyer embolisation - block the blood supply causing ti to shrink
* Myomectomy - laproscopic removal
* Hyserectomy
* Gnhr agonists can be used befroe surgery to reduce the size

  • Heavy blleeidn - aneamis
  • Reduced fertilitu
  • Consitpatoin
  • Pregnancy complications
  • Urinary obstruction
  • Torsoin
  • Malignant change t leiomyosarcoma
  • Red degeneration - infarction and necrosisof et hfibroid during pregnancy - severe abdominal pain, tachycardia, fever, vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

fibroids presentaion and tests

A

Key presentations

  • Asymptomatic
  • Menorrhagia
  • Prolonged menstruation - over 7 days
  • Bloating and feeling full
  • Urinary and bowel symptoms
  • Deep dyspareunia
  • Reduced fertility
  • Bimanual examination may reveal palpable pelvic mass

Signs

Symptoms

Tests

  • Hysterospcpt for submucosal with heavy mensturla bleeding
  • Pelvic ultrasound
  • MRI scanner
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

define and risk fctors for ectopic pregnancy

A
  • Pregnancy implants outside of the uterus such as in a fallopian tube, ovary, cervix or abdomen.
  • Previous ectopic pregnancy
  • Previous pelvic inflammatory disease
  • Previous fallopian tube surgery
  • Older age
  • Coils
  • Smoking
  • Endometriosis!!
  • IVF treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

key presentaton and tests for ectopic preganncy

A
  • 6-8 weeks gestation
  • Always ask about possibility of pregnancy
  • Missed periods
  • Constant lower abdominal pain
  • Vag bleeding
  • Lower abdo and pelvic tenderness
  • Cervical motion tenderness
  • Shoulder tip pain
  • Dizziness or syncope
  • Ultrasound scan will show adnexal mass moving separately to the ovary or comprising a gestational sac and yolk/fetal pole.
  • Transvag ultrasound
  • Gestational sac containt yolk or fetal pole might be found
  • Non specific mass iht be alled a blob sign
  • Empty uterus, fluid in uterus mistaken for gestational sack
  • Pregnancy of unknown location - positive pregnacy test but no evidance of pregency on ultrasound
  • A fall in HCG greater than 50% is likey to be a misscaragge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

treatment of ectopc pregnancy

A

Management and monitoring

  • Referral to early pregnancy assessment unit
  • Expectant management - wait for normal termination
  • Medical management (methotrexate)
  • Surgical management (salpingectomy)

Criteria for expectant management:
* Follow up needed on day 2,4,7
* Ectopic is unruptured
* Adnexal mass <35mm
* No visible heartbeat
* No pain and clinically stable
* HCG level <1500 IU

For methotrexate - HCG above 5000, confirmed pregnancy on ultrasound. It is very toxc to pregancy, women shouldn’t get pregnancy within 3 months of having it.

  • Surgical mamgement - pain, adnexal mass >35cm, visible heartbeat, hcg >500, signs of rupture, heamodynamically instable
  • Laproscpoic salpingectomy - general anasthetic, removal of fallopian tube
  • laparoscopic salpingotomy - fallopian tube is opened, pregancy is removed and then its sown back up again
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

termination of preganncy medical and surgual

A
  • Mifepristone (anti-progestogen) - relaxes cervix, and terminates fetus
  • Misoprostol (prostaglandin analogue) 1 – 2 day later - softens cervix and stimulates contractions. From 10 weeks, additional doses are required
  • Rhessus negative women require anti D prophylaxis from 10 weeks gestation onwards
  • Less than 10 weeks - medication at home
  • Oramorph and morphine pain killers in pregnancy
  • Local anasthetic, sedation ot general
  • Cervical priming with misoprostol, mifepristone, osmotic dilators
  • Cervical dialation dn suction - up to 14 weeks.
  • Cervical dilation and exaltation using forceps

Beyond 18 weeks its surgical.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what is teh criteria for polycyssitc ovary syndomr

A

rotterdam - 2/3 needed
* Anovulation
* Hyperandrogenism - hirsutism and acne
Polycysitc overus on ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

key presentaitonis of polycystic ovary syndrome

A
  • Oligomenorrohea
  • Infertility
  • Obesity
  • Acne
  • Hirsutism
  • Male pattern hair loss
  • Insulin resistance
  • Acanthos nigricans
  • Hypercholesterima
  • Depressiona dn aanxiety
  • Obstructive sleep aponea
  • CVD disease
  • Sex issues
    Acanthosis nigricans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

test sfor polycyctic ovary syndrome

A
  • Testosterone
  • Sex hormone binding globulin
  • Lunatizing hormone
  • Follicle stimulating hormone
  • Prolactin
  • Thyroid stimulating hormone
  • Raised lunatising hormone
  • Raised testosterone
  • Raised insulin
  • Normal or raised oestrogen levels
  • Raised LH:FSH ratio!
  • Oral glucose tolerance test, for diabeties checkign
  • Transvaginal ultrasound is gold standard!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

management and complications of polycystic ovary syndroem

A
  • Manage risks associated - weight loss, exercise, stop smoking, statins, antihypertensives
  • Weight loss is a large management and can restore fertility
  • Orlistat may be sed to helpo weight loss in BMI >30. it is a lipase inhibitor.
  • They have increased risk of endometrial cancer - mirena coil, orla contraceptie pill, cyclical progesterones.
  • Managing infertilty - weight loss, Clomifene, Laparoscopic ovarian drilling, In vitro fertilisation (IVF)
  • Management of hiratusm - dianette OCP, topical eloflorinate, spirinolactone
  • For the hair growht - cominded pill (yasmin preferably or maybe dianette)
  • Spiranalactone can be used as an offliscence treatment

Hiratusm can also be causeed by - medications ( phenytoin, ciclosporin, corticosteroids, testosterone and anabolic), ovarian/adrenal tumous
Cushings

* Inferetility 
* Diabeties (insulin resistance) 
* Hypercholesteremia 
* Cardiovascualr diesaes earlier?
* Cancer - ovarian, endometrium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

causes and pathpphysology od pelvc nflamatory disease

A
  • Multiple partners
  • Young age
  • STIs
  • Previous inflammatory disease
  • Intrauterine device

STIs:
* Neisseria gonorrhoea
* Chlaymidia trachomatis
* Mycoplasma genitalium

Non STIs
* Gardenella vaginalis (BV)
* Heamophilus influenzae
* Estrichia coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

ey presnitations and tests for pelvc inflamatory disease

A
  • Pelvic/lower abdominal pain
  • Abnormla discharge
  • Pain during sex
  • Fever
  • Dysuria

Exam:
* Pelvic tenderness
* Cervcal motion tenderness
* Purulent dishcarge
Fever/ sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

managemetn adn complciations of pelvic inflamatory dsiease

A
  • GUM medicniie refferal
  • Contact tracing

A single dose of intramuscular ceftriaxone 1g (to cover gonorrhoea)
Doxycycline 100mg twice daily for 14 days (to cover chlamydia and Mycoplasma genitalium)
Metronidazole 400mg twice daily for 14 days (to cover anaerobes such as Gardnerella vaginalis)

Ceftriaxone and doxyxycline are also good!!!

  • They may require hospita admission and V antibiotis if there is sepsis or they are preggers.
  • May need surgery of tehre is an abcess
  • Sepsis
  • Abcess
  • Infertility
  • Chronic pelvic pain
  • Ectopic preg
  • Fitz- hugh- curtis syndrome - infection of glissons capsule (liver capsule)
    , spread thouhh blood, lymphatics or from pelvic cavity,
  • RUQ pain, laproscopy and treat adhesions.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

varian torision path, presentations and risk factors

A

The ovary twists in relation to the surroundign tissue, fallopian tube and blood supply.

Pregnacny
Before menarche

Often occurs due to an ovarian mass >5cm such as a cyst or tumout. It can cause the blood supply to be cut off leadingto necrosis, it is an emergancy.

  • Severe sudden onset, unilateral pelvic pain.
  • Pain is constatnt, gets progressibly worse
  • Nausua and vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

tests, monitering and coplications of ovarian torson

A

Pelvic ultrasound - ideally transvaginal
Whirlpool sign - free fluid in the pelvis and oedema of the ovary
Doppler may show lack of blood flow

Laproscopic surgeyr for removal or untwisting and fixing it in place.

  • Delay in treatment may lead to loss of function
  • The other one can normallyompensate fertility wise
  • Infection
  • Necrosis, rupture, sepsis
  • Peritonitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

ovaran cancer risk factors

A

Often diagnosed late as non-specific symptoms. 70% is diagnosed after it has spread beyond the pelvis.

  • Age 60
  • Increased number of ovulations
  • Obestiy
  • Smoking
  • Recurrent clomifene use

Protective -
* Oral pill
* Pregnancy
* Breastfeeging
* As these all stop ovulation for a while

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

ovarani cancer path and key presintations

A
  • Epithelial cell tumours are the most common type - subtypes of this are - serous tumours, endometroid carcinomas, clear cell tumours, mucinous tumours, undifferentiated tumours
  • Dermoir cysts and germ cell tumours- tereatomas which come from ger cells. They are bengign.
  • Sex cord-stromal tumours - sertoli and leydig and granuola cell tumorus
  • Metastasis - krunken tumours are from GI cancer and look like signet rings in histology microscopy

Non specific
* Abdominal bloating
* Early satiety
* Loss of appetite
* Pelvic pain
* Urinary symptoms
* Weight loss
* Abdominal or pelvic pain
* Ascites

  • It may press on the obturator nerve and cause referred hip or groin pain

Refer to 2 week wait if they have ascities, pelvic mass or ambominal mass.

In women over 50 with
* New symptoms of IBS / change in bowel habit
* Abdominal bloating
* Early satiety
* Pelvic pain
* Urinary frequency or urgency
* Weight loss

Do CA125 blood test before referral.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

test for ovaruan cancer

A

CA125 blood test - >35 IU/ml is significant
Pelvic ultrasound

CT scan
Histology
Paracentesis

Germ cell tumour
* alfa fetoprotiesn
* HCG

CA125 - can be raised due to endometriosis, fibroids, adenomyosis, pelcin infection, liver disease, pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

ovaran cyst pathophyssoolgy

A

Multiple cysts (string of pearls) is polycystic overian syndrome if they have no other conditions, it also requires two of anovulation, hyperandrogenism, polycystic ovaries on ultrasound.

Follicular cysts are the most common and are when the egg is released they persist. Normally they disappear after a few menstural cycles

Corpus luteumncysts - often seen in early pregnancy

* Serous cystadenoma - epitherla cells 
* Mucison cystadenoma 
* Endometrioma 
* Dermoid cysts - teratomas  Sex cord stromal tumous - sertoli, leydig and granulosa cell tumours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

ey presntatno of ovaran cyst

A
  • Asymptomatic
  • Pelivc pain
  • Fullness in the abdomen
  • Palpable pelvic mass

Distuinbigh if it is benign or malignant

  • Abdmonial bloating
  • Reduced appetite
  • Early satiety
  • Weight loss
  • Urinary symptoms
  • Pain
  • Ascities
  • Lymphadenopathy

Risk factors:

  • Age
  • Postmenopause
  • Increased number of ovulations
  • Obesity
  • Hormone replacement therapy
  • Smoking
  • Breastfeeding (protective)
    Family history and BRCA1 and BRCA2 genes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

test managemnt and complcatons of ovaran cyst

A
  • Premenopausal women with a simple cysts less than 5 cm on ultrasound can be left
    Blood:
    • CA125 - tumour marker for ovarian cancer to check

Women under 40 with a complex ovarian mass look for germ cell tumour
* Lactate dehydrogenase
* HCG
* Alfa-fetoprotien

  • For suspected cancer - 2 week wait

Simple cycts on premenopausal wmen:
* Less than 5cm cysts will almost always resolve within three cycles. They do not require a follow-up scan.
* 5cm to 7cm: Require routine referral to gynaecology and yearly ultrasound monitoring.
* More than 7cm: Consider an MRI scan or surgical evaluation as they can be difficult to characterise with ultrasoun

  • Enlarged cyts might need surgical intervention - remove cyst or ovary
  • Torsion
  • Haemorrhage
  • Rupture
  • Meigs syndrome - ovarnain fibroma, pleural effusion, ascieties. This is in older women. Requires removal of the tumour.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

causes and tests for multple miscarriges

A
  • Idiopathic
  • Antiphospholipid syndrome - low dose aspin and LMWH
  • Hereditary phrombophilias - factor V leidan, gactor II gebe mutation, protoein S deficancy
  • Uterine abnormalaties -
  • Genetics
  • Chronci histocytic intervillositis - very rarem histocytes and macrophaes build ip and causes inflamation.
  • Diabeties
  • Untreated thyroid disease
  • SLE

Investiagete after three or more 1st trimester ones, or one second trimester one.

Antiphospholipid antibodies
Testing for hereditary thrombophilias
Pelvic ultrasound
Genetic testing of the products of conception from the third or future miscarriages
Genetic testing on parents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what are the tyeps of miscarrige

A
  • Missed - fetus is dead but there are no symptoms
    • Threatened - vag bleeding with closed cervix and alive fetus
    • Inevitable - vag bleeding with open cervix
    • incomplete - products of conception remain after miscarriage
    • Compete - full miscarriage has occurred and the uterus is empty
      Anembryonic pregnancy - gestational sack but no embryo
    • Inevitable - you do a vginal exma and the cervix is open, yo miht be able to see some sack, the misscarrige is going to happen.
      Delayed - the women have no symptoms, but the feotus is over 7mm and there is no heartbeat on ultrasound. This will have to come away. They often present to antenatal clinic unaware.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

tests and differentials for misscarrgieg

A
  • Transvag ultrasound - three features used, as each appears the last one becomes less important - mean gestational sac diameter, fetal pole and crown rump length, fetal heartbeat.
  • When there is crown rump length of 7mm and no heartbeat after 2 weeks, it is non viable.
  • When the mean gestational sac is 25mm and there is no fetal pole, after a week it is an anembryonic pregnancy
  • A speculum exam can also be good to look at the cervix
  • bHCG levels need to be moniterd to ensure failing iUP
  • Normally bHCG should double every day, so if it is falling you know the feotus is coming away

Vaginal ultrasound!

  • Ectopic pregnancy
  • Cervical caner! Alays just swab them as you don’t want to miss it!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

management of miscarrige

A
  • <6 weeks - if in no pain just leave them, repeat pregnancy test after 7 days, if negative it is a miscarrige
  • <6 weeks - refer to early pregnancy assesment unit, ultrasoun for location and viability of the pregnancy. Then expecanct manegment, medical management, surgical management.
  • Medical manegent - misoprostol - prostaglandin analouge which softens cervix and simulates uterine contractions, side effects of heavy bleeding, pain, vomiting, diarrhoea.
  • Manual vaccum aspiraition - local anasthetic, a tibe goes into eth cervix and then a syringe is used to manyually aspirate the contents of the uterus . <10 weeks gestation.
  • electric vaccum aspiration (general anasthetic) cervix is widedned a a vaccum put inn to suck out the contents,
  • Anti rhesus d MUST be given to resus negative women
  • Rretained products of conceotio can lead to infection, needs misoprostol or surgical managetment with vaccum and cutterage. A coplication of cutterage is endometritis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

pregnancy and brth plans for dfferent tyeps of twns

A

32-336 for uncomplcated monochoronc monoamnotc twns

before 35- 6 for trples

monoamnotc are c secton

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

complcatons for mum and babes wth twns

A
  • Anaemia
  • Hypertension
  • Spontanous preterm birth
  • Cesarean
  • Potpartum hemmoarge
  • Polyhydramnios
  • Miscarrige
  • Fetal growth restiricion
  • Prematurit y
  • Twin twin transufuion syndreome- one twin recieves roe bllood getting heartfaliure and poluhydamnio, the other ets anama, olidohydramnios and growth restriction
  • Twin anaemia polycythermia sequance - less acute but same as above
    Congenital abnormalaties
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

what s a hydatdform mole and the 2 type

A

path - tumour that grows le a pregnancy n teh uterus

partal - 2 sperm fertalse a normla egg and it divides into a tuour but some fetal material may grow

complete - 2 sperm fertalise an empty egg and form a tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

what are teh risks of obestiry during pregnanc

A
  • Miscarrige
    • Gestational diabeteis
    • High blood perssure and preeclampsi a
    • Blood clots
    • Shoulder dysocia
    • Heavy bleeding after birth
    • Need for forceos of ceasarean
    • Stillbirth
      Spinal bifida
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

what shows on th ultrasoud of a hydatidiform mole and hat is teh treatment

A

snowstorm appearcne
bunch of grapes

exaculation and hisological examination
chemo if metastasised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

risk factros for gestationsl diabeties

A
  • Previous gestational diabeteis
  • Previosu macrosomic baby
  • BMI >30
  • Black, middle eastern and south asian ethnicity
    Family histroy of diabeties
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what is teh test and resukts for gestational diabeties

A

anyone wit risk factos shold have oral clugcole tolerance test at 24-28 weeks gestation

Oral glucose toleracne test -
* Fast, drink 75g glucose, measure blood after and before.
* Fasting: < 5.6 mmol/l
At 2 hours: < 7.8 mmol/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

managemtne of gestational diabeties and complications

A
  • Education to the women
  • 4 week ultrasounds
  • Fasting glucose less than 7 mmol/l: trial of diet and exercise for 1-2 weeks, followed by metformin, then insulin
  • Fasting glucose above 7 mmol/l: start insulin ± metformin
  • Fasting glucose above 6 mmol/l plus macrosomia (or other complications): start insulin ± metformin
  • They should monitor the blood sugar levels a few times a day,
    Fasting: 5.3 mmol/l
    1 hour post-meal: 7.8 mmol/l
    2 hours post-meal: 6.4 mmol/l
    Avoiding levels of 4 mmol/l or below
  • Resoloves immedatly after birth
  • Babies can be at risk of hypoglycaemia, cardiomyopathy, congenital ehart disease, jaundice, polycythaemia

Macrosomia and hypoglycaemia are the 2 biggest coplicatiosn for the baby!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

manegemtne of preexising diabeties in pregnanyc nad delivery

A
  • Take 5mg folic acid untill 12 weeks gestation
  • Aim for the same targets as in gestational
  • Use insulin and metformin, other diabetic medications should be stopped
  • Diabetic retinopathy screening would take place!
  • Planned delivery 37 +6 weeks
    Sliding scale insulin reigeme during labour may be needed. Dextrsoe and insulin infusion.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

defen gestatonal hylerteston and pre eclampsa

A
  • Chronic hypertension exists before 20 weeks gestation and is not caused by dysfunction of the placenta.
  • Gestatonal hypertention - hypertention that occurs after 20 weeks without protnudia
  • Pre-ecalmpsa - hypertention and end organ dmaage - protinuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

physology of pre eclampsa

A
  • The lacunae formed are inadequate and there is high vascular resistance with poor perfusion
    This causes oxidative stress on the placenta and inflammatory chemicals to be released leading to systemic inflammation and impaired endothelial function.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

symptoms of pre eclamta

A
  • Headache
  • Visual disturbances
  • Nausea and vomiting
  • Upper abdominal pain
  • Oedema
  • Reduced urine output
  • Brisk reflexes
  • Odema in hands and face!!
  • Hypertention + proinuria and at least one of:
  • Severe headache
  • Visual disturbaces
  • Papilloedema
  • Clonus
  • Liver tenderness
  • Abnrmal liver enzymes
  • Platelet couunt falls to <100 x 109 litre

Blood pressure over 150 is very worrying!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

dagboss of preeclampsa

A
  • Diagnose if there is a systolic blood pressure above 140 or diastolic blood pressure above 90 PLUS
  • Proteinuria, organ dysfunction, placental dysfunction.

Placental growth factor is a protein that stimulates development of new blood vessles. In preeclampsia the levels are low.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

treatmen of pre eclampsa

A

Prophylaxis
* Asprin is used as a prophylaxis against preeclampsia if they have a high risk factor or 2 moderate risk factors.
* Monitored with blood pressure, symptoms and urine dipstick for proteinuria.

Diagnosed:
* Scorint systems on if to admit or not
* Blood pressure monitered at least evry 48 hours
* Ultrasound every 2 weeks

  • Labetolol is first-line as an antihypertensive (beta blocker)
  • Nifedipine (modified-release) is commonly used second-line
  • Methyldopa is used third-line (needs to be stopped within two days of birth)
  • Intravenous hydralazine may be used as an antihypertensive in critical care in severe pre-eclampsia or eclampsia
  • IV magnesium sulphate is given during labour and in the 24 hours afterwards to prevent seizures
  • Fluid restriction is used during labour in severe pre-eclampsia or eclampsia, to avoid fluid overload as a lot of It can go into the 3rd space (oedema). Restrict to 80mls an hour.
    Bloood tets fo plateltes, renal and liver.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

what is hellp syndrome

A
  • Help syndreom -
  • Haemolysis
  • Elevated liver enzymes
  • Low platelets

Onset of seizures in a woman with pre-eclampsia
Seizures in a pregnant woman are always eclampsia until proven otherwise
IV MgSo4 4gms given over 5 minutes, followed by an infusion of 1 g/hour maintained for 24 hours
Recurrent seizures may require further doses
Treat hypertension (labetalol , nifedipine , methyldopa, hydralazine)
Stabilise mum first, then deliver baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

risk factors of VTE n pregnancy

A
  • Smoking
  • Parity >3
  • Over 35 YO
  • Reduced mobility
  • Multiple pregnancies
  • Pre eclampsia
  • Varicose veins
  • Family history
  • Thrombophillia
    IVF pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

VTE prophylaxs n pregnancy

A
  • Start VTE proyphylaxis at 28 weeks if there are 3 risk factors
  • First trimester if tehre are 4 or more risk factors
  • Also start if there is hospital admission, surgical prodedures, previous VTE, cance or arthiritis.
  • Low molecular weight heparin - enoxaparin, daltaparin, tinzaparin. Start as soon as possible In very high risk patients.
  • Continue for 6 weeks postnatally but stop briefly during labour.
    Antiembolic compressoin stockings, intermittenet pneumatic compression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

rs factos for sepss in pregnancy

A
  • Obesity
  • Diabetes
  • Impaired immunity / immunosuppressant medication
  • Anaemia
  • Vaginal discharge
  • History of pelvic infection
  • History of group B Strep infection
  • Amniocentesis and other invasive procedures
  • Cervical cerclage
  • Prolonged spontaneous rupture of membranes
    Group A Strep infection in close contacts / family members
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

treatment of eclampsa

A

IV magnesum sulphate!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

group b strep what antbotc

A

V benzylpenclln

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

obsetrc cholestass defne and epdemology

A

reduced outflow of ble acds from lver
also ncreased oestrogoen and progesterone levels

1% of women
develops after 2 wees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

key presentatons of obestrc cholesstass

A
  • Third trimester
  • Itching is the main symptom - palm and hands and soles of feet
  • Fatigue
  • Dark urine
  • Pale greasy stools
  • Jaundice

There is no rash!!! If there is one present think about polympophic eruption of pregnancy o pemphigoid gestationis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

tests for obsetrc cholestass

A

FT - abnotmla ALT, AST, GGT
* Bile acids - raised

ALP is noramllyl raised in preganncy becuased the pakcenta makes some, so if only this is raised think again

89
Q

treatment for obsetc cholestass

A
  • Emollients for the itching - chalmomile lotion
  • Antihistamines ot help with sleep - doesn’t help itching
  • Water soulble vitmain K can be given if prothrobin time is deragnced
    Early delivery may be needed if it is really bad
90
Q

causs of UTI in pregncancy bacteria

A
  • e.coli is most common
  • Kelbsiella pneumnoiae
  • Enterococcus
  • Pseudomons aerginosa
  • Staphylococcus saphrohyticus
    Candida albicans
91
Q

pregancy cystss and pyelonephrts symptoms

A
  • Dysuria
  • Suprapubic pain
  • Increased frequency
  • Urgency
  • Incontinence
  • Haematuria

Pyelonephritis:
* Fever
* Loin, suprapubic or back pain
* Feeling unwell
* Loss of appetite
* Heamaturia
* Renal angle tenderness

92
Q

uti n pregnancy treatment

A

7 days antbotcs!!!
ntrofuranton - avodn n 3rd trmesyyer
* Amoxixillin
Cefalecin

93
Q

what are teh risks of varcella zoster

A

an lead to varicella pneumonitis, hepatitis and encephalitis,

* Congenital varicella syndrome - 1% of chicken pox cases and happens whe the infection is in the first 28 weeks of gestation. There is fetal growth restriction, microcephaly, hydrocepahlus and learning disability. Scars, limb hypoplasia and cataracts.
94
Q

management of varcalla zoster n pregnancy

A
  • Varicella vaccine prior to pregnancy
  • IV varicella immunoglobulins within 10 days as prophylaxis if they have been exposed
  • If thery present with rash, treat with oral aciclovir if theyr resent withtin 24 hours and they are over 20 week gestaiton
95
Q

what is olgohydramnos and ts causes

A

Abnormally low voulme of amniotic fluid surrounding the fetus.

  • Fetal growth restriction
  • Maternal comorbidities - hypertension
  • Placental abnormalities
  • Placental abnormalities
  • Fetal urinal tract anomalies
  • Maternal drug use - NSAID, ACE inhibitors
  • Post term pregnancy
96
Q

dagnoss of olgohydramnos

A
  • Ultraousnd -
  • In the first method, the maximum vertical pocket (MVP) is identified and measured. A normal MVP is 2 cm to 8 cm.
  • The second method calculates the amniotic fluid index (AFI) and involves dividing the uterus into four quadrants and then adding together the MVP from each quadrant. A normal AFI is 5 cm to 25 cm.2
  • Oligohydrosis is:
  • AFI <5 cm or
    MVP <2 cm
97
Q

what are teh tests for amniotic fluid leakage

A
  • Ferning test - cervical secretions are dried on a slide, amniotic fluid forms crystals.
  • Amnisure: a vaginal swab to screen for the presence of placental alpha microglobulin-1 (PAMG-1) which is found in high concentration in amniotic fluid.
  • Actim-PROM: a swab that screens for insulin-like growth factor binding protein-1 (IGFBP-1) which is found in high concentration in amniotic fluid.
98
Q

complcatons of olgohydramnos

A
  • The earlier it is diagnosed, the worse the outcomes.
  • Limb deformitys
  • Pulmonary hypoplasia
    Cord compression an happen during labour.
99
Q

polyhydramnos causes

A

multple pregancy
dabetes
gut atresa
nfecton
rehseus dease
placentl ssues

100
Q

ey presetatons of polyhyramnose

A

breathlesness
heartburn
constpato
oedema n hands and feet
enlarged vulcva tihhttness n stomach

101
Q

treatment and complcatons of polyhydramnos

A
  • Extra antenatal appointments
  • Blood test for diabetes
  • Amniocentesis
  • Change in diet
  • Idomethacin - lowers the amount of urine youre baby makes
  • Preterm birth
  • Waters break early
  • Prolapsed umbilical cord
  • Heavy bleeding after baby
  • Placental abruption
  • Stillbirth
  • Postpartum hemorrhage
  • Fetal malposition
  • Uterine atony
  • Macrosomnia
102
Q

what are the dfferent types of placenta accereta

A

accreta - into the myometruu but not beyond
incretta - deeply inoy the myometrum
percreta - past the myomerum and permetroum, potentially invading other organs

103
Q

management of placnta acccrta

A
  • Ideally diagnosed antenatally by ultrasound to allow planning
  • MRI scans to asses depth and width
  • Complex uterine surgery
  • Blood transfusions
  • Intensive care for the mother
  • Neonatal intensive care
  • Delivery is planned between 35 to 36 + 6 weeks gestation to reduce the risk of spontaneous labour and delivery. Antenatal steroids are given to mature the fetal lungs before delivery.

Caesarean with:
* Hysterectomy with the placenta remaining in the uterus (recommended)
* Uterus preserving surgery, with resection of part of the myometrium along with the placenta
* Expectant management, leaving the placenta in place to be reabsorbed over time, this is very risky.

  • At 20w scan watch for anterior LLP if previous CS
  • Loss of definition between wall of uterus and Abnormal vasculature
  • MRI scan may be useful
  • Arrange elective CS at 36 to 37 weeks
  • Discussion and consent includes possible interventions (such as hysterectomy, leaving the placenta in place, cell salvage and intervention radiology)
  • Multidisciplinary involvement in pre-op and procedure: consultant obstetrician, consultant anaesthetist and blood bank/ Haematologists
  • Blood and blood products available
    Local availability of a level 2 critical care bed (HDU)
104
Q

placcental abrubtoni and risk factors

A

Placenta separates from the wall of the uterus during pregnancy, often leading to antepartum haemorrhage.

  • Previous placental abruption
  • Preeclampsi a
  • Bleeing in early pregancy
  • Trauma
  • Multiple pregnacy
  • Fetal growth restirction
  • Multigravida
  • Increased maternal age
  • smoking
  • Cocaine/amphetamine use
  • \ntiphospholid
105
Q

differen levels f heamorage and amounts of blood

A

Spotting: spots of blood noticed on underwear
Minor haemorrhage: less than 50ml blood loss
Major haemorrhage: 50 – 1000ml blood loss
Massive haemorrhage: more than 1000 ml blood loss, or signs of shock

106
Q

placental abruption presentations

A
  • Sudden sever continous abdo pain
  • Vaginal bleeding
  • Shock - hypotnsio and tachycardia
  • Abnormalaties on CTG
  • Woody plpation of abdomen
  • Maternal shock out of proportion to bleeging

Spotting: spots of blood noticed on underwear
Minor haemorrhage: less than 50ml blood loss
Major haemorrhage: 50 – 1000ml blood loss
Massive haemorrhage: more than 1000 ml blood loss, or signs of shock

There is also concealed abruption wheere the cervixal os remains closed and the bleeding can easilty be underestinated.

107
Q

management of placental abruption

A
  • Notify midwife, senior obstiatrician and anaesthetist
    • 2x grey cancula
    • Bloods - FBC, UE LFT, Coagulaiton study
    • Cross match 4 units of blood
    • Fluid and blood recusitation
    • CTG monitering of the feotus
    • Close monitering of mother

Steroids if pretetm delivery
Rhesus D
Emergcyanc c section
Active managemtn of third stage

108
Q

vasa preva meanng and patho

A

*exposed feotal vessles cross the OS.

The fetal vessels should always be protected by the umbilical cord or by the placenta. Whartons jelly is the connective tissue that makes up the outside of the umbilical cord.

2 thngs can leave the vessles exposed:
* Velamentous umbilical cord is where the umbilical cord insets into the chorioamnitotic membrane and the fetal vessles travel unproteced though the membranes before joining the placenta
* An accessory libe of the placenta is connected by fetal vessles that travels though the chorioamnitotic memebrane between the lobes.

The exposed vessels are prone to bleeding, paritciualry whe the
membrane rupture. Wheich leads to fetal blood loss and death

109
Q

tyoes of vasa oreavia

A
  • Type I vasa praevia – the fetal vessels are exposed as a velamentous umbilical cord. ths s when it attaches into eh chorioamntiotic membrane and travel unprotected before jooing the placenta.
  • Type II vasa praevia – the fetal vessels are exposed as they travel to an accessory placental lobe
110
Q

treatment of vasa peava

A

Management and monitoring

  • Planned c section if found on ultraousnd - 34-36 weeks
  • Corticosteroids t 32 weeks to mature feotal lings
  • Fetal mrotality is 60% if not known about prior to birth
111
Q

define low lying plcaneta and placenta prvia

A
  • Low-lying placenta is used when the placenta is within 20mm of the internal cervical os
    Placenta praevia is used only when the placenta is over the internal cervical os
112
Q

risk factor for placenta previa

A
  • Previous caesarean sections
  • Previous placenta praevia
  • Older maternal age
  • Maternal smoking
  • Structural uterine abnormalities (e.g. fibroids)
    Assisted reproduction (e.g. IVF)
113
Q

what are teh different types of placenta preavia

A
  • Minor praevia, or grade I – the placenta is in the lower uterus but not reaching the internal cervical os
  • Marginal praevia, or grade II – the placenta is reaching, but not covering, the internal cervical os
  • Partial praevia, or grade III – the placenta is partially covering the internal cervical os
    Complete praevia, or grade IV – the placenta is completely covering the internal cervical os
114
Q

treatment of major heamorage in delivery

A
  • Emergency caesarean section
    • Blood transfusions
    • Intrauterine balloon tamponade
    • Uterine artery occlusion
    • Emergency hysterectomy
    • ABCDE
    • If major bleed: two 14/16 G cannulas, IV fluids (crystalloid), X match 6 units, inform senior team and Paeds ASAP
115
Q

management of placenta previa

A

repeat transvaginal ultrasound scan at:
32 weeks gestation
36 weeks gestation (if present on the 32-week scan, to guide decisions about delivery)

* Planned delivery at 36-37 weeks - c section
* Steroids between 34-35+6 weeks to mature the foetal lungs 
* C sections incisions may have to be made vertically to avoid the placenta 

* Come to hospital if there is any bleeding 
* Avoid sex  Give anti D
116
Q

how ot induce labour

A
  • Pessary - propess (contains dinoprostone) (put in for 24 hours)
    • Then you can do a second pessary or a balloon
    • Then you can rupture the membranes
      Start on an oxytocin dri
117
Q

what are teh weeks of the different trimesters

A

First
1–12 weeks
Second
13–26 weeks
Third
27–end of pregnancy

118
Q

when is normla delivery time

A

37-42 weeks

119
Q

mos importatnt chemicla in labour

A

prostoglandin E2 (dinoprostone)

120
Q

what are teh three phases of teh frist stage of labour

A

Latent phase: From 0 to 3cm dilation of the cervix. This progresses at around 0.5cm per hour. There are irregular contractions.
Active phase: From 3cm to 7cm dilation of the cervix. This progresses at around 1cm per hour, and there are regular contractions.
Transition phase: From 7cm to 10cm dilation of the cervix. This progresses at around 1cm per hour, and there are strong and regular contractions.

121
Q

pre labour treatment of breech

A
  • External cephalc version acan be used at 37 weeks to turn them, 50% sucesfu
  • . Given tocolysis to relax the uterus with subcut terbutaline. It is a beta agonist reduced contractility of the myometrum
  • Rhesus D negative women need anti D prophylaxis. Kleihaur test is used to quantify the does of anti D needed.
  • Elective C seciton
    If the first baby in twins is breach a C seciton is requred
122
Q

pesentatons of puperal nfecton

A
  • Fever
  • Chills
  • Body aches
  • Loss of appetie
  • Discomfot
  • Pain below waist
  • Pale slammy skin
  • Increased heart rate
  • Foul smelling vaginal dischage
    Heavy bleeding that doesn’t improve
123
Q

tests for purpureal infection

A
  • Temp
  • White cell count
  • Vaginal swabs
  • Urine culture and sensitivitues
    Ultrasoubn for eetained products of conception
124
Q

what the types of uterine rupture and risk factors

A
    • Muscle layer of the uterus ruptures during labour
  • Incomplete rupture - the uterine serosa (perimetrium) remains intact
  • Complete rupture - all contents of the uterus are released itno the peritoneal cavity
    High mobidity for motehr and baby

Revious C section, can rupture with excessive pressure
* Rare for it to happen in first birth
* Increased BMI
* High parity
* Increased age
* Induced labour
Use of oxytocin to simulate contractoins

125
Q

key presentations of uterine rupture

A
  • Abnormal CTG
  • Abdominal pain
  • Vaginal bleeding
  • Ceasing of uterine contractions
  • Hypotension
  • Tachycardia
  • Collapse
126
Q

causes of preterm birth

A
  • 25-40% of preterm birhts are due to infection
  • Commonly ureaplasma urackyticum, e coli
  • The bactera can ascend from the vagina, be tranplacental t retrograde seeding from peritonea caviy through the fallopean tube. The proinflamatory cytokines which causes terine rubture
  • Ischeamia to the placenta
  • Uterine overdistention in twins
    Cervical weakness - congenital or traua
127
Q

who is screended for preterm birth and what is teh tests

A

Screenign:
* Previous preterm birth
* Pervious cervical cerclage
* Multipe pregnancy
* Intrauterine adhesiosn
* Uterine abnormlaties
* Previous C section

Cervical length is measured usinf a transvaginal ultrasond. Cervical length of less than 25mm between weeks 16-24 is a bad sign, and these mothers are at higer risk

  • Fetal fibromectin - extracellular matrix glucoprotien localozed at the maternal fetal interface of eth amniotic membrane
    Sould not be detectable at high levels in the cervicovaginal secretions at pretemr, its prescence is associated with decidual membrane activation
128
Q

symostome of preterm labour

A
  • Abso pain
  • Vaginal pressure
  • Increased vag discharge, bleeding, watery loss
  • GI disturbance
  • Urinary symptoms
  • Contractions
  • Vulvl chnages
  • Cercical softenign r dilation
  • Liquor drainage
    CTG changes
129
Q

prophylaxis of preterm labour

A

Prophylaxis of preterm labour:
* Progesterone gel vaginally to maintain pregnancy by decreasing myometriun activity. Offerend to women with cervial length less than 25mm on vag ultrasound bewteen 16-24 weeks gestation
* Cervical cercalage - a stich in the cervix to add support. For women with a cervix less than 25mm between 16-20 weeks or who have had a previous premature birth or cervical trauma
Rescue cerclage can be offered when there is cervical dilation without rupture of membranes

130
Q

medications an dprocedure for labour of a premmie

A
  • Tocolytic - stop uterne contractons. First line is nifedipine
    • Steriois - given when baby is abot to be beron withtin 24-48 hours
    • Magnesium - neuroprotective of hypoxia and redced cerebal palsy risk
    • Theroregulation - put them in a warm bag
    • Delayed cord clamping
      Maternal early breast milk
131
Q

management of premature rupture of membranes

A
  • prophylactic antibiotics - erythromycin 250mg 4xday, for 10 days
    Induction of labour might be offered
132
Q

management of preterm labour wth nitact membranes

A

etal monitoring (CTG or intermittent auscultation)
* Tocolysis with nifedipine: nifedipine is a calcium channel blocker that suppresses labour
* Maternal corticosteroids: can be offered before 35 weeks gestation to reduce neonatal morbidity and mortality
* IV magnesium sulphate: can be given before 34 weeks gestation and helps protect the baby’s brain
* Delayed cord clamping or cord milking: can increase the circulating blood volume and haemoglobin in the baby at birth

  • Tocolysis is using medication to stop contractions
  • Nifedipine is a CCB, atosiban is a oxytocin receptor antagonist that can also be used.
  • Give corticosteroids to help the fetal lungs to develop in less than 36 weeks - 2x dose of intramuscular betamethasone 24 hours apart
    Magnesium sulphate IV - protect the foetal brain
133
Q

shoulder dystoca defne and rs factors

A

Failure for the anterior shoulder to pass under the symphysis pubis
after delivery of the foetal head

  • 1%
  • Macrosomia (most cases occur in normally grown babies)
  • Maternal diabetes
  • Previous shoulder dystocia
  • Disproportion between mother and feotus
  • Post maturity and induction of labour
  • Maternal obesity
  • Prolonged 1st or 2nd stage of labour
  • Instrumental delivery
134
Q

shoulder dystoca management

A

Failure for the anterior shoulder to pass under the symphysis pubis
after delivery of the foetal head

H – Call for help (emergency buzzer)
* E – Evaluate for episiotomy
* L – Legs in McRoberts (90% will come at this point)
* P – Suprapubic pressure
* E – Enter pelvis
* R – Rotational manoeuvres
* R – Remove posterior arm
(R – Replace head and deliver by LSCS -Zavanelli)

135
Q

shoulder dystoca complcatons for mum and baby

A
  • Maternal
  • PPH
  • Extensive vaginal tear (3rd and 4th degree)
    Psychological
  • Neonatal
  • Hypoxia
  • Fits
  • Cerebral palsy
    Injury to brachial plexus
136
Q

what are teh dffernt degrees of tears

A

First-degree tears are small and skin-deep. Second-degree tears are deeper and affect the muscle of your perineum. Third-degree tears also involve the muscle that controls your anus (the anal sphincter) Fourth-degree tears goes further into the lining of your anus or bowel

137
Q

cord prolapse defne and rs factors

A

Umbilical cord descends below the feotus into ethe vagina, after rupture of foetal membranes. There is a risk of compression leading to fetal hypoxia. t can also lead to vasospasm.

  • Fetus being in an abnormal position, with room for the cord to descend.
  • Rare: 0.2 – 0.6%
    Premature rupture membranes
    Polyhydramnios (i.e. a large volume of amniotic fluid)
    Long umbilical cord
    Fetal malpresentation (e.g. if baby’s head not down)
    Multiparity
    Multiple pregnancy
138
Q

management of cord prolapse

A
  • Emergancy c section
  • Don’t push it back in or handle it
  • When there is compression, Lie in left lateral positionor knee chest to use gravity (exaggerated smms poston)
  • Tocolytic medication (terbtaline) can be used to minmise contractions.
  • emergency buzzer
  • Infuse fluid into bladder via catheter if at home
  • Trendelenburg position (feet higher than head)
  • Constant fetal monitoring
  • Alleviate pressure on cord
    Transfer to theatre and prepare for delivery
139
Q

what s falure to progress n each of thebthree stages of labour

A
  • Delay in the first stage is when there is eitehr less than 2cm dilation in 4 hours ot slowing of progress in a multiparous women

When the active pushing stage lasts longer than:

  • 2 hours in a nulliparous woman
  • 1 hour in a multiparous woman

More than 30 minutes with active management
More than 60 minutes with physiological management

Active management involves intramuscular oxytocin and controlled cord traction.

140
Q

what does a partogarm measure

A
  • Cervical dilatation (measured by a 4-hourly vaginal examination)
  • Descent of the fetal head (in relation to the ischial spines)
  • Maternal pulse, blood pressure, temperature and urine output
  • Fetal heart rate
  • Frequency of contractions
  • Status of the membranes, presence of liquor and whether the liquor is stained by blood or meconium
    Drugs and fluids that have been given
141
Q

what are teh affectng parts of teh 2nd stage of labour

A
  • Power - uterine contractions
  • Passage - shape and size of pelvis and soft tissue
  • Passenger
  • size
  • altitude - posture o fteh feotus (how rounded the back and flexed the limbs)
  • Presentation - cephalic, shoulder, breech
    Lie - longitudinal, transverse, oblique (angled)
141
Q

what are teh nterventons for teh second stage of labour

A

Initial:
* Food
* Water
* Pain relief
* mobilisation

Secondary:
* Abdominal palpation
* Vaginal exam
* CTG

Tertiary:
* Rupture of membranes
Oxytocin drip

Interventions may be requires such as:
- Changing positions
- Analgesia
- Oxytocin
- Epesiotomu
- Instarmenal delivery
C section

142
Q

amntotc flud embolsm rs factors and mortalty rate

A

61% mortality rate associated.

  • Multiple pregnancy
  • Maternal age >35
  • Instrumental delivery
  • Placental abruption
143
Q

manageent of amniotic fluid embolosm

A
  • First priority is respiratory faliure - mask vent and call anaesthatist
  • Moniter for feotal distress
  • Pulmonary artery catherterization
    Treat DIC with whole blood, packed cells r fresh frozen plasma
144
Q

indcatons for of nstramental delivery

A
  • Faliure to progress
    • Fetal distress
    • Maternal exhaustion
      Contorl of head
145
Q

complcatons of nstrmantal delvery

A
  • Postpartum haemorrhage
    • Epesiotomy
    • Peritineal tears
    • Injury to anal sphincter
    • Incontinance of bowel and bladder
    • Nerve injury to femoral or obturator. Normally resolves after 6-8 weeks
    • Obturato - weakness of hip adduction, rotation and numbness of medial thight
    • Femoral - weakness of extension, loss of patella reflex and numbness of anterior tigh and medial lower leg
    • Cephaloheamatoma (blood betwwen skull and periosteum) with ventours
    • Facial nerve palsy with forceps
    • Subgaleal heamorrhage
    • Intercranial haemorrhage
    • Skull fracture
      Spinal cord injury

gve sngle dose of co amox when forceps are used

146
Q

the are teh margns of postpartum heamorage

A

Definition

Bleeding after delivery of baby and placenta . Must be over 500ml for vag delivery and 1000ml after caesarean

* Minor - <1000ml
* Major > 1000ml 
* Moderte 1000-12000
* Severe >2000

Primary -bleedign withtin 2 horus
Secondary - 24 hours to 12 weeks

147
Q

rs factors for post partum heamorge

A
  • Prebous PPH
  • Multipe pregnacy
  • Obestiy
  • Lrge bay
  • Faliure to preogress
  • Preolonged
  • Pre ecplasia
  • Placenta accreta
  • Retained placenta
  • Instramental delivery
    Perineal tear
148
Q

what are teh 4 Ts of postpartum heamorage

A
  • Tone - uterine atony (most common)
    • Trauma - perineal tear
    • Tissue - retained pacenta
      Thrombin - bleeding disorder
149
Q

preventon of PPH

A
  • Treat anaemai during antenatal
    • Empty bladder for birth
    • IM oxytocin for 3rd stage
      Intravenous tranexamic acid in hgh risk patients
150
Q

emerganc [athway after PPH

A
  • Recusitate with ABCDE
    • Lie flat
    • 2 large bore canulas
    • Blood for FBC, UE, Clotting #
    • Group and cross match 4 units
    • Warm IV fluid
    • Oxygen
      Fresh flozen plasam after 4 units have been given
151
Q

surgcal management of PPH

A
  • Intrauterine balloon tamponade - for atony
    B lynch suture - putting suture around urters to compress it
152
Q

medcal management of PPH

A
  • Rub the uterus to stimulate contraction
    • Cathetrissation to empty bladder
    • Oxytocin - injectio and tehn infusion
    • Ergometrine - smooth muscle contrcation stimulator (contraindicated in those with hypertention)
    • Carboprost = prostaglandin analouge
    • Misoprostol - prostaglandin analouge
      Tranexamic acid - antifibrolytic that reduces bleeding
153
Q

secondary PPH cause and manamgement

A

Secondary PPH is liekly due to infection or retianed priducts of conception

* Ultraousn 
* Ensocervical and high vag swabs for inectino  Surgical evacuation and antibiotics!!
154
Q

low brth weght mmedate and prolonef complcatons

A
  • Resporatry distress syndrome
  • Intraventricular heamorrage
  • Patent ductus arteriosus
  • Jaundice
  • Retinoapthy
  • Infetison

Later on condition:
* Diabetes
* Heart disease
* High blood pressure
* Intellectual and developmental disabilities
* Metabolic syndrome
Obesity

155
Q

manageent of rhesus dsease of the newborn

A
  • Give anti rhesus D injections to rhesus negative motehers as prophylaxis. This is given 28 week gestation and at birh
  • It should also be give any time sensations could occur - antepartum haemorrhage, amniocentesis, abdominal trauma.
  • Given within 72 hours of exposure
    After 20 weeks, the Keilhauer test is used to asses how mych further anti d is needed. Add acid to a sample of motehr blood, the fetal is more resitatnt to acid and will remain fine but the moterhs cells will be destroyed.
156
Q

WHAT S babay blues

A

Baby blues

  • Affects more than 50 % of women after birth
  • Mood swings, low mood, anxiety, irritability, tearfulness
  • Usually self resolves in 2 weeks
  • Caused by hormonal changes, added responsibilitys, fattigue, recovery from birth
  • It is a physiological change that happens in first week.
157
Q

postnatal depresson

A

Postnatal depression

1/10 women

  • Triad of low mood, anhedonia (lack of pleasure), low energy
  • 3 montsh after birth, symptoms should last 2 weeks before its diagnosed
  • Mild cases - more support
  • Modertae - SSRI and CBT
  • Severe - psychiaty services and inpatient care sometiems
  • Edinbough postnatal depression scale has 10 question and 30 points, 10 or moe points is indicative
158
Q

management of depresson througjout preganncy

A

lthum and sodum valporate must be stopped

SSR can be taen - fluoxatne us th best
the baby needs to stay n 4 hours after brth to monter for seratonn ssues

159
Q

breast cycst defne epdemology tests management symotons

A

Fluid filled lumps

30-50

  • Most common cause of breat lumps
  • Painful sometiems
  • Smooth
  • Well circumscribed
  • Mobile
  • Pssibly fluctulant

Furtehr to rule out cancer

Aspiration

160
Q

fbroadenomas epdemology,
key presentaton,

A

Common benign tumours of stromal/epithermal breast duct tissue.

  • 20-40 YO
  • Respond to hormones and often regress after menopause
  • Small and mobile within the tissue - sometimes called a breast mouse as they can be moved
  • Painless
  • Smooth
  • Round
  • Well circumsided
  • Firm
  • Up to 3cm
161
Q

fat necross define causes presentaton test and manageemnt

A

Local degeneration and scarring of fat tissue in the breast, leading to fibrosis and necrosis

Localised trama
Radiotheray
Surgery

  • Painless
  • Firm
  • Irregular
  • Fixed
  • Maybe skin dimpling or nipple inversion
  • Ultraosun ro mammogram may be similar to breast cancerm fne needle aspiration and core biopsy is neede.

conservatve or surgcal excson

162
Q

lpoma ey presentaton and management

A

Benign fat tumours

  • Soft
  • Painless
  • Mobile
  • No skin changes

c
onservative management
Surgical excision

163
Q

fbrocystc changes of teh breast defne symotms and management

A

The stroma ducts and lobules respond to progesterone and oesterogen and so fluctuate wthn th e cycle

  • Fluctuate wth cycle - worse 10 days befroe menstruatng and symproms reslove after menstraton ocurs
  • Lumpness
  • Tenderness
  • Fluctaton of sze

Supportve bra
NSAD
Avod caffne
Apply heat
Hormal treatment - tamoxfen

164
Q

breast abcess rs factos and bacteral colonsaton

A
  • Smoking
  • Damage to nipple - eczema, candida infection, piercings
  • Breat disease - cancer
  • Staph aureus (most common)
  • Streptococcal
    Enterococcal
165
Q

sympotma of breast abcess

A
  • Swollen lump
  • Fluctuant lump - able to move the fluid around within the lump using palpation
  • It has to be fluctuant to be an abscess

General infection symptoms too - muscle aches, fatigue, fever, sepsis

166
Q

management of breas abcess

A

Management and monitoring

ANTIOBIOTICS!
* Fluxolxacillin for staph
* Co amoxiclav or metronidazole for anerobic bacteria

* Referral to the on-call surgical team in the hospital for management
* Antibiotics
* Ultrasound (confirm the diagnosis and exclude other pathology)
* Drainage (needle aspiration or surgical incision and drainage)
* Microscopy, culture and sensitivities of the drained fluid
167
Q

mastss path

A

Inflamation of the breast tissue, often related to breastfeeling but sometomes due to infection.

Infection enters the nipples and backtracks up the ducts to cause inflammation and infection. Mastitis may precede an abscess. It can also be caused by obstruction of the sucts

168
Q

mastss management (lactatonal and non) and complacatons

A

Lactational :
* Conservative management
* Continue breastfeeding, express milk and breast massage
* Heat packs, warm showers and simple analgesia
* Antiobiotics (flucloxacillin or clarithromycin if symptoms rent improving

Continue breast feeding, regularly express milk f feeding is painful, resume feeding when possible.
Non - Lactational:
* Analgesia
* Antibiotics bread sprectrum -
Co-amoxiclav
Erythromycin/clarithromycin (macrolides) plus metronidazole (to cover anaerobes)
* Treatment for underlying causes - eczema or candida infection

Candida infections can occur after antibiotics. This elads to recurrent mastitis and causes cracked skin onteh nipple. Associated with oral thrush and candidal nappy rash. Sore niplpes bilaterally, craked and shiny areola, white patches around the mouth and on eh tounge of baby.

You need to treat bothe the mother and baby:
* Topical miconazole 2% after each breastfeed
* Treatment for the baby (e.g. miconazole gel or nystatin)

169
Q

mastts ey presentatons

A
  • Nipple changes
  • Purulent nipple discharge (pus from the nipple)
  • Localised pain
  • Tenderness
  • Warmth
  • Erythema (redness)
  • Hardening of the skin or breast tissue
  • Swelling
    Fever
170
Q

breast cancer epdemology abnd rs factors

A
  • Most common cancer in UK
  • 1/8 women affected
  • 1% of all cases are men
  • Female
  • Increased oestrogen exposure
  • More dense breast tissue obesty
  • Smoking
  • Family history
  • COCP
  • HRT - particularly combined
  • BRCA - breast cancer genes, they are tumor surpressor genes which are faulty
  • BRCA1- chromosone 17, 80% will develop breast cancer, 50% ovarian
    BRCA2 gene - chromosone 13 - 60% will develop breast and 20% ovarian
171
Q

6 types of brest cancer

A
  • Ductal carcnomas in situ - precancerou sor cancer osu cells of the breat ducts, localsed pced up on mammograms notmally good prognosis
  • Lobular carcnomas n situ - precancerous condton n premenopausal women, asymptomaic and pcked up on mammogram, increased risk of invasive braest cancer
  • Nvasve ductal carcnoma non specfc - orgnate n eh breast ducts
  • Nvasve lobular carcnomas - not always vsble on mammograms breat lobules
  • Nflamatory - 1-3% of breast cancers loos le mastts but wont repond to antibotcs
    Pagets disease of the nipple - looks like eczea on nipple, invasive
172
Q

screenng for breast cancer

A

Screening:
* Mammogram every 3 years ages 50-70
* 1/100 women are diagnosed after going for a mammogram

  • A first-degree relative with breast cancer under 40 years
  • A first-degree male relative with breast cancer
  • A first-degree relative with bilateral breast cancer, first diagnosed under 50 years
  • Two first-degree relatives with breast cancer
  • They are speciially montered have genetic councelg annual mammograms and may be offered tamoxfen n premenopausalor anastrazole f postmenopausal as preventative.
    Rsk reducing mastectomy or bilateral oophroectomy
173
Q

presentatons of breast cancer

A
  • Lumps that are hard rrcgular paunless, fixed
  • Tetherd to skini to chest wall
  • Niipple retracioni
  • Skkin dimplinig ot oedema
  • Lymphadenopahy
174
Q

tests for breast cancer

A
  • Refer for 2 week wat f there s an unexplained breast lupmp over age 30 or unlateral npple chage n over 50s
  • Also cobsder f tehr s an unexplaed lump n the axlla ot sn changes on brast
  • They should receve clncal assesment magng and potetnally bopsy
  • Ultrasoun scans are bettern n younger women
  • Mamograms are beter n older
  • MR for those wih higher risks or to further asses a tumour
  • Stage is the anatomcal extent - size, anatomical position, spread.
  • Grade is what it looks like down the mircroscope

Tr[le assesment - examination, magng and hstologu (core needle bopsy).

175
Q

managememt of breast cancer

A
  • Often eh cancer cells hae receptors - oestrogen progeserone ot human epdermal growth factor.
  • Trple negatve breastcancer meanas that t doesn’t have any of the receotprs and are harder to treat
  • TNM staging - lymoh node bopsy MRU of breast and axilla laver ultrasound CT of abdomen thorax and pelvis, isotope bone scan.
  • Surgery - breast conserving or mastectomy
  • Axillerya clearance of lymoh nodes if cancer is in tehre
  • Radiotherapy - session every day for 3 weeeks, general fatigue, fibrosis, shrinking of tiissue, long term skin changes
  • Chemo -
    Neoadjuvant therapy – intended to shrink the tumour before surgery
    Adjuvant chemotherapy – given after surgery to reduce recurrence
    Treatment of metastatic or recurrent breast cancer

Hormone treatments:
* For oestrogen :
Tamoxifen for premenopausal women - blocks OR in breats and stimulates in bones and uterus, prvents osteoproosis but increaed risk of endometrial cancer
Aromatase inhibitors for postmenopausal women (e.g., letrozole, anastrozole or exemestane) - aromatase normally is fond in adipose and vconverts androgens to oestrogen
* Use for 5-10 years

  • Trastuzamab - herceptin - targets HER 2 receptors
  • Pertuzumab - targets HER2 recepros (monoclonal antibody)
  • Neratinib - tyrosine kinase inhibitor
  • Have yearly mammograms after for 5 years
  • Reconstructive surgery

Lumpectomy unless there are multiple tumour,

176
Q

complcatons fo breast cancer

A
  • Lungs lver bones and bran are the most common place to metastases to.
    Chronic lymphoedema - massage techniques, compression bandages, weight loss, skin care
177
Q

ductal ectasa defnton and rs facctors

A
  • There is dilation of the large ducts leading to intermittent discharge from the nipple
  • Ectasia means dilation
  • There is inflammation leading to intermittent discharge which may be white green to grey

Perinenopausal women
Smokers

178
Q

ey presentaton and etsts for ductal ectasa

A
  • Nipple discharge
  • Tenderness/pain
  • Nipple retraction or inversion
  • Breast lump
  • Exclude breast cancer - clinical assessment, imaging, histology
  • Microcalcifications are a key fnidinig on mammogram
  • Ductograpy - contrast is injected ad then mammogram
  • Nipple discharge cytology
  • Ductoscopy - tiiny camera
179
Q

management of ducta ectasa

A
  • No trearment - can slef resolove
  • Antibiotics for any additional infections
  • Surgical exccons of eh affected duct
  • Symptomatic maganemen - supportive bra and warm compress
    Reassure about cancer
180
Q

reconstructve breast surgeyr tupes

A

Reconstrucitve surgery is offered to eveyr who has a mastectomy
Imidate or delayed

* After breast conserving surgery there can be partial reconstruction using a flap or reduction and reshaping. Remocing tissue and reshaping both breasts to match 
* After masectomy - breast implants (synthetic) flap reconstruction (using tissue from a different part of the body) 

* Implants - minimal scarring, good appearance but can feel unateral and have issue with hardening, leaking ect 
* Latissumus dorsi flap  - the tissue is tunneled under the skin  - pediculated means it keeps the original blood supply, free flap means comepletly transplanting it to a new construction 
* Transverse rectus abdominas flap  Seep infereor epigastric perforator flap  - uses skin and subcutanoues fat as a free flap
181
Q

paplloma defne epdemolog and presentatons

A

Warty lesion in a breast duct, caused by proliferation for the epitherlial cells. Presents with clear no blood strained nipple discharge.

35-55 YO

Asymptomatic
Nipple discharge
Tenderness/pain
Palpable lump

182
Q

tests and treatment of paplloma

A
  • Clinical assessment
  • Imaging - ultrasoonb, mammography and MRI
  • Histology - core or vaccum assisted biopsy
  • Ductography - injecting contrast into eh duct, there will be a filling defect with papilloma’s

Surgical excision
Tissue examined for cancer!

183
Q

path and ris factors of bacterial vaginoss

A

An overgrowth of bacteria in the vagina - specifically anerobic. It is cause by a loss of lactobacilli (good bacteria) in the vagina.

  • Multiple sexual partners
  • Excessive vaginal cleaning
  • Recent antibiotics
  • Smoking
  • Copper coil

It occurs less in women using the combined pill or who use condoms.

  • Lactobacilli are the main good bacteria in the vagina and prodice lactic acid to create a low pH (4.5) for the vagina. When tehre are reduced numbers the pH rises and anaerobic bacteria begins to overgrow. The most common causes are Gardnerella vaginosis, mycoplasma hominis and prevotella.
  • Gardnerella vaginalis is the most common cause!
184
Q

key rpesentatios and test for BV. what s normal vagnal ph

A
  • Fishy smelling watery grey/white discharge
  • Asymptomatic
    If there is itching and pain it suggests a co infection or different causes
  • Sometimes a speculum examination to look at discharge
  • High vaginal swab
  • Vaginal pH swab - normal is 3.5-4.5. BV is when it is above 4.5
  • Charcoal vaginal swab for microscopy (high one done with a speculum or a low one done by self)
    It gives CLUE CELLS on microscopy. These are epithelial cells with bacteria stuck inside of them
185
Q

manageent and complcations of BV

A
  • May naturally resolve.
  • Metronidazole targets anaerobic bacteria - oral or vaginal gel
  • Clindamycin is alternative
  • Always assses additional infections - chlaymidia and gonhoreaa
  • Provide info for prevention

When prescribing metronidazole, no alcohol otherise they will get really ill!!!!

  • Increase risk of STIs
  • Miscarrige
  • Postpartum endometritis
  • Preterm deilvery
  • Low borth weight

Ask about use of soaps and vaginal douching, and then explain how this increases the risk of BV.

186
Q

candadiasis path and isk factos

A

Vaginal yeast infection of the candida family - normally candidan albicans

  • Increased oestrogen - pregnancy
  • Poorly ocntrolled diabeites
  • Immunosurpression
  • Broad spectrum antibiotics

Colonise the vagina and not cause symptoms unless tehre are enviromentla changes such as pregnancy or broad specturm antibiotics

187
Q

presentationi and test of canidiasis

A
  • Thick white non smelly discharge
  • Vulval and vaginal itching, irritation and discomfort

More severe can lead to:
* Erythema
* Fissures
* Oedema
* Pain during sex (dyspareunia)
* Dysuria
* Excoriation
*

  • Treated based on the presntaton
  • Test vagnap ph to distuinguish between bacterial vaginosis and trichomonas (pH > 4.5) and candidiasis (pH < 4.5).
  • A charcoal swab and microscopy can confirm the diagnosis
188
Q

treatment of candidiasis

A
  • Antfungal cream (clotrmzole) into the vag
  • Antfungal pessary
  • Oral antifungal tablets (fluclazone)

Nice suggests -
* A single dose of intravaginal clotrimazole cream (5g of 10% cream) at night
* A single dose of clotrimazole pessary (500mg) at night
* Three doses of clotrimazole pessaries (200mg) over three nights
* A single dose of fluconazole (150mg)

  • Canesten Due can be bought over the counter
  • Recurrent nfectons can be treated with manitnance antfungals

Antfungal creasms can damage latex condoms and prevent spermcdes form worng so use alternatve contracepton for at least 5 days.

189
Q

trichomoniasis vaginalis [resentations

A
  • Asymptomatic
  • Vag discharge
  • Itcing
  • Dysuria
  • Dysparunia
  • Balanitis
  • Frothy and yellow green dischareg
  • Fish smell
  • Strawberry cervix
    Vag pH of above 4.5
190
Q

tests, management and complications of trichomoniasis

A
  • Charcole swab and microscopy, take from posteior fornix ofwomen or a self swab
  • Uretheral swab or first catch urin in men as it lives in the urethra
  • Refer to GUM specalist
  • Contact tracing
  • Metronidazole
  • Preterm delivery
  • Prelabour membrane rupture
  • Lwo brith weight
  • Pelvic inflamatory disease
  • Cervical cancer
  • BV
  • HIV risk increased
191
Q

ballanitis path and causes

A

Inflammation of glans penis

  • Non-specific dermatitis with Candida albicans or bacterial infection.
  • Other infections such as anaerobes or sexually transmitted infections.
  • Inflammatory skin conditions such as irritant or allergic contact dermatitis, seborrhoeic dermatitis, psoriasis, lichen sclerosus, lichen planus, or Zoon’s balanitis.
  • Mechanical irritation and poor hygiene.
  • Pre-malignant conditions (penile intraepithelial neoplasia).
192
Q

key presentaton of ballants

A

Penile discomfort and itch, bleeding, skin splitting, urethral discharge, urinary symptoms and/or sexual dysfunction.
Redness and swelling of the glans penis and/or foreskin with possible sub-preputial discharge, fissuring, or ulceration.

May presnt as uti but with only the pain symptom.

193
Q

management and complcations of ballanitis

A
  • Good hygine
  • Topicla corticostreoid
  • Poteintally an antifungal cream as well

Safety net about sweeling occuring so much it prevents urintaiot - go to hospital.

194
Q

first line treatment for intrahelaptc cholesstaaoss

A

urosodeoxycholuc acid

195
Q

what s a chancrod and what bactera causes it and treatment

A

ulcers
rased lumps
red shuny skin
leaage of pus and flud

heamphlus ducreyi

azthromycn

196
Q

Lymphogranuloma Venereum presntaton treatment and complcatosn

A

Causes swollen lymph glands n the groin on one or both sides, also ulcers

  • Lood
  • Pain in anal area
  • Consipation
  • Incomplete bowel emptying

Test for chlamydia, if positive and there are smptms above, it is LGV.

  • Doxycycline 2x a day for 3 weeks.
  • Permennt geniatl swelling
  • Long term bowel complications
  • Bloodstreaminfeciton cuasing inflamtion of joints and liver
197
Q

reasons for sexual dysfuncton

A
  • Vascular: hypertension, atherosclerosis, hyperlipidemia, smoking
  • Neurological: Parkinson’s disease, multiple sclerosis, stroke, spinal cord injury, peripheral neuropathy
  • Hormonal: hypogonadism, hyperprolactinaemia, thyroid disease, Cushing’s disease
  • Drug-induced: antihypertensives, beta-blockers, diuretics, antidepressants, antipsychotics, anticonvulsants, recreational drugs
  • Systemic disease: diabetes mellitus, renal failure
  • Structural: pelvic trauma, penile trauma, Peyronie’s disease
    Psychogenic: depression, anxiety, performance anxiety, schizophrenia
198
Q

tests for sexual dysfuncton

A

FBC
LFTs
U&Es
TFTs
Lipid profile
Fasting glucose and/or HbA1C
Serum total testosterone: if testosterone is reduced, serum prolactin will then be checked to screen for secondary hypogonadism

* Doppler to see blood flow  Nocturnal penile tumescence - measures erections tougout the night to see if it psychilogica or not.
199
Q

management of sexual dysfuncton

A
  • Weight loss
  • Stop smoking
  • Less alcohol
  • Psychosexual councelling
  • Phosphodiesterase 5 inhibitors - relexation fo peniel blood vessles
  • Hormone therapys - refer to specalist
    Penile prosthesis - inflatable implants or semirigid rods
200
Q

what are teh fraser gudelnes and mnumonc

A

UPSII:
* Understand
* Parents
* Suffer
* Intercourse anyway
Interests

  • Fraser guidelines:
  • He/she has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
  • He/she cannot be persuaded to tell her parents or to allow the doctor to tell them
  • He/she is very likely to begin or continue having sexual intercourse with or without contraceptive treatment
  • His/her physical or mental health is likely to suffer unless he/she received the advice or treatment
    The advice or treatment is in the young person’s best interests.
201
Q

OCP sde effects

A
  • Not suitable for quite a few groups of people - VTE risk, high blood pressure, obese patients, smokers, ex-smokers >35, migraine with auras.
    Anti-epileptics
202
Q

progesterone sde effects

A
  • weight gain
  • reduced bone mineral density
  • Acne, reduced libido, hair loss, mood changes, headache
    Irregular bleeding
203
Q

sde offects of depot injecton

A
  • weight gain
  • reduced bone mineral density
  • Acne, reduced libido, hair loss, mood changes, headache
    Irregular bleeding
204
Q

treatment for chlamyda trchomats

A

doxycyclne 7 dyas
azthromycn n pregnancy

205
Q

symptoms of chlamda n men and women

A
  • Main sight of infection if urethra
    • Dysuria and ureteral discharge
    • Asymptomatic
    • Empdydimo-orichitis and reactive arthritis complications
    • high transmission to females

FEMALES:

* Main infection sight is endocerviacl canal 
* Non specific symptoms - dischage, menstra irragularity, dysuria
* Asymtpatic 
* High transmission 
* Complications: pelvic inflammatory disease, ectopic preganc, chronic pelvic pain, infertility  Neonatal transmission
206
Q

test for chamyda and gonohorea

A

Nuclec acd amplfcaton test - NAAT

207
Q

path of chlamyda and gonnohrea

A

Infect the non squamous epithelia - urethra, endocervical canal, rectum, pharynx, conjunctiva

In neonates it affects the conjunctiva and sometimes can causes atypical pneumonia

Infect the non squamous epithelia - urethra, endocervical canal, rectum, pharynx, conjunctiva

208
Q

symtoms of gonnhoreoea n men and womrn

A

Symptoms in women
In women, symptoms of gonorrhoea can include:

an unusual vaginal discharge, which may be thin or watery and green or yellow in colour
pain or a burning sensation when passing urine
pain or tenderness in the lower abdominal area – this is less common
bleeding between periods, heavier periods and bleeding after sex – this is less common

Symptoms in men
In men, symptoms of gonorrhoea can include:

an unusual discharge from the tip of the penis, which may be white, yellow or green
pain or a burning sensation when urinating
inflammation (swelling) of the foreskin
pain or tenderness in the testicles – this is rare

209
Q

treatment og gonnhorea

A

Partner notification
Test for other STI’s
Continuous surveillance of antibiotic sensitivity
Single dose treatment preferred
Aim to cure at least 95% of people at first visit
Current regime – Ceftriaxone IM injection
Ciprofloxavin oral if senstivty

210
Q

syph path and presntaton

A

Treponema pallidum sub species - spiral gram negative bacteria

Early infectious syphilis (within 2 years of infection)
Primary, Secondary and Early Latent
Late syphilis (over 2 years since infection)
Late latent, CNS, gummatous

Male
High risk in male to male intercourse

  • Primary syphilis: painless ulcer called a chancre on genitals, local lymphadenopath
  • Secondary - sysetmic symptoms on musouc memebrane, rash, low grade fever, alopecia, oral lesions
  • Latent -phase
  • Terriary - gummas development, cardiovascualr and neurological complications, aortic anyerisms, neurosyphilis - headache, dementia, altered behaviour, paralysis, sensory imparement
211
Q

sph tests and treatment

A

Early moist lesions
Genital ulcers
Dark fiel microscopy, polymerase chair reaction
SEROLOGY- look for antibodies against T pallidum antigens
* there are primary sceeenign tests and then tests done in more detail for those which test postive
* Treponema pallidum particle agglutination test (TPPA)

  • Penicillin IM
  • Efficant follow up and partner notification
  • A single deep intramuscular dose of benzathine benzylpenicillin (penicillin) is the standard treatment for syphilis.
212
Q

when to stop methotrexate of tyrng to conceve

A

6 monts before for both men and women

213
Q

what is the test for gestational diabeties

A

oral glucsoe tolerance test

214
Q

ME defne

A

debltatngfatgue for >6 months wth cogntve dysfuncton total body pan unrefreshng sleep and post exertonal malaise.

215
Q

ME presentaton

A
  • onset of persistent disabling fatigue
  • post-exertional malaise (PEM)/exertional exhaustion
  • unrefreshing sleep
  • cognitive and autonomic dysfunction,
  • Myalgia
  • Arthralgia
  • headaches
  • sore throat
  • tender lymph nodes (without palpable lymphadenopathy)
    symptoms lasting at least 6 months.
216
Q

test and treatment of ME

A
  • DePaul symptom questionnaire is the screening tool
  • Blood tests - FBC, ESR, CRP to rule things out
  • Thyroid function test
  • ANA and RF test
  • Individulised therapy - cnsellig and supportive care. They learn to conserve energy, break dow large tasks, individulised excercse programs
  • Mindfulness and sleep hygine
  • CBT
  • Occupational therapy
  • Can amanage symtoms with sleeping tablets
217
Q
A

photophoba
pain
changes in vision

218
Q

whatare teh cases of conjunctivitis and how to dustuingish between teh different types

A

viral, allergic
bacterial - H influenzea or s pneumonia

  • Bacterial will have purulent discharge which is worse in the morning, highly contagious
    viral conjunctivitis - clear discharge, also other symptoms of viral infetio - sore throat blocked nose ect
219
Q

define antenal vbleeding

A

bleeeding fomr teh genitla tract after 24 weeks gestations

220
Q

define postpartum bleeding primary and secondary

A

bleeding form teh dgenital tract wit in 24 hours of delivery

bleeding form teh gential tract between 24 hours and 6 weeks after delivery

221
Q

risk factors for catching HPV

A

early sex
nreased sexual partners
not usng condoms
not engainig with cervial screening
COCP use
more full term pregannces
FH
smong
HV

222
Q

descrbe CIN grading

A

dagnosed at colposcopy!!
I - mild only affecting 1/3 thcenss ley to resolve
II - moderate dysplasia - liekyl to pregress to cancer, affecitng 2/3
III - server dysplasia - very lek to progress to cacner

223
Q

what is teh stainign process for cervicak cacner

A

colposcopy used
acetic acid turns ells white (acetowhite)
then add iodene, abmormal cells wll stay white and not turn brown

224
Q

what staging system is used fro cervical CANCER

A

1 - in cervix
2 - invades upper 2/3 of vagina or lower uterus
3 - invades oelvic wall or lowe 2/3 of vagina
4 - invaes bladder recutm or beyond pelvis

225
Q

tretment for obetrc cholestass

A
  • Emollients for the itching - chalmomile lotion
  • Antihistamines - chlorphenamine ot help with sleep - doesn’t help itching
  • Water soulble vitmain K can be given if prothrobin time is deragnced
  • Induce pregancy at 37-3 weeks
    Ursodeocycholic acid
226
Q
A

3A :0 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions