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My Final Year 4 Revision > Womens health > Flashcards

Womens health Flashcards

1
Q

I though about making a joke at the begining of this topic. But, I see the news and I don’t think it would be funny to make fun of women.

A

Instead here is a link to a charity I like:

https://www.golddiggertrust.co.uk

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2
Q

What medical management can aid with becoming pregnancy?

A

400mcg folic acid

5mcg Vit D

Diet and wieght control

Medication review

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3
Q

Which patient need to have more folic acid (5mg) suplimentation pre-pregnancy?

A

Past NTD

DM
Obesity

Bowel disease

Anti-epileptic meds

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4
Q

What factors indicate a high risk pregnancy?

A

1840

PMH/ PSH

IVF

Previous cesearian

Previous pregnancy complications

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5
Q

What is involved in the combination test for down syndrome?

A

Blood test - PAPP-A and HCG

Nucal translucency

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6
Q

When is the combination test performed and what does it involve?

A

Performed at 12 weeks with dating scan

USS - Nuchal translucency

Bloods - B-HCG PAPP-A

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7
Q

When is the anomaly scan performed?

A

20 weeks

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8
Q

What definitive test are there for Down syndrome

A

Chorionic villus biopsy

Amniocentesis

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9
Q

What happens to BP during pregnancy?

A

BP decreases

Even though HR and SV increase total peripheral resistance decreases

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10
Q

What cuases aneamia during a normal pregnancy?

A

Increase in RBC volume

Increase in plasma volume

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11
Q

Why is there a greated chance VTE during pregnancy?

A

Increased prouction of clotting factor

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12
Q

What is a 3rd degree tear?

A

A tear from the vaginal wall to the anal sphincter muscle

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13
Q

What is a 4th degree tear?

A

A tear from the vaginal wall to the anus or rectum

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14
Q

What conditiond are exacerbated during pregnancy?

A

Some cardiac disease

renal disease

DM

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15
Q

What conditions are improveed during pregnancy?

A

Muiltiple sclerosis

Rheumatological diseases

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16
Q

Which mother should be screened for GDM?

A

> BMI

Ethnicity

Previous GDM

FH of GDM

GGT performed at 26 weeks

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17
Q

What blood glucose indicates gestational diabetes mellitus (GDM)?

A

fasting > 5.3

1 hour post meal > 7.8

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18
Q

What risk with GDM?

A

Macrosomnia - neonatal hypo, shoulder dystopia (Erbs palsy)

Birth defects

Still births

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19
Q

What treatments are there fore GDM?

A

Diet controlled

Metformin

Insulin

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20
Q

What increases the chance of shoulder dystopia during birth?

A

Microsomnia

GDM

Previous episode

High BMI

Induction

instrumental delivery

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21
Q

Should pregnanct women on insulin be carried to term?

A

Yes, >39/40 as any less can iindice ARDS in neonate

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22
Q

What medication can be used to mature then lungs and therefore avoid ARDS?

A

Steroids, however watch out for glycaemic control

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23
Q

What medication are used to avoid VTE in at riskk pregnant women?

A

LMWH

75mg aspririn OD

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24
Q

What is Oligohydramnios?

A

Deficiency of amniotic fluid

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25
Q

What is pregnancy induced hypertension?

A

HTN after 20 weeks gestation

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26
Q

What is pre-eclempsia?

A

HTN after 20 weeks with proteinurea (spot protien/creatinine ratio)

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27
Q

What is eclempsia?

A

Siezures during pregnancy as a result of pre-eclempsia

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28
Q

What is HELP syndrome?

A

Heamolysis

Elevated Liver enzymes

Low Platelets

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29
Q

What symptoms are there for pre-eclempsia?

A

Headaches

visual changes

epigastric pain

Oedema

N+V

Orthostatic hypotension -dizzines on standing

O/E - brisk reflexes and decreased urine output

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30
Q
A

Underperfused placenta which then activates maternal vascular endothelium. This leads to HTN and end-organ damage. Baby may develope Intra-uterine growth restriction

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31
Q

What treatments are there for pre-eclempsia?

A

C- sections

Antihypertensives

Fluid restriction

magnesium sulfate - for fits

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32
Q

What medicaiton can be used to treat hypertension in pregnancy?

A

Labetalol

Nifedipine

Hydralazine

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33
Q

What is the definition of Small for Gestational Age (SGA)?

A

<10 centile on costomised growth chart

Normal growth velocity

Not due to pathology oftern constitutionally small

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34
Q

What is the definition for Fetal Growth resiction (FGR)?

A

Failure to reach pre-determind growth potential due to pathology

Poorer growth velocity or static growth

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35
Q

What is the cause of symterical (equivalent head and abdomen size) FGR?

A

Causes earlier on in pregnancy

Chromosomal/ congenital abnormalites

Infections - rubella CMV

Fetal alcohol syndrome

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36
Q

What is the cause of asymetrical (non-equivalent head and abdomen) FGR?

A

Later on in pregnancy where blood flow is proritised to head from abdomen.

HTN and pre-eclempsia

smoking

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37
Q

Is anaemia a risk fractor for SGA?

A

NO

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38
Q

What is the Hadlock calculation?

A

Estimates fetal height involving:

Head circumfrance

Abdomen circumfrance

Femur length

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39
Q

WHat is used to determin a babies zise and well being?

A

Hadlock calculation

Liquor volume

Umbilical artery doppler

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40
Q

What features should be in a normal arterial doppler

A

No back flow/ Decreased diastolic flow

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41
Q

Is this a normal umbilical artery doppler and why?

A

Noo shows reverse flow, this can indicate poor perfusion and therefore fetal acidosis which in turn may require delivery

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42
Q

What is APGAR scoring and what are its components?

A

APGAR - scoring of neonates to identify problems

Involves measuring the following at 1 and 5 mins:

Apearence

Pulse

Grimace

Activity

Respirations

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43
Q

What does an APGAR of <3 indicate?

A

Immediate resus of baby needed

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44
Q

What does an APGAR of >7 indicate?

A

Baby is fine

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45
Q

What are the indicators of magnesium toxicity?

A

Loss of tendon reflexes

Respiratory depression

Cardiac arrest

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46
Q

What medication can be used to controll post partum heamorrhage?

A

Oxytocin - synocnin, syntometrine

Prostoglandins - misoprostol, carborpstol

Clotting agents - tranexamic acid

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47
Q

What is the first stage of labour?

A

Latent phase - ≥ 4cm cervical dilation with braxton hicks contractions

Active phase 4-10 cm cervical dilatation with active contractions

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48
Q

What is the second stage of labour?

A

Propulsive and expilsive phase ending with the delivery of the baby. This includes the mechanism of labour

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49
Q

What is delivered in the third stage of labour?

A

placenta

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50
Q

What are the steps in the mechanism of labour?

A

Descent

Flextion

Internal roation

Extension

External roation (restitution)

delivery of anterior and then posterior shoudlers

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51
Q

At watch age is abnormal uterine bleeding should be reffered as a 2 ww?

A

Women aged > 40

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52
Q

What are the a causes of abnormal vaginal bleeding?

Think of the acronym

A

PALM COEN

Poyps

Adenmyosis

Liomyomas

Malignancy

Coagulopathy

Ovarian dysfunciton

Endomtrial dysfunction

Not yet classified

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53
Q

What cuases of abnormal menstratl bleeding is most common in post menopausal women?

A

PALM

Polyps

Adenomyosis

Leiomyomas

Malignancy

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54
Q

What are Uterine leiomyomas?

A

Fibromas

Benign and responsive to oestrogen

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55
Q

How are leiomyomas treated?

A

mostly conservative

OCP, GnRH agnoist, interventional uterine artery embolisaiton, surgically by myomectomy nad hysterectomy

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56
Q

What are the red flag symptoms for gyneoncologica problems:

> 45 years old

persistnet intramenstrual bleeding

post coital or post menopausal bleeding

enlarged uterus/ abdo mass

lesion on cervix

A

> 45 years old

persistnet intramenstrual bleeding

post coital or post menopausal bleeding

enlarged uterus/ abdo mass

lesion on cervix

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57
Q

What is the treatment for menrrhagia when a patient prefference is not contraception?

A

Tranexamic acid

Mefenamic acid (NSAID)

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58
Q

What is the treatment for menorragia when contraceptive are appropriate?

A

1st line Mirena coil

OCP

Dep injeciton

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59
Q

What is a Mirena coil and what are its side effects?

A

Progesterone releasing IUD

SE - ovarian cysts, acne, mood changes and breast soreness

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60
Q

What a threatened miscarraige?

A

Vaginal bleed with a known pregnancy

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61
Q

What is an inevitable miscarraige?

A

When the cervix is open

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62
Q

What symptoms can accompany an ectopic pregnancy?

A

Abdo pain

Shoulder tip pain

Peritonitis

D+V

lightheadedness

Potential pregnancy -LMP, sexual history

Cervical excitation

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63
Q

Risk factors for ectopic pregnancy?

A

Infertility

Prior surgery

Smoking
Pelvic inflammatory disease - chlamydia

Assisted reprodeuctive techniques

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64
Q

What is investigation is done when an ectopic or misscarraige is suspected?

A

Trans-abdominal and then trans-vaginal USS

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65
Q

When a scan is inconclusive and a pregnancy of unknown origin (PUO) is diagnosed what is the next investigation?

A

HCG

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66
Q

What HCG indicate a uterine pregnancy?

A

>1500

doubles every 48 hours

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67
Q

What is the medical management of ectopic pregnancy?

A

Methotrexate SC

Strict criteria - low HCG, small ectopic

Need follow up HCG

Advice no pregnancy in the next 3 months

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68
Q

F 24yo has a 2 week history of abdo pain with postcoital PV bleed. There is a purulent vaginal discharge.

O/E there is diffuse abdo tenderness.

What is a possible diagnosis

A

Pelvic inflammatory disease - Ascending infection through cervix to uterus

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69
Q

What is the term for a failed pregnancy?

A

> 24 weeks = preterm

< 24 weeks = miscarraige

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70
Q

What causes are there for 1st trimester miscarraiges?

A

Congenital

Chromosomal abnormalities

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71
Q

What causes are there for 2nd trimester miscarraiges?

A

Thromobophilia - Liedons FV

Cervical incompetance - LETTS or cone biopsy

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72
Q

What eponymous names of stiches can be used to for a incompetant cervix during pregnancy?

A

Shirodkar - common in UK

McDonalds

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73
Q

What is the definition of recurrent pregnancy loss?

A

≥ 3concecutive miscarriage

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74
Q

When visualising the cervix what histolgy is in the ectocervix and endocervix?

A

Endovervix - columnar epithelium

Ectocervix - Squamous epthithium

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75
Q

What is the SCJ and what happens to it during in puberty?

A

Sqaumo-calumnar junction

This can move forward during menarchy leading to ectropion.

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76
Q

What is the tranformative zone?

A

The ectropion - site between original and current SCJ. This is the site of most dyskariosis

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77
Q

During copolscopy a smear may be taken. What can acetic acid and iodine on the cervix reveal?

A

Acetic acid can show dyskariosis

Iodine can show normal squamous epithelium

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78
Q

What are the 2 main types of ovarian cyst?

A

Physiological - Eostrogen dependent/ cyclical pain, most common.

Malignant - differentiated on scan, muiltilobulated irregular and suspicious looking.

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79
Q

What does progesterone do in pregnancy?

A

Relaxes the uterus

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80
Q

What does estorgen do in pregnancy?

A

Increases oxytocin receptors in the placenta

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81
Q

What hormonal pathway is thought to lead to labour?

A

ACTH released by feotus leads to cortisol release which increases oxytocin and decreases progerstrone and oestrogen. This contract uterus and cervix which therefore leads to more oxytocin release. Positive feedback loop is formed.

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82
Q

A baby is poapated and scanned and showen to be in the foetal position. What are the next steps in managment?

A

Offer External Cephalic Version (ECV). If unsecceful contineue to breach birth or C-section (preffered)

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83
Q

What can be the cause of abnormal labour

A

3Ps:

Passenger

Passage

Power

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84
Q

What is the main problems which occur with the “Passenger” during labour?

A

Cephalopelvic dyspropotion

foetal compromise

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85
Q

A mother notices a decreased fetal movements and therefore a CTG is done. This is abnormal and meconium is noticed in the amniotic fluid. What would you be concerned of?

A

Feotal distress.

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86
Q

What is intraptartum heamorrhage?

A

Blood loss for the onset of labour to the end of the 2nd stage

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87
Q

What are the common causes of intraptartum heamorrhage?

A

Uterine rupture

Vasa Previa

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88
Q

When should uterine rupture be suspected?

A

A PMH of classical C-section and oxytocin induction with a muiltiparous women.

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89
Q

What is Vasa Previa?

A

When the cord runs along the fetal membrane and into the internal os. Compression lead to foetal distress or death.

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90
Q

What is a primary PPH?

A

≥500ml lost with in 24 hours of delivery

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91
Q

What are the 4Ts of PPH?

A

Tissue

Tone

Trauma

Thrombin

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92
Q

What is the most common cause of primary PPH?

A

80% is caused by uterine atony

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93
Q

How long should it take to deliver the placenta (3rd stage)?

A

Within 30mins of babies delivery

Managment includes Oxytocin or manual delivery in theater.

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94
Q

What is Secondary PPH?

A

Significant blood loss from 24hours to 6 weeks

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95
Q

What can cause 2nd PPH?

A

Reatiained product of conception

Infection

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96
Q

A Mother has a succesful delivery. However suddenly collapses. What condictions should be susected?

A

PE

Amniotic fluid embolus

97
Q

What is shoulder dystocia and what major complication can it cuase?

A

Any addition abstertric manoeuvres to release the shoulder after gentle downwards traction has failed.

This can cause Erbs Palsy

98
Q

What are the indications for a C section?

A
99
Q

Placental praevia

Breech position

Cephalopelvic dyproportion

IUGR

HIV
Cervical cancer

A
100
Q

What are contraindication for vaginal birth after cesarean (VBAC)?

A

Classical C section

Previous uterine rupture

Normal C-section indications

101
Q

What indication are there for instrumental vaginal delivery?

A

Failure to progress

Maternal distress

Controll of baby’s head

102
Q

What is the main complication of ventous delivery?

A

Cephaloheamatoma

103
Q

What is the main complication of forceps delivery?

A

Facial nerve palsy

104
Q
A
105
Q
A
106
Q

When is it recommended for a female to take folic acid tablets?

A

When they start trying to conceive and for the first 12 weeks of pregnancy

107
Q

Why is folic acid intake important for expectant mother’s?

A

It decreases the risk of neural tube defects such as spina bifida and cleft palate as well as helping to produce RBC

108
Q

What is the normal dose recommended for folic acid?

A

400 micrograms daily

109
Q

Which group of women is it recommended take 5mg of folic acid daily?

A

Previous pregnancy with NTD, family history of NTD, anti-eplieptic medication, diabetes, bowel disease, obesity

110
Q

How many appointments will a nulliparous woman have for an uncomplicated pregnancy?

A

10

111
Q

How many appointments will a parous woman have for an uncomplicated pregnancy?

A

7

112
Q

Why should pregnant women avoid liver?

A

it contains high levels of vitamin A which could be teratogenic if intake above 700 micrograms

113
Q

How much is the recommended supplement of vitamin D?

A

10 micrograms daily

114
Q

Which groups of women is it vital to recommend vitamin D supplement?

A

Those with dark skin or with limited exposure to sunlight (housebound, skin covered for cultural reasons)

115
Q

Which foods should pregnant women avoid to reduce the risk of listeriosis?

A

unpasteurised milkcamembert, brie and blue-veined cheesesany type of pateuncooked or underprepared ready meals

116
Q

Which foods should pregnant women avoid to reduce the risk of salmonella?

A

raw or partially cooked eggs or meat especially poultry and mayonnaise

117
Q

What are the recommendations regarding alcohol consumption during pregnancy?

A

No safe limitIncreased risk of miscarriage in the first trimesterBinge drinking (>5 drinks on one occasion) maybe harmful to unborn baby

118
Q

How should a pregnant woman wear a three point seatbelt?

A

Above and below the bump, not over it

119
Q

Which interventions appear to be effective in reducing symptoms of morning sickness?

A

gingerP6 (wrist) acupressureantihistamines

120
Q

What is the normal range of haemoglobin levels for pregnant women?

A

110g/L at first contact105g/L at 28 weeks

121
Q

If the woman is identified as a carrier of a clinically significant haemoglobinopathy what is the recommendation?

A

The father should be offered counselling and appropriate screening without delay

122
Q

What are the four options to be discussed with the woman regarding the anomaly scan to enable an informed choice?

A

Reproductive choiceParents to prepareManaged birth at specialist centreIntrauterine therapy

123
Q

What is included in a ‘combined test’?

A

nuchal translucencybeta-human chorionic gonadotrophinpregnancy-associated plasma protein-A

124
Q

Which strain of hepatitis should be serologically screened for in pregnancy?

A

Hepatitis Bso that effective postnatal interventions can be offered to reduce the risk of mother to child transmission

125
Q

What are the five primary prevention measures to avoid toxoplasmosis infection for pregnant women?

A

Washing hands before handling foodThoroughly washing all fruit and veg, including pre-prepared saladsThoroughly cooking raw meats and ready mealsWearing gardening gloves and thoroughly washing hands after handling soliAvioding cat faeces in cat litter and soil

126
Q

Name 5 of the 9 risk factors for pre-eclampsia

A

Aged 40 or aboveNulliparityPregnancy interval greater than 10 yearsFamily historyPrevious historyBMI 30kg/m2 and abovePre-existing vascular diseasePre-existing renal diseaseMultiple pregnancy

127
Q

What are the main 5 symptoms of pre-eclapsia?

A

Severe headacheProblems with vision (blurring or flashing lights)Severe pain just below the ribsVomitingSudden swelling of the face, hands or feet

128
Q

Which age groups are at higher risk of having problems with the grow of their baby?

A

less than 18more than 40

129
Q

What are the 3 main risks identified from the family origin questionnaire?

A

DiabetesHaematological disorder such as Thalassaemia or Sickle Cell DiseaseFGM

130
Q

What events in a previous pregnancy can impact a current one?

A

PrematurityFetal growth restrictionAntepartum haemorrhageGestational hypertension, pre-eclampsia, diabetes, thrombocytopeniaAssisted delivery, c section, forceps, ventousePPHPrevious stillbirth, late miscarriage or neonatal death3rd or 4th degree tear

131
Q

Family history is associated with which risks in pregnancy?

A

First degree relative with diabetes increases risk of gestational diabetesFirst degree relative with gestational hypertension or pre-eclampsia is at increased risk

132
Q

Why is social history so important during antenatal booking?

A

Women are most vulnerable when pregnantWomen who do not usually engage with services are in contact with medical or midwifery services.It is an important time to identify domestic abuse, homelessness, addiction, or financial problems

133
Q

Which blood tests are taken at the booking appointment?

A

Haemoglobin levelPlateletsInfections - HIV, syphilis, Hepatitis BBlood group and antibody statusSickle cell & thalassaemia if indicated by FOQ

134
Q

When is the dating ultrasound scan usually performed?

A

Between 8 to 14 weeks

135
Q

Which factors are considered to give a predicted risk of the baby having down syndrome?

A

Size of nuchal fold combined with blood test, maternal age and some other factors

136
Q

The quad test can be carried out between 14-20 weeks, what does it include?

A

Blood test for Alpha-fetoprotein, Inhibin A, Oestriol and Beta-HCG

137
Q

What are the diagnostic tests for T21?

A

Chorionic villous samplingAmniocentesis

138
Q

When is the anomaly screening ultrasound scan usually performed?

A

Between 18-21 weeks

139
Q

What are the 6 risk factors for gestational diabetes?

A

BMI>30EthnicityFirst degree relative with DMPCOSPrevious baby >4.5kg (9lb 15)Previous gestational diabetes

140
Q

Under which circumstances is a baby’s blood tested at birth and why?

A

If the mother is Rh-ve, she is at risk of Rhesus disease if her baby is Rh+veRhesus disease will affect future pregnancies unless prophylactice Anti-D is injected

141
Q

Which of the following is diagnostic for gestational diabetes?A - Fasting glucose >3.5B - Fasting glucose >2.5C - 2 hour glucose >6.0D - 2 hour glucose >7.8

A

D

142
Q

Which of the following is not a physiological change observed in early pregnancy?A - Increased cardiac outputB - Reduction in blood pressureC - Reduction in clotting factorsD - Increase in red cell volume

A

C

143
Q

How and when would you screen for gestational diabetes?

A

GTT between 26-28 weeks

144
Q

What are the risks of poorly controlled blood glucose in pregnancy?

A

miscarriagecongenital malformationstill birthneonatal death

145
Q

What advice should you given to diabetic women who are planning pregnancy?

A

Diet, weight & exerciserisks of hypoglycaemiaNausea and vomiting effect of BGRisk of large babies - birth trauma, induction & c sectionassess diabetic retinopathyassess diabetic nephropathyimportance of controlling maternal BG during labourtemporary neonatal health problemsrisk of child developing obesity or diabetes later in life

146
Q

What advice would you give regarding folic acid?

A

Take 5mg and day from starting to plan pregnancy until 12 weeks gestation

147
Q

How often should women with diabetes who are trying to conceive have their HbA1c level monitored?

A

Monthly

148
Q

What is the preconception advice around ketoaemia for type 1 diabetics?

A

Offer women blood ketone testing strips and meter so they can test if they become hyperglycaemic or unwell

149
Q

What are the target blood glucose levels for diabetic women preconception?

A

Fasting plasma glucose 5-7 mmmol/L on wakingPlasma glucose 4-7 mmol/l before meals and other times of day

150
Q

What is the target HbA1c level for diabetic women preconception?

A

48 mmol/L

151
Q

At what HbA1c level and above would you advise diabetic women not to get pregnant?

A

86 mmol/L

152
Q

Which diabetic medicines are considered safe during preconception and pregnancy?

A

Metformin for blood glucose lowering agentsLong-acting insulin - isophane insulin AKA NPH insulin is first line insulin therapy

153
Q

Which medicines should be discontinued or replaced during preconception and pregnancy?

A

ACEi and Angiotensin 2 receptor antagonists - find alternative anti-hypertensivesDiscontinue statins

154
Q

What is the lifetime risk of ovarian cancer of women in England and Wales?

A

2%

155
Q

What is the overall 5 year survival rate for women with ovarian cancer?

A

Less than 35%

156
Q

What are the symptoms of ovarian cancer?

A

persistent abdominal distensionearly satiety or loss of appetitepelvic or abdominal painincreased urinary urgency / frequency

157
Q

What is the first test of ovarian cancer?

A

Measure serum CA125 and arrange USS if greater or equal to 35 IU/ml

158
Q

What symptoms are red flag if a woman is over 50?

A

IBS symptoms if presenting for the first time

159
Q

What test would you order for women under 40 with symptoms of OC?

A

CA125AFP - aplha fetoproteinbeta-hCG - beta human chorionic gonadotrophin

160
Q

What are the 5 characteristics on an ultrasound to note for RMI?

A

Multilocular cystsSolid areasmetastasesascitesbilateral lesions

161
Q

Define Heavy Menstrual Bleeding

A

Excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and/or material quality of life

162
Q

What percentage of women are affected by HMB?A - 10-20%B - 15-25%C - 20-30%D - 25-35%E - 30-40%

A

C

163
Q

What are the four main areas to ask about during history for HMB?

A

Age (over 45 = high risk of pathology)Is the bleeding regular? Irregular bleeding need to rule out malignancyAssociated symptoms - heaviness in pelvis, urinary problemsOther issues with history such as clotting disorders, thyroid dysfunction or anti-coagulant medication

164
Q

Match the types of fibroid (Intramural, Subserosal, Submucosal, Pedunculated) with the location of development (perimetrium, myometrium, endometrium, attached via stalk)

A

Intramural = myometriumSubserosal = perimetriumSubmucosal = endometriumPedunculated = via stalk

165
Q

How many cycles should a patient wait before seeing results after the insertion of Levonorgestrel-releasing IUS?

A

6

166
Q

What six subjects should you discuss with the patient when considering hysterectomy for treatment of fibroids?

A

Sexual feelingsFertilityBladder functionExpectationsPsychological impactfurther treatment & complications

167
Q

What are the 3 main risks to discuss with a patient regarding hysterectomy?

A

Damage to abdominal organsIntraoperative haemorrhageLoss of ovarian function and consequences of this

168
Q

What treatments are offered for fibroids less than 3cm if LNG-IUS declined?

A

tranexamic acidNSAIDScombined pillcyclical progestogens

169
Q

What are the 7 RED FLAGS for heavy menstrual bleeding?

A

Age >45Persistent intramenstrual bleedingPost-coital bleedingEnlarged uterusPelvic massLesion on cervixPost-menopausal bleeding

170
Q

What are the side effects of Mirena?

A

risk of ovarian cystsacnemood changesbreast soreness

171
Q

What are the statistics linked to endometrial ablation?

A

90% of patients it reduces HMB50% of patients it stops menstrual bleeding completely1% risk of uterine perforation and/or infection

172
Q

A 49 year old woman presents to her GP with a six months history of HMB. What should the GP do?A - insert mirena IUDB - Arrange ultrasound scan and check her haemoglobinC - Prescribe tranexamic acid and review in 3 monthsD - Refer to gynaecologist for hysteroscopy and biopsy

A

D

173
Q

A 35 year old has HMB, is trying to conceive and has a normal US. Should the GP do?A - reassure the scan is normal and should not have treatment as trying to conceiveB - Prescribe tranexamic acid and mefanemic acid to be taken during her periodC - refer for hysteroscopyD - Prescribe norethisterone 5mg tds between days 41-25 of her cycle

A

B

174
Q

What are the three main symptoms of an ectopic pregnancy?

A

Abdominal or pelvic painAmenorrhoeavaginal bleeding

175
Q

Name three other reported symptoms of ectopic pregnancy

A

breast tendernessGI symptomsDizziness or syncopeshoulder tip painurinary symptomspain of defecation

176
Q

What are the non-sexually transmitted infection causes of vaginal discharge?

A

Bacterial vaginosisCandida

177
Q

Name the sexually transmitted infection causes of vaginal discharge?

A

Chlamydia trachomatisNeisseria gonorrhoeaeTrichomonas vaginalisHerpes simplex virus

178
Q

What are the non-infection causes of vaginal discharge?

A

Foreign bodies e.g. tampons, condomsCervical polypsGenital tract malignancyFistulae

179
Q

What is the medical terminology for pain during sexual intercourse?

A

Dyspareunia

180
Q

During a Colposcopy, when staining with acetic acid there are some patches of white - what does this show?

A

CIN = Cervical interepithelial neoplasia

181
Q

What medication is administered during augmentation of labour?

A

Syntocinon (Synthetic oxytocin)

182
Q

Where is natural oxytocin produced and stored?

A

Hypothalamusstored in posterior pituitary

183
Q

What does Oxytocin do?

A

Caused the uterus to contract

184
Q

When does labour change from latent to established?

A

Cervix dilated to 3cm and regular contractions

185
Q

When should a patient contact their midwive during first stage labour?

A

Contractions become regular and 3 in 10Waters breakContractions are strong and need pain reliefIf the patient is worried about anything

186
Q

How often will the midwife listen to the baby’s heart rate during established labour?

A

Every 15 mins

187
Q

What are the two alternatives for speeding up labour?

A

Breaking the patients watersOxytocin drip

188
Q

What risk factors indicate that an operative vaginal delivery is more common?

A

Primiparous womenSupine and lithotomy positionsEpidural anaesthesia

189
Q

What mnemonic is used to assess a CTG?

A

DR C BRAVADODefine RiskContractionsBaseline RAteVariabilityAccelerationsDecelerationsOverall

190
Q

What is the definition of Miscarriage?

A

UK = Loss of intrauterine pregnancy <24 weeks gestationWHO = Expulsion of fetus / embryo weighing 500g or less

191
Q

What is the difference between early and late miscarriage?

A

Early = loss before 12 weeksLate = loss between 12-24 weeks

192
Q

What percentage of miscarriages are caused by chromosomal abnormalities?

A

50%

193
Q

How would you diagnose a miscarriage?

A

Crown-Rump length of embryo 7mm or more with No fetal heart actionMean sac diameter of 25mm gestational sac with no yolk sac or embryo

194
Q

What is a threatened miscarriage?

A

Pregnancy confirmed, presenting with vaginal bleeding

195
Q

What is an inevitable miscarriage?

A

Cervix open on examination, miscarriage likely imminent

196
Q

Complete miscarriage?

A

when all pregnancy tissue has passed out of uterus

197
Q

Incomplete miscarriage?

A

when some pregnancy tissue remains in the uterus

198
Q

Delayed miscarriage?

A

When pregnancy has stopped growing or when fetus has died and there is no sign of bleeding

199
Q

What are the three management options of miscarriage?

A

Expectant - let’s the pregnancy pass naturallyMedical - Misoprostol is given to instigate uterine contraction and passing of tissueSurgical - operation to remove pregnancy tissue

200
Q

What are the three management options for Ectopic pregnancy?

A

Surgical - if symptomatic or unstableMedical - Methotrexate (folate antagonist)Conservative - if asymptomatic or falling HCG

201
Q

What is the definition of an ectopic pregnancy?

A

Implantation of pregnancy outside the womb

202
Q

How much is the of ectopic pregnancy increased following a first ectopic?

A

10%

203
Q

If a patient with a previous ectopic pregnancy becomes pregnant again, what additional appointment would they have during antenatal care?

A

Offer an ultrasound scan at 7 weeks to determine if pregnancy is intrauterine

204
Q

Where is the most common site for ectopic pregnancy?

A

Fallopian tubes

205
Q

What happens to serum HCG in a normal viable pregnancy?

A

Increase by at least 53% every 48 hours

206
Q

abnormal vaginal bleeding and severe lower abdo pain

A

ectopic

207
Q

copper coil IUD

A

most effective type of emergency contraception and can be left in for long term contraception can make periods heavier and more painful

208
Q

how to treat UTI

A

nitrofuratoin or trimethoprim

209
Q

UTI in first trimester

A

nitrofurantoin

210
Q

UTI in end of pregnancy

A

trimethoprim

211
Q

high risk pregnancy

A

advanced age, medical problems, gynae surgey, IVF, c-section, diabetes, previous obs Hx- HTN, growth restriction etc

212
Q

20 week scan

A

anomaly scan

213
Q

12 week scan

A

dating

214
Q

26 weeks

A

Glucose tolerance test

215
Q

gestational diabetes screening

A

BMI over 30, previosu macrosomic baby, previous GDM, FH, ethnicity

216
Q

treatment of gestational diabetes

A

diet, metfomin , insulin. escalate appropriately

217
Q

headache, vision changes, vomiting, swelling of face, hands and feet

A

think pre-eclampsia. check BP

218
Q

treatment of pre eclampsia

A

deliver babyreduce BP- labetalol

219
Q

quick evaluation of newborn

A

APGAR- appearance, pulse, grimace, activity, resp

220
Q

What should you advise people who are concerned about their fertility?

A

Vaginal sexual intercourse every 2-3 days optimises the chance of pregnancy

221
Q

What proportion of couples conceive in 1 year if the woman is under 40 and the have regular sex without contraception?

A

80%

222
Q

What proportion of women under 40 conceive using intrauterine insemination within 6 cycles?

A

50%

223
Q

What should men be informed about alcohol consumption?

A

Remaining within DoH recommended limits is unlikely to effect semen quality, however excessive alcohol intake is detrimental to semen quality

224
Q

What should women be informed about alcohol consumption?

A

Drink no more than 1/2 units once or twice a week and avoid intoxication

225
Q

Does smoking affect fertility in men?

A

Yes

226
Q

Does passive smoking affect fertility in women?

A

Yes

227
Q

Does caffeine affect fertility?

A

No

228
Q

How does a BMI above 30 affect fertility?

A

Women BMI>30 take longer to conceive as they may not ovulateMen BMI>30 are likely to have reduced fertility

229
Q

What advice is given to women of BMI<19?

A

Increasing weight is will increase likelihood of conception

230
Q

Define infertility

A

A couple of reproductive age who has not conceived after 1 year of regular unprotected vaginal sexual intercourse

231
Q

What are the seven WHO reference values for semen analysis?

A

Semen volume: 1.5ml or morepH: 7.2 or moresperm concentration: 15 million per ml or moretotal sperm number 39 million or moretotal motility: 40% or more motile or 32% or more with progressive motilityVitality: 58% or moresperm morphology: 4% or more

232
Q

When should a repeat semen analysis take place following an abnormal result?

A

3 months after initial analysis to allow for the cycle of spermatozoa formation

233
Q

What are the three measures used to predict the ovarian response to gonadotrophin stimulation in IVF?

A

Total antral follicle count less than 4 indicates low response and higher than 16 indicates a high responseAnti-Mullerian hormone less than 5.4 pmol/l indicates low response and higher than 25 pmol/l indicates high responseFSH greater the 8.9 IU/l indicates low response and less than 4 IU/l indicate high response

234
Q

How is ovulation confirmed?

A

A blood test to measure serum progesterone in the mid-luteal phase (21-28 days)

235
Q

What are the four first line investigations for infertility?

A

OvulationOvarian reserveTubes and transportSperm

236
Q

What are the four main reasons why fertility is reducing in the general population in the last 100 years?

A

AgeObesitySTISperm reduction due to processed foods and oestrogen remaining in water

237
Q

How is PCOS diagnosed?

A

Irregular, infrequent periodsAndrogen excessUltrasound scan showing more than 10 follicles

238
Q

What are the two medications that can be used for a woman with PCOS to promote ovulation?

A

MetforminClomiphene

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