Womens Health Flashcards
1
Q
List 5 factors that increase the risk of breast cancer
A
- Alcohol
- Increased radiation
- Increasing age
INCREASED OESTROGEN - Obesity (post-menopausal)
- COCP
- Having children in later life, early
- Late menopause
2
Q
What 2 genes are linked with breast cancer? (main ones)
A
- BRAC1, BRAC2
3
Q
List 4 signs of breast cancer (nipple)
A
- Painless lump (hard and irregular)
- Dimpling of the skin (pea de orange)
- bleeding from the nipple
- Nipple discharge
- Nipple inversion
- Rash or napple around the risk
4
Q
Does breast cancer screening occur, and if so for what age?
A
Yes
Currently 47-73.
5
Q
How do you screen for breast cancer?
A
- Mammogram > 40
- US /MRI < 40 due to dense breasts
- Core needle biopsy - sentinel nodes, spread to lymph (mainly axilla)
6
Q
Why should you give women with breast cancer bisphosphonates?
A
High risk post menopausal women due to risk of metastatic disease to bone
7
Q
Other than breast cancer, what other cancer are BRAC1/2 carriers at an increased risk of?
A
Ovarian
8
Q
What are the treatments for breast cancer?
A
- Lumpectomy
- Mastectomy
- Radiotherapy
- Chemotherapy
- Targeted drugs
- Axillary clearance
9
Q
What are the indiciations of doing a mastectomy / lumpectomy?
A
- Tumour > 25% of the breast
- Multiple cancers
- Large family history
- Patient choice
10
Q
What are protective factors against breast cancer?
A
- Early pregnancy
- Breast feeding
11
Q
What drug can be used for women with oestrogen receptor positive breast cancer?
(list one for both pre and post menopausal)
A
- Tamoxifen - premenopausal
- Aromatase inhibitors - postmenopausal women
12
Q
Name 3 causes of bleeding during pregnancy (antepartum)
A
- Placenta Praevia
- Placental abruption
- BE AWARE OF DOMESTIC VIOLENCE
- Local causes - trauma to vagina, etc
- Vasa Praevia
- Miscarriage
13
Q
What are the 2 main types of breast cancer?
A
- Ductal
- Lobular
14
Q
What staging system is used?
A
TNM Staging
Tumour
Nodes
Metastise
- Stage: where it is / spread to
- Grade: what it looks like down the microscope
15
Q
What is a specifcally nasty type of breast cancer?
A
HER2 receptor positive - treat with herceptin (trastuzumab) and chemotherapy
16
Q
What should you give a women with bleeding during pregnancy?
A
ANTI-D (28 weeks)
17
Q
A woman presents to the ED with profuse vaginal bleeding during pregnancy. You feel her abdomen and it feels ‘woody’ and tense. What is this likely to be?
A
Placental abruption
18
Q
What should all mothers birthing premature babies be given?
A
Steroids - mature babies lungs (type 2 pneumocytes to produce surfactant)
19
Q
List 3 causes of polyhydramnios
A
- Duodenal atresia - baby (increased in Downs)
- Gestatonal Diabetes
20
Q
What is a miscarriage?
A
Loss of pregnancy < 24 weeks
21
Q
List 4 T’s causes of post-partum haemorrhage
A
- TONE (uterine atony, distended bladder)
- TISSUE (retained placenta or clots)
- TRUAMA (lacerations of the uterus, cervix or vagina)
- THROMBIN (pre-exisitng or acquired blood disorder)
22
Q
What is HELLP syndrome?
A
- Haemolysis
- Elevated liver enzymes
- Low platelets
23
Q
What is the classic triad of vasa praevia?
A
- Membrane rupture
- Painless vaginal bleeding
- Fetal bradycardia or fetal death
24
Q
List 4 indications for giving Anti-D (SENSITISING SITUATIONS)
A
- Miscarriage > 12 weeks
- Abortion
- Amniocentesis
- Ectopic pregnancy
- Abdominal trauma
- Bleeding during pregnancy
- At birth mother and babies blood mixes
25
Describe the pathophysiology of Anti-D
Rhesus negative mum
Rhesus postive baby
Antibodies against rhesus positive - attack babies blood cells, causing jaundice and neurological problems
26
How do you check Anti-D?
Indirect coombs test
27
What test tells you the amount of Anti-D that you need?
Kleihaeur betke test
| measures the amount of foetal Hb transferred from foetal to mothers blood stream
28
What medication can you give women with gestational diabetes?
Insulin and metformin
29
How do you check for Downs, Patuas, Edwards?
- Nucchal translucency - 12 weeks
| -
30
What are the two cardinal signs of pre-eclampsia?
HIGH BP AND PROTEINURIA
| oedema now not included in the triad
31
List 5 symptoms of pre-eclampsia
- headache
- visual distrubance
- papilloedema
- ankle oedema
- RUQ / epigastric pain (hepatic inflammation)
- Hyperreflexia (sustained ankle clonus)
32
How do you manage pre-eclampsia?
DELIVERY OF THE BABY only way to cure.
- IV magnesium sulphate
- Oral labetalol - BP
33
Can you use labetalol for women with asthma?
NO!
Beta blocker narrow airways
First line for these women = nifedipine.
34
What is the scale used to screen for post-natal depression?
Edinburgh Scale
| Max score =30
35
How do you know the menopause has started?
12 months since the cessation of the last period
36
List 6 periomenopasual symptoms
Irregular periods
Short term → vasomotor (hot flushes, night sweats), mood changes / irritability, loss of memory / concentration (loss of oestrogen on brain cell function), headaches, dry and itchy skin, joint pains (loss of collagen)
Medium term → urogenital atrophy (painful intercourse, vaginal dryness, UTI’s, PMB?, urinary incontinence and prolapse (lack of collagen)
Long term → OSTEOPAROSIS (oestrogen effects on the bone → , cardiovascular disease (adverse changes in lipid, oestrogen plays a role in lipid degradation)
Loss of libido
Difficulty sleeping
37
What is HRT?
Hormonal replacement therapy
| Used to improve menopausal symptoms
38
Name 4 contraindications for HRT
- VTE
- Breast cancer
- Ovarian cancer
- Stroke
- CV disease
39
What is FGM?
Female genital mutilation
Partial or total removal of the external female genitalia with no medical reason
NO acceptable justification for it
40
What is a type 1 FGM?
Clitoris removal
41
What is a type 2 FGM?
Clitoris and labia minora removal
42
What is a type 4 FGM?
Piercings, prickings, etc.
43
List 4 gnaey and 4 obstetric complications of FGM
GYNAEY
- Infection, e.g. UTI
- Keloid scar formation
- Psychological damage e.g. PTSD
- Sexual dysfunction, e.g. vaginismus, pain
- Incontinence
OBS
- Problems with pregnancy - Too narrow for childbirht
- Increased likelihood of PPH
- Increased likelihood of C-section
- Difficulty performing vaginal examinations
44
Can anything be done for FGM?
- Damage permanent
| - Only symptomatic management - deinfibulation (opening up the vagina)
45
Name 3 differentials for pelvic pain
GYNAEY
- PID
- Ovarian cysts
- Endometroisis
- Fibroid degeneration
- Ovarian torsion
OBS
- Ectopic pregnancy
BOWEL - rememver this can present as pelvic pain!
- IBS
- IBD
- UTI
- Appendicitis
- Diverticulitis
46
What is the key differential for endometriosis?
Adenomyosis
47
Name 3 differences between endometriosis adenomyosis?
Adenomysosis --> often seen in those who have had children, older. Lots of fluid in the myometrium with many holes.
48
What is the cause of PID?
CHLAMYDIA
| gonorrhoea
49
What are the investigations for PCOS and what would you find?
LH: FSH = 3:1
Testosterone = raised
Sex hormone binding globulin = low (therefore increased free testosterone)
US = massive ovaries with many cysts
Fasting glucose and OGTT = diabetic / insulin resistance
Fasting lipid levels
50
What is mittelschmertz?
Ovulation paon
51
Where is the most common place for an ectopic pregnancy to occur?
AMPULLA of the fallopian tube
52
Name 3 things that can increase the risk of an ectopic pregnancy
Anything that slows the passage of the agg to the uterus:
- IVF
- PID increases the risk (STI)
- Causes inflammation in the tube → occlusion → increased likelihood of egg implantation in the tube
- IUCD USE
- Adhesions
- Endometriosis
- Previous surgery on the tubes
- Previous ectopic pregnancy ^^^
53
What is a molar pregnancy?
Non viable egg implants into the uterus, creates a mass.
54
What is most common pathology of cervical cancer?
Squamous cell carcinoma
55
What is the prognosis for ovarian cancer?
POOR --> Non-specific symptoms
56
What should you worry about if post-menopausal women present with bleeding?
GYNAECOLOGICAL CANCER
- Endometrial
57
What is the key differential for ectopic pregnancy, and how would you distinguish?
Miscarriage - bleeding would come first here, and then the pain would come second
58
Name 2 places outside of the uterus that you may find endometriosis
- Pouch of douglas
- Colon
- Bladder
- Lungs
- CNS
- Pericardium
59
How is it thought that endometriosis occurs?
- Retrograde menstruation
- Dysfunction of immune system
- lymph / blood spread
- Metaplasia
60
How would you treat fibroids?
- TXA
- Mirena coil - shrinks fiborids and reduces blood loss
- GnRH can be used to shrink the fibroids before removal
Patients that want to reamin fertile:
- myomectomy
Older patients who dont want childrne:
- Hysterectomy
61
What is a serious complication of fibroids?
Red degeneration - causes pain, uterine tenderness, vomiting, severe pain, fever. Lead to necrosis.
62
Name 3 causes of miscarriage
- Thrombophillias
- Infection
- Chromosomal abnroamlities (why seen in women of increasing age)
63
What is a threatened miscarriage?
- Cervical os closed
- Bleeding during pregnancy
- Pregnancy may still be viable
64
What is a missed / delayed miscarriage?
- Fetus is dead but retained within the uterus.
- Uterus is small for dates
- Picked up on US
65
What is an incomplete miscarriage?
Cervical os open, some of the POC have come out of the vagina.
66
What is an inevitable miscarriage?
Cervical os is open - miscarriage will occur, progress to either complete or incomplete.
67
What is a complete misscarriage?
US, no POC in the uterus.
68
What is the treatment for miscarriage
| medical and non-medical
Management:
- EPAU
- Counselling
Medical
- MISOPRISTOL (opens the cervix)
Surgical and equipment-
- Forceps
- Surgery
69
List 3 factors associated with miscarriage
- Smoking
- Maternal age
- Previous miscarriages
- Stress/ anxiety
70
Define primary PPH
Severe blood loss < 24 hours of birth
71
Which test is used to determine ovulation?
Mid luteal progesterone 7 days before end of cycle (bleeding)
USUALLY DAY 21.
72
How does COCP work?
- Small risk of breast and endometrial and cervical cancer
- Risk of VTE
- Doesnt protect against STI
73
What are the most common causes of heavy mesntrual bleeding?
- Ovulatory
- Coagulation disorders
- Endometrial dysfunction
74
What are fibroids?
Benign tumours of the MYOMETRIUM
75
What are polyps?
Benign localised growths of the endometrium
76
Define primary PPH
Severe blood loss < 24 hours of birth, > 500mls
77
Define secondary PPH
after 24 hours, > 12 weeks delivery
| Can be minor < 500mls or major > 1000mls
78
What is adenomyosis?
- Endometrium in the myometrium
| - LOTS OF PAIN
79
How do you treat adenomyosis?
- Hysterectomy definitive treatment -
80
Why do you need to know if the uterus is retroverted or. anterior?
Surgery = may damage it with intrsuments that push trhough the wall
81
List causes of heavy menstrual bleeding
- Hypothyroid
- Fibroids
- Polyps
- Ovarain cyst
- Endometriosis
- PID
- Medications - blood thinners
82
What is the treatment for fibroids?
< 3cm then MIRENA COIL
If a woman wants children:
- Myomectomy
- Uterine artery ablation
If a women doesn't want children, older
- May do hysterectomy if there is loads
83
What investigations would you do for someone with irregular menstrual bleeding?
- FBC / haemanitics
- Coagulation
- TFTs
- TVUS
- US abdo and pelvis
84
What is the first line treatment for heavy menstrual bleeding?
- COCP (if no contraindications)
- Progesterone only pill
- Mirena
85
Why do you need to know if the uterus is retroverted or. anterior?
May damage it with intrsuments that push though the wall e.g. surgery, insertion of the coil
86
What is the first line treatment for heavy menstrual bleeding?
- Mirena
- COCP (if no contraindications)
- Progesterone only pill
Women that want to get pregnant soon:
- TXA
- Mefanamic
- Progestins e.g. northisterone
Women that don't want any more children / are older:
- Hysterectomy
- Endometrial ablation
87
What type of drug is TXA?
Antifibrinolytic
88
What type of drug is mefenamic acid?
NSAID
| COX inhibitor
89
Why is Danazol not a mainstay treatment?
Can cause male hair growth in women
90
What would the levels of FSH and LH be like in post-menopausal women?
HIGH (no inhibition from oestrogen)
91
What 3 infections are screened for antenatally?
Blood test
HIV, Hep B, Syphillis
92
What are the risk factors for PPH?
- Macrosomia
- Multiple pregnancies
- Infections
- Shoulder dystocia
93
How are babies that present in the breech position delivered?
Elective C-section
94
What haemoglobinopathies are tested for in pregnancy?
- Sickle Cell
| - Thalassemia
95
What happens if a chromosomal abnormality is picked up on NT?
- Amniocentesis
- CVS
Test babies cells.
96
What is sepsis 6?
```
Blood cultures
Urine output
Fluids
ABx
Lactate
Oxygen
```
97
List 3 causes of obstretric emergencies (maternal)
- PPH
- APH
- Pre-eclampsia
- VTE / PE
98
What is the treatment for an ectopic pregnancy?
METHOTREXATE
If not, can do surgery to remove the tubes, or remove the implantation.
99
List 3 causes of obstretric emergency (fetal)
- Cord prolapse
- Shoulder dystocia
-
100
How do you interpret a CTG? (7)
Dr CBraVADO
```
DR: Define Risk
C: Contractions
Bra: Baseline HR
V: Variability
A: Acceleration
D: Decceleration
O: Outcome
```
101
What is the treatment for cord prolapse?
CAT 1 C-SECTION
102
What is a braxton hicks contraction?
Practice contractions
Remain concentrated towards the front of the abdomen
Not regular and will subside
103
What does a reassuring CTG look like?
Reassuring
110-160
> 5
Present
104
What features would you see in an abnormal CTG?
Non-reassuring ( 1 FEATURE) or Abnormal (2 FEATURES)
BPM: < 110 or > 160
Variability: < 5
Acceleration: Early deceleration > 90 minutes
105
Diabetes
Increased risk of endometrial cancer and PCOS
106
How do you date a baby?
- Start with the LMP - work out when to do the dating scan from there
- Scan at 12 weeks --> crown rump length
107
What measurements do you need (from mother) to come up with a personalised growth chart for a mothers baby?
Height, weight and ethnicity
108
What are indicators for giving aspirin during pregnancy?
| 75 once per day, from 12 weeks
High risk (1+).
- CKD
- Preeclampsia
- Autoimmune disease
- Type 1/2 diabetes
- Chronic hypertension
Moderate risk, 2< risk factors:
- first pregnancy
- Older women
- BMI > 35
- Family history of pre-eclampsia
109
What is gravida?
Total number of pregnancies that you have had
110
What is parity?
Delieries after > 24 weeks
| + indicates loss before 24 weeks
- indicates loss after 24 weeks
Termination included
111
GBS
- ABx
| - Penzylbenicillin
112
What would you class as a preterm baby?
< 37 weeks
113
What would you class as a post-term baby?
> 42 weeks
114
What is the first stage of labour?
4cm - 10cm cervix
| Latent and active
115
What is the second stage of labour?
Cervix is fully dilated - birth of fetus
116
What are the cardinal movements that a baby makes to get through the pelvic inlet?
1. Decent: Downward movement of the foetus into the pelvic inlet
2. Engagement
3. Flexion: foetus pushes its chin against its chest
4. Internal rotation: shoulders internally rotate so they are in the widest part of the pelvic inlet
5. Extension: foetal head changes from flexion to extension. Head emerges.
6. Restitution: head externally rotates so shoulders can pass through the pelvis
7. Expulsion: anterior shoulder slips under the symphysis pubis and the rest of the body comes out of the vagina
117
What is the third stage of labour?
Birth of fetus - placental delivery.
| Normally takes 5 minutes (could be longer)
118
What is Bishops score?
Determines whether you will need an induction of labour
119
What is a partogram?
Key maternal and fetal data during labour.
- Cervical dilation
- Fetal heart rate
- Contractions
- Whether induction was needed - oxcytocin, how much was needed, when given
- Any drugs given
- Urine dips (protein and urine output)
- Mums vital signs
- Duration of labour
120
What is a babies normal heart rate?
110 -160 BPM
121
How do you usually describe contractions?
How many in 10 minutes
| 3/10 = 3 in 10.
122
What should a normal tocogram show?
Variability > 5
Accelerations present
Fetal HR = 110-160BPM
Decelerations
123
Give 5 indications for consultant led care during pregnancy
MATERNAL MEDICAL CONDITIONS
- Coagulation disorders
- Diabetes
- Hypertension
- Epilepsy
LAST PREG PROBS
- Microsomia
- C-section
- Emergency situation
- Tears
124
When do you need to assess women for risk during pregnancy?
- At the start of pregnancy
| - At the start of labour
125
What ways can you monitor the fetus during pregnancy?
- CTG
- Growth chart
- Doppler of the placenta
126
What two signs would you see on a CTG that would make you worry about fetal hypoxia?
- Late deccelerations
| - Reduced variability
127
What 3 measurements are needed to measure fetal growth?
- Femur length
- Abdominal length
- Head circumference
128
What happens to the serum hCG of those with viable pregnancy
- Double in 36-48 hours during the first few weeks
129
What is an ectopic pregnancy?
Pregnancy that occurs OUTSIDE the uterus
130
What would you see in the serum hCG levels of someone with an ectopic pregnancy?
Levels fall dramatically
| < 50% drop from previously level
131
What would you expect to see on a swab contaminated with gonorrhoea?
Gram negative diploccoci
132
A pregnant lady comes in in shock. You feel her uterus and it feels 'woody' and hard. What do you suspect the diagnosis it?
Placental abruption
133
What are the investigations you can do for infertility?
- Serum 21 progesterone
- Hysterosalpingoscopy
- Semen analysis
134
What is hyperemesis gravidum associated with?
High levels of serum hCG
135
What is the treatment of hyperemesis gravidum?
- IV fluids (normal saline)
- IV anti-emetics
- Oral anti-emetics at home, frequently
- Frequent small meals
OTHERS:
- THIAMINE
- LMWH - dehydration and hospitalised, also pregnancy is a hypercoagulable state
136
What is the difference between a partial and complete molar pregnancy?
Complete = empty ovum.
Partial = some fetal products. Ovum is fertilised by TWO sperms and therefore
137
What is the origin of the name hydatiform mole?
Molar pregnancies characterised by large fluid filled vesicles in the placenta
138
What would you expect to see on the serum hCG of someone with a molar pregnancy?
EXCESSIVELY HIGH levels of hCG
139
What is the typical presentatoin on US of a molar pregnancy?
SNOW STORM APPEARANCE
140
What might be the cause of hyperemesis gravidum?
High levels of serum hCG
141
What is the treatment of hyperemesis gravidum?
- IV fluids (normal saline) +/- K+
- IV anti-emetics
- Oral anti-emetics at home, frequently
- Frequent small meals
OTHERS:
- THIAMINE (vitamin B1) - can lead to wernickes encepalopathy
- LMWH - dehydration and hospitalised, also pregnancy is a hypercoagulable state
142
What is the difference between a partial and complete molar pregnancy?
Complete = empty ovum.
Partial = some fetal products. Ovum is fertilised by TWO sperms. 69 chromsomes.
143
What is the treatment for a molar pregnancy?
Only surgical - empty the uterus.
Chemo offered to all women in whose hCG levels do not fall to a satisfactory level.
144
What are the indications of hyperemesis gravidum (as opposed to normal vomitting)
- Persistent and severe vomiting
- Fluid and electrolyte disturbance
- Ketonuria
- Nutritional deficiency
- Weight loss.
145
What is your responsibility as a doctor regarding FGM?
Must report it in individuals < 18 - police force within 24 hours.
146
List 4 causes of primary ammenhorea
- Turners
- CAH
- CAI (complete androgen insensitivity syndrome)
- Hypothalamic: pituiatary axis - prolactinoma
- Anatomical
147
List 3 causes of secondary ammenhoroea
- PCOS
- Weight loss
- Exessive exercise
148
List 3 causes of heavy periods
- Endometriosis
| -
149
What is the name of programmed cell death?
- Apoptosis
150
What increases the risk of developing endometrial cancer?
```
UNOPPOSED OESTROGEN (progesterone protected effect on the endomertrium) - oestrogen causes it to grow and grow:
- early menopause
```
151
Why is obesity linked to problems with periods, infertility, etc?
Adipose cell converts androgens to oestrogen, increasing the levels
of oestrogen in the body.
152
An elderly woman presents to the GP with POST-MENOPAUSAL bleeding. What are you thinking?
Endometrial cancer
153
What is the main cause of cervical cancer?
High risk HPV (16)
154
What are the 7 criteria needed for a screening programme (Wilson and Jugner)
1. important health problem
2. accepted treatment
3. facilities for diagnosis and treatment
4. recognisable latent r early symptomatic stage
5. suitable test
6. test acceptable to population
7. natural history of the disease well understood
155
What is the vaccination used for HPV?
Gardasil (covers 6,11,16,18)
| dont learn really as they change the vaccines every year
156
What are the two main types of HPV (causing cervical cancer?)
16 and 18
157
Who is at increased risk of HPV?
- Multiple sexual partners
- Previous STDs
- Immunosuppression
- Lack of vaccination
- Most women come into contact with HPV but the immune system clears the infection within 2 years
- Smoking → Prevents immune system from clearing HPV infection
158
What is the most common pathology of cervical cancer?
SQUAMOUS CELL CARCINOMA (90%)
159
What issues might you need to consider when managing a 25 year old woman with a diagnosis of cervical cancer?
- fertility
- bowel and bladder
- impact on life
160
What is the most common form of vulval cancer?
Squamous cells
161
Name 3 cancers that can result from HPV
- Cervical
- Vulval
- Penile
- Anal
- Head
- Neck
162
What is the most common form of vulval cancer?
Squamous cell carcinoma
163
What is the most common type of ovarian cancer?
Epithelial cells
164
What things may show a rise in CA125
- Diverticulitis
- Liver disease
- Endometriosis
- Menstruation
- PID
- Pregnancy
- Ovarian cancer
- Fibroids
165
What 3 things are done as part of the triple breast examination?
- Clinical assessment
- Imaging (US/MRI)
- Pathological assessment (core biopsy, FNA)
166
When are women screened for breast cancer in the UK (NHS breast screening programme)?
47 - 73
Every 3 years.
167
What are the two most common types of breast cancer?
- Ductal (70%)
| - Lobular (10%)
168
What are the 3 receptors related to breast cancer?
- Oestrogen
- HER2
- Ki67
169
What is the prognostic index for breast cancer?
Nottinghma prognostic index
170
List 3 SE of chemotherapy
Alopecia
Mouth ulcers
Tiredness
Nausea and vomitting
171
What is the hormonal first line treatment for breast cancer for:
a) pre-menopsual women
b) post-menopausal women
a) tamoxifen
b) aromatase inhibitor
*aromatase - enzyme that converts adrenal and adrogens to oestrogen in the fatty tissue - the only source of oestrogen in postmenopusal women. No effect on the endometrium.
172
What are the most common places for cancer to metastasise?
- Bone
- Lung
- Liver
- Brain
- Lymph
- Skin
173
Is breast pain a sign of cancer?
NO
174
What is mastalgia?
Breast pain
175
List 4 causes of breast lumps
- Fibroadenoma
- Cyst
- Fat Necrosis
- Malignancy
176
Define thelarce
Appearance of breast development in girls
177
Wghat 3 things make up RMI?
Menopause age
US findings
CA125 markers
178
When are women invited for cervical screening?
Age 25 - 49 every 3 years
| 50 - 64 every 5 years
179
List two side effects of HRT
-Breast tenderness
| -
180
What cancer does HRT reduce the risk of?
Colorectal
181
List 4 risks associated with HRT
- Increased risk of breast cancer
- VTE
- Endometrial cancer with unopposed oestrogen
- galbladder disease
182
What type of gynaelocigcal cancer is HPNCC associated with?
Endometrial
183
What are the most common types of high risk oncongenic subtypes of HPV?
16,18,31,33
184
A 62 year old lady presents with IBS like symptoms. What should you be worried aboiut?
OVARIAN CANCER
185
What is the marker of CAH
| *need to distinguish from PCOS, could be late onset and also presents with hirtuism
17 hydroxyprogesterone
186
What would you see on an US of someone with an ovarian tumour?
adnexal mass (mass within the uterus, ovary, fallopian tubes) - fixed, nodular, irregular, solid, bilateral, ascites within the abdominal cavity.
187
What are three tests you would do if you suspect a DVT?
- US doppler of the leg
- D dimer
- Wells scoring to assess the risk
(bringing this up in gynaey as COCP and pregnancy can increase the risk of a PE)
188
When is a womens most fertile period (menstrual cycle)?
5 days before ovulation (sperm can live up to 7 days) and up to 1-2 days after
189
Where are FSH and LH produced from?
Anterior pituitary
190
What hormone causes the release of gonadotrpphins (FSH and LH) and where is this released from?
GnRH
| Hypothalamus
191
What produces bHCG in a woman?
The placenta after the ovum has implanted into the endometrium.
192
Define primary ammenhorroea
Never had a period > 16 years old.
193
Define secondary ammenhorroea
> 6 months without period having previously had one
194
List 4 causes of secondary ammenorrhoea
- Thyrotoxicosis
- PCOS
- Hypothalamus causes - increased exercise, loss of weight
- Prolactinoma
- Turners
- Ashermaans
- Sheehans
- PREGNANCY = main one!
195
List 5 tests you would do in someone with ammenhorroea
- FSH and LH
- Prolactin
- TSH
- Fasting glucose / lipid ratio - diabetes (PCOS)
196
A woman presents to EPAU with a very large uterus for dates, vomitting profusely and vaginal bleeding. What investigations would you do and what might you find? What do you suspect has happened?
Molar pregnancy
bHCG - very high levels (complete)
US - snowstorm appearance
197
What us the NHS breast screening programme?
Women aged 47-73 invited every 3 years for a mammogram / US.
198
What is the triple assessment for breast cancer?
Imaging
Clinical assessment
Score on biopsy
199
List 4 causes of breast lumps
- Cyst
- Fibroadenoma
- Breast cancer
- Lipoma
- Fat necrosis
200
What are the three stages of labour?
1. First (latent and active) - cervix dilates fully to 10cm, regular contractions
2. Second stage = cervix dilated to 10cm - birth of the baby
3. Third stage = birth of the baby - birth of the placenta.
201
What is Bishops score?
Scoring system used to determine if you need any help inducing labour.
> 8 means that the woman is ready for labour.
202
List 3 reasons why a woman might fail to progress during labour
- Fetal malpresentation
- Uterine contractions not coordinated / strong enough
- Cervical stenosis
- Babies head / body too large to fit through the birth canal - cephalopelvic disproportion
203
Give 3 non-pharmalogical methods of pain releif that can be used during labour
Water immersion
Aromatherapy
Massage
Hypnobirthing
204
What methods can be used to induce labour?
- Membrane Sweep
- AROM
- Oxcytocin
- Misopristol (prostaglandin - used for miscarriage / abortion)
205
What is the name of the medication used to suppress labour?
Tocolytics
(premature birth - delay so that the fetal lungs can mature)
Usually prospone pregnancy by around 2 days - enough time to allow the administration of steroids that will help the babies lungs mature.
206
What are braxton hicks contractions?
Practice contractions, helps to prepare the uterus for labour. Irregular.
Not all pregnant mothers feel them
207
After doing a CTG for 30 minutes you notice that there has been no accelerations. What should you do?
In order to find out whether there is a pathological cause for this you must continue doing the CTG - babies can be resting for > 40 minutes and so it may be that this is completely normal.
208
What vitamin should women avoid in pregnancy?
VITAMIN A
209
What diseases are tested for during the first antenatal booking appointment?
- Hep b
- HIV
- Syphillis
- Rubella
210
How does clomifene work?
Blocks oestrogen receptors in the pituitary and hypothalamus
211
What is a good marker of preterm delivery?
Fetal fibrinectin - glue that sticks the placenta to the uterus, high levels indicate a preterm delivery.
212
What medication changes should diabetic women make during pregnancy?
- Add folic acid
- Increase insulin dose as hey are at risk of hypoglycaemia
- Add metformin if not on this previously
- Take away all other hypoglcyaemic agents instead of insulin (including AceI, ARBs, etc)
- Statins need to be stopped
- Swap antihypertensives for labetalol, as this has proven safe in pregnancy
- Add aspirin - due to hypertension and therefore potential risk of preeclampsia ?
213
List 3 pregnancy complications and 3 fetal complications that may result from uncontrolled diabetes during pregnancy
Pregnancy:
- Polyhydramnios
- Infection
- Abortion and prematurity
- Preeclampsia
- C-section delivery
Fetal complications:
- Macrosomia - SHOULDER DSYTOCIA?
- Congenital malformation - neural tube or heart defect
- Neonatal hypoglycaemia - may need to give them dextrose when they are born
- RDS
- Still birth
214
What happens when a baby has IUGR in utero?
- Serial growth scans (fortnightly)
| - Weekly scans to measure doppler flow (blood flow tp the placenta) and the amniotic fluid volume.
215
What are the risks associated with IUGR?
Impaired development in pregnancy
Intrauterine death
Distress in labour
Oxygen deprivation in labour (asphyxia)
Meconium aspiration during the birth
Low blood sugar after birth and consequent complications
216
How would you be able to tell between mastititis / breast abcess and inflammatory breast cancer?
Hard as they can present veyr similarly.
With an abcess, would usually feel a lump whhereas in many cases of inflammatory breast cance rthis is not the case - there is diffuse swelling and inflammation.
Mastitis tends to occur around breast feeding - staph aureus invades the skin.
217
What is the first line method of induction in women past due by date?
Prostaglandins
218
What are the 5 assessment criteria on Bishops scoring?
- Effacement
- Position
- Dilation
- Consistency
- Fetal station (where it is in relation to ischial spine)
219
Why would you want to induce a woman that has gone past term - what are the complications?
BABY:
- IUGR (placenta begins to move away from the wall)
- Macrosomia (baby continues to grow)
- Meconium aspiration
MOTHER:
- C-section
- Instrumental delivery
- PPH
- Tears
220
How often do women having had a cervical smear test?
Also known as repeat recall
3 years 25 -49
5 years 50 - 64
221
What happens if your results come back positive for HPV on cervical smear?
Cytology
If cells normal on this, then you will be reviewed in 12 months.
If positive - go on for firther Ix and explore treatment.
222
What happens if your sample is inadequate om cervical smear?
Repeat the sample in 3 months.
If this happens twice, need to do colposcopy
223
What is fitz-hugh curtis syndrome?
- Rare complication of PID
- Liver capsule inflammation, leading to hepatic adhesions
- Always keep on the lookout in exams - RUQ pain aggrevated by breathing / laughing
224
What do variable cord compressions suggest (CTG)?
Cord compression
225
What AB would you give a woman with PPROM?
Erythromycin
226
How would you treat a woman with PPROM?
- Admit
- Give AB (erythromycin)
- Give steroids (foetal lungs)
- Get her to give birth by 34 weeks (before then increased complicatiosn of baby)
227
What is mcroberts manoeuvre?
- Flex
| - Abduction
228
What are the complications of diabetes during pregnancy?
SMASH
- Shoulder dystocia
- Macrosomia
- Amniotic fluid excess
- Stillbirth
- Hypertension / hypoglycaemia baby
229
What are the causes of small for gestational age babies?
SWAN
- Starved small
- Wrong small
- Abnormal small
- Normal small
230
What are the risks associated with COCP?
- Increased risk of breast and cervical cancer (but less likely to use barrier contraception?)
- Increased risk of VTE, stroke, ischemic heart disease
231
What is a side effect of the depot injection?
Weight gain
232
What is the treatment for heavy menstrual bleeding?
Contraception: Mirena, COCP
No contraception: TXA or NSAIDs
