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Finals Club (Dundee Medicine Master Summary Deck) > Year 3: Sexual Health and Reproduction > Flashcards

Year 3: Sexual Health and Reproduction Flashcards

Everything you need to know to pass for Sexual Health and Reproduction in Dundee Medical School

1
Q

Presentation of Chlamydia

A

Female:

  • 70% Asymptomatic
  • Dyspareunia
  • Bleeding post sex
  • Watery clear discharge

Male:

  • 50% asymptomatic
  • Dysuria
  • Discharge
  • Epididymitis
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2
Q

Chlamydia trachomatis

A

Chlamydia

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3
Q

Serovers A-C for chlamydia

A

Eye trachomatis

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4
Q

Serovers D-K for chlamydia

A

Genital Chlamydia

“D-K for dick”

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5
Q

Serovers L1-L3 for chlamydia

A

LGV lymph: Lymphogranuloma venereum

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6
Q

Chlamydia typically affects ages

A

20-24

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7
Q

Test for chlamydia after

A

14 days since exposure

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8
Q

Investigations for chlamydia

A

Combined: Nucleic Acid Amplification Test (NAAT)/ PCR

  • Male: First pass urine
  • Female: Vaginal swab
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9
Q

Treatment for Chlamydia

A
  • Doxycycline (7 days) Twice per day

Pregnant: Azithromycin

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10
Q

Presentation for Gonorrhoea

A

Females:

  • 50% asymptomatic
  • Vaginal discharge (green pus)
  • Dysuria
  • Pelvic pain

Males:

  • Purluent discharge (green)
  • Dysuria
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11
Q

Neisseria Gonorrhea

Gram-negative (2 kidney beans facing eachother)

A

Gonorrhea

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12
Q

Investigations for Gonorrhea

A

Combined: Nucleic Acid Amplification Test (NAAT)/ PCR

Male: First pass urine

Female: Vaginal swab

MSM: Rectal swab

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13
Q

Treatment for Gonorrhea

A

Ceftriaxone IM

If refused: Cefixime

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14
Q

Primary Syphilis

A

Chancre (painless ulcer at site of infection)

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15
Q

Secondary Syphilis

A
  • Macules on hands and soles
  • Snail track ulcers
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16
Q

Latent Syphilis

A

No symptoms

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17
Q

Tertiary Syphilis

A

CVS and CNS effects “Neurosyphilis” etc

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18
Q

Treponema Pallidum

Spiral organism, 21 days incubation

A

Syphilis organism

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19
Q

Investigations for Syphilis

A
  • Swab of a lesion: PCR/ dark film microscopy
  • ELISA (IgM, IgG) + TPPA- to diagnose
  • VRDL + RPR- how active disease is
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20
Q

Treatment for Syphilis

A

Penicillin G (IM)

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21
Q

Herpes Simplex Virus (HSV) causes

Enveloped shaped virus, migrates to sacral root ganglion to hide

A

Herpes

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22
Q

Herpes presentation

A

Painful blisters and ulcers

Lymphadenopathy

Fever

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23
Q

Type 1 HSV causes

A

Cold sores

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24
Q

Type 2 HSV causes

A

Genital Herpes

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25
Q

Investigations for Herpes

A

Swab and PCR

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26
Q

Treatment for Herpes

A

Aciclovir

5% topical lignocaine

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27
Q

Human Papilloma Virus (HPV) 1 and 2 cause

A

Palmer warts

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28
Q

Human Papilloma Virus (HPV) 6 and 11 cause

A

Anogenital warts

  • “thickened cauliflower epithelium”
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29
Q

Human Papilloma Virus (HPV) 16 and 18 cause

A

Cervical cancer

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30
Q

Vaccinations for HPV

A

Gardasil: 6, 11, 16, 18

  • Females 11-13
  • MSM
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31
Q

Treatment for Genital warts

A
  • Podophyllotoxin cream
  • Imiquimod cream
  • Cryotherapy
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32
Q

Trichomonas Vaginalis is a

A

protazoal parasite

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33
Q

Trichomonas vaginalis presentation

A
  • Purulent green frothy vaginal discharge
  • Musty odour
  • Itchy
  • Strawberry spots “strawberry cervix”
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34
Q

Investigations for Trichomonas vaginalis

A

High vaginal swab for microscopy

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35
Q

Treatment for Trichomonas vaginalis

A

Metronidazole

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36
Q

Candida Albicans is a

A

fungal infection

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37
Q

Candida albicans presentation

A
  • White discharge like “cottage cheese”
  • Intense itch
  • Common in immunocompromised or diabetics
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38
Q

Investigations for Candida albicans

A

HVS for culture

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39
Q

Treatment for candida albicans

A

Oral fluconazole

Topical Cotrimazole

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40
Q

Phthirus Pubis are

A

pubic lice

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41
Q

Treatment for pubic lice

A

Malathion lotion

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42
Q

Investigations for HIV

A
  • 3rd gen: IgM and IgG antibodies = sensitive after 3 months
  • 4th gen: p24 antigen = sensitive after 1 month
  • Rapid HIV fingerprick testing
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43
Q

Gardnerella vaginalis causes

Coccobacilli

A

Bacterial vaginosis

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44
Q

Presentation of bacterial vaginosis

A
  • Thin watery discharge
  • Stinks of fish (due to hydrogen peroxide)
  • pH of vagina is > 4.5
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45
Q

Investigation for bacterial vaginosis

A

HVS for microscopy

  • Clue cells can be seen
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46
Q

Treatment for bacterial vaginosis

A

Metronidazole

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47
Q

Normal vaginal flora

A

Lactobacillus

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48
Q

Risks of contracting HIV

A
  • Black
  • IVDU
  • MSM (anoreceptive especially)
  • Vaginal delivery (25%)
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49
Q

In pregnancy with HIV mothers should

A
  • Opt for C-section if high viral load
  • Never breastfeed
  • Mothers should take HAART indefinitely
  • Infants should take PEP for 4 weeks
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50
Q

Acute HIV infection

A

13 weeks

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51
Q

Viral replication for HIV

A

6-12 hrs

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52
Q

HIV reduces

A

CD4+ T cells

through CCRJ surface receptor, this makes the individual more susceptible to infection

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53
Q

Normal CD4+ count is

A

>500

Anything < 200 = infectinon risk

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54
Q

Treatment for HIV

A

HAART (Highly Active Antiretroviral Therapy)

  • Tenofovir: nucleoside reverse transcriptase inhibitors(NRTI)
  • Emtricitabine: nucleoside reverse transcriptase inhibitors(NRTI)
  • Efavirenz: non-nucleoside reverse transcriptase inhibitor (NNRTI)
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55
Q

Side effects of tenofovir

A

Nephrotoxic

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56
Q

Side effects of Efavirenz

A
  • Sleep disturbance
  • Mood disorders
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57
Q

Post Exposure Prophylaxis should be taken

A

within 72hrs for 28 days

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58
Q

Cancers that AIDS (acquired immune deficiency syndrome) increases risk of

A
  • NHL (EBV)
  • Cervical Cancer (HPV)
  • Kaposi’s Sarcoma (HHV8 herpes)
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59
Q

Infections AIDS increased risk of

A
  • Progressive Multifocal Lymphadenopathy (PML)
  • Pneumocystis Pneumonia
  • Cerebral toxoplasmosis- when <150 CD4+ toxoplasma gondi
  • Cytomegalovirus- when < 50 CD4+
  • TB
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60
Q

PML is caused by

A

John Cunningham virus

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61
Q

Pneumocystis Pneumonia is caused by

A

Pneumocystis jiroveci

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62
Q

Treatment for Pneumocystis pneumonia

A

Cotrimoxazole

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63
Q

Cerebral toxoplasmosis is caused by

A

toxoplasma gondi

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64
Q

Treatment for Toxoplasmosis

A

Pyrimethamine and Sulfadiazine

or cotrimoxazole

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65
Q

TB is caused by

A

Mycobacterium Tuberculosis

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66
Q

Menstruation lasts

A

28 days

<21 days = Polymenorrhea

>35 days = Oliomenorrhea

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67
Q

Normal volume of blood per period (cycle)

A

80ml

Any more than this (and for an extended period of time) is considered menorrhagia

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68
Q

Peak bleeding occurs

A

1-2 Days in

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69
Q

No periods in > 6 months is

A

amenorrhoea

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70
Q

Menometrorrhagia

A

Spotting between periods

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71
Q

Menstrual cycle is split into two phases divided by ovulation

A
  • Follicular phase (starts at day 1)
  • Menstrual stage
  • Proliferative stage
  • Ovulation (day 14)
  • Luteal phase (ends at day 28)
  • Secretory phase
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72
Q

Oestrogen is responsible for

A

Follicular phase

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73
Q

Progesterone is responsible for

A

Luteal phase

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74
Q

At ovulation, there is a

A

LH spike

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75
Q

Progesterone is secreted by

A

the corpus luteum

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76
Q

Progesterone peaks

A

7 days after ovulation

7 days before day 28

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77
Q

Fertility testing tests

A

Progesterone 7 days before end of period

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78
Q

Hypothalamus produces

A

GnRH

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79
Q

GnRH then stimulates

A

Anterior pituitary to produce LH and FSH

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80
Q

LH stimulates

A

Theca cells to produce androgens

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81
Q

FSH stimulates

A

granulosa cells to convert androgens to oestrogen

(by aromatase)

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82
Q

Oestrogen then goes on to

A

proliferate endometrial growth

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83
Q

A women is most fertile on

A

days 12, 13, 14

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84
Q

In males LH stimulates

A

Leydig cells to produce testosterone

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85
Q

In males FSH stimulates

A

sertoli cells to enhace spermatogenesis

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86
Q

Anti-mullerian hormone is used to measure

A

Ovarian reserve (levels of oocytes)

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87
Q

B-hCG (Human chorionic gonadotrophin)

A
  • Secreted by syncytiotrophoblasts (early placenta structure)
  • Is used as a pregnancy test
  • Can also be very high in molar pregnancies, and ectopic pregnancies
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88
Q

Oestrogen increases

A

Breast development

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89
Q

Progesterone increases

A

breast tissue growth

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90
Q

Prolactin increases

A

mammary gland growth in breasts

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91
Q

Prolactin is inhibited by

A

dopamine

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92
Q

45 XO- missing an X

  • Only effects females
  • No pubic hair
  • Small breasts
  • Amenorrhea
  • Short stature
  • Webbed neck
A

Turner’s syndrome

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93
Q

47 XXY- extra X

  • Only males
  • Wide hips
  • Tall
  • Reduced facial hair
  • Female pubic hair
  • Testicular atrophy
  • Gynecomastia
A

Kleinfelter’s Syndrome

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94
Q

47 XXX

  • Tall
  • Low IQ
  • Reduced motor and speech development
A

Triple X

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95
Q

Menopause happens around

A

51

< 40 = premature
< 45 = early
> 54 = late

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96
Q

What can cause premature menopause

A
  • Past chemotherapy
  • Mumps
  • No oocytes (taken out in surgery etc)
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97
Q

Symptoms of Menopause

A
  • Hot flush
  • Mood swings
  • DUB
  • Decreased collagen = vaginal dryness
  • Weight gain
  • Osteoporosis
  • Increased LH and FSH
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98
Q

Treatment for menopause

A
  • 1st: HRT (oestrogen and progesterone) = COC
  • Can take just oestrogen if you have had a hysterectomy
  • Clonidine (Alpha agonist) for hot flushes
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99
Q

Oestrogen and desogestrel (type of progesterone)

A

Inhibit ovulation

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100
Q

All other progesterones

A

thicken cervical mucus

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101
Q

Combined Oral Contraceptive contains

A

Oestrogen and desogestrel (type of progesterone)

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102
Q

Method of COC

A

Inhibits ovulation

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103
Q

COC is useful for

A
  • Controlling acne
  • Controlling heavy bleeding
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104
Q

COC increases the risk of

A
  • Venous thromboembolism
  • Cervical cancer
  • Breast Cancer
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105
Q

COC is protective for

A
  • Ovarian cancer
  • Endometrial cancer
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106
Q

COC is contraindicated in

A
  • BMI > 35
  • Patients on PPIs (effects drugs)
  • Patients on Carbamazepine (effects drugs)
  • Migraines with Aura
  • 6 weeks post pregnancy
  • Thrombophilias
  • Immobile people
  • Smoking > 15/day
  • Past VTE
  • PHx of Breast cancer
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107
Q

Starting COC

A

Day 1-5: no need for additional contraception

Day 5+: Additional contraception for 7 days

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108
Q

Missed COC and no UPSI

A

1 pill: take ASAP
2 pills: take ASAP + additional contraception for 7 days

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109
Q

Missed pills and UPSI

A
  • Week 1: EC required
  • Week 2: EC required
  • Week 3-4: omit pill-free interval
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110
Q

Progesterone Only Pills

A

Old: Progesterones

New: Desogestrel

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111
Q

Old POPs method of action

A

Thicken cervical mucus

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112
Q

New POP

A

Inhibits ovulation

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113
Q

POP increases risk of

A

Breast cancer

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114
Q

If you miss a POP then

A
  • EC is required
  • Additional contraception for 2/7 days
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115
Q

Depo-Provera

A

IM Progesterone given every 12 weeks

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116
Q

Method of Depo-Provera

A
  • Inhibits ovulation
  • Thickens cervical mucus
  • Thins endometrium
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117
Q

Side effects of depo-provera

A
  • Weight gain
  • Decreased fertility for 3 months after stopping
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118
Q

Starting depo-provera

A

First 5 days

5 days + = additional contraception for 7 days

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119
Q

Intra-Uterine System (IUS)

“Mirena”

A

Hormonal coil containing progesterone

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120
Q

Method of IUS

A

Thins endometrium

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121
Q

IUS is used for

A

5 years

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122
Q

Starting IUS

A

Within first 7 days

7 days + = additional contraception for 7 days

  • Can start post pregnancy either <48hrs or after 4 weeks
  • Can start immediately after TOP
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123
Q

IUS is often used to give women

A

Lighter and less frequent periods

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124
Q

Implant

“Nexplanon”

A

Subdermal rod that contains progesterone

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125
Q

Method of implant

A

Inhibits ovulation

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126
Q

implant is used for

A

3 years

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127
Q

Start implant

A

First 5 days

First 5 days + = additional contraception

  • 5 days post TOP
  • < 21 days post-partum
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128
Q

Most effective contraceptive

A

Implant

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129
Q

Intra-Uterine Device (IUD)

A

Copper coil

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130
Q

Method of IUD

A

Toxic to sperm and egg

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131
Q

Start IUD

A

First 7 days

  • Can be used up to 120hrs post UPSI
  • <48hrs or after 4 weeks post pregnancy
  • Immediately after TOP
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132
Q

IUD lasts for

A

5 years (sometimes 10)

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133
Q

What is required in a vasectomy

A
  • Contraception for 8 weeks
  • Post-procedure semen analysis to confirm
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134
Q

3 types of emergency contraceptives

A
  • Levonelle (oral)
  • EllaOne (oral)
  • IUD
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135
Q

Levonelle

A

Contains levonorgestrel (Increases progesterone)

Used up to 72 hours post-UPSI

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136
Q

EllaOne

A

Contains ulipristal acetate (blocks progesterone)

Used up to 120 hours post-UPSI

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137
Q

When taking Emergency contraception you must

A
  • Repeat dose if you vomit (for orals)
  • Follow up pregnancy test in 3 weeks
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138
Q

Termination of pregnancy can happen

A
  • 23+6 weeks for social TOP
  • Any time for an anomaly/ emergency
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139
Q

Medical TOP

A
  • Early (< 9 weeks)

Mifepristone + Misoprostol

  • Late (9-12 weeks)

Mifepristone + Prostaglandins (3 hourly)
No more than 5 in 24hrs
* Mid-trimester (12-24 weeks)

Mifepristone + Prostaglandins (3 hourly)​
No more than 5 in 24hrs

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140
Q

Mifepristone

A

Used to terminate pregnancy

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141
Q

Misoprostol (synthetic prostaglandin) + prostaglandins

A

Push foetus out

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142
Q

Surgical TOP

A
  • 6-12 weeks = Vacuum aspiration
  • 12-24 = Dilatation and Excavation
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143
Q

During Surgical TOP

A
  • Fit with IUD/IUS
  • If woman is rhesus negative then give Anti-D within 72hrs
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144
Q

After TOP

A

follow up with pregnancy test 2-3 weeks later

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145
Q

Due to testosterone and Mullerian inhibiting factor in males

A

Wolffian ducts will become the reproductive tract
Mullerian ducts will degenerate

“Wolffian = male alpha like wolf”

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146
Q

In females

A

Mullerian tracts will become the reproductive tract

Wolffian ducts will degenerate

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147
Q

a condition in which one or both of the testes fail to descend from the abdomen into the scrotum

A

Cryptorchidism

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148
Q

Cryptorchidism increases your risk of

A

testicular cancer

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149
Q

Treatment for Cryptorchidism

A

Orchidopexy

(Moving testicles from abdomen into scrotum)

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150
Q

Androgen Insensitivity syndrome

A

Genetically male (XY) but is resistant to male hormones

  • Symptoms don’t appear until puberty
  • Phenotypically is female
  • Undescended testes
  • X-linked recessive
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151
Q

Imperforate hymen can cause

A
  • Amennorrhea
  • Abdominal pain
  • Usually presents around time of menarche
  • Normal breast development
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152
Q

Normal testicular size

A

12-25ml

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153
Q
  • Primary amenorrhea
  • Undefined sexual characteristics
  • Small testicle volume

Low LH and FSH

No sense of smell (anosmia)

A

Kallman’s syndrome

(hypogonadotropic hypogonadism)

  • Failure to produce GnRH
  • Failure to start puberty
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154
Q

High GnRH

Low FSH/ LH

Low oestrogen

A

Pituitary dysfunction

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155
Q
  • Non-functioning pituitary
  • Post-partum haemorrhage
A

Sheehan’s Syndrome

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156
Q

Reasons for infertility in men

A
  • CF
  • Hypogonadism (Kleinfelters etc)
  • Cryptorchidism
  • Testicular tumour
  • Due to previous chemo/radio therapy
  • Vasectomy
  • Drugs
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157
Q

Reasons for infertility in women

A
  • PID
  • PCOS
  • Structural damage etc
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158
Q

For a couple to try IVF they need to have been trying for a baby for

A

2 years

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159
Q

Drug treatments in IVF

A
  • GnRH agonist (buserelin) used to down regulate cycle
  • FSH and LH given 36 hours prior to implantation
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160
Q
  • Rapid weight gain (15kg in 10 days)
  • Decreased urine output
  • Abdominal pain
  • Shortness of breath
  • Vomiting/ nausea
  • Tight abdomen
A

Ovarian Hyperstimulation Syndrome

(Increased GnRH (from IVF medication) causes extensive luteinization ant release of VEGF, causing leaky vessels and hypovolaemia)

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161
Q

Small white mucus-filled cyst on the cervix

A

Nabolthian cyst

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162
Q

Cervical polyps

A
  • Benign tumours
  • Usually asymptomatic
  • Tx: - take them out
163
Q

Clear, non-smelling vaginal discharge

A

Cervial ectropion

(completely normal)

164
Q

Cervical cancer screening

A
  • Starts age 25
  • Every 3 years until 50
  • Then every 5 years until 64
165
Q

Inside the cervix is

A

columnar (secretory tissue)

166
Q

Outside the cervix is

A

Squamous

167
Q

In cervical cancer HPV 16, 18

A

block p53 (tumour suppressor)

168
Q

Risk factors for Cervical cancer

A
  • Early reproductive age
  • Many partners
169
Q

Koilocytes

A

Cells infected by HPV

(peri-nuclear halos)

170
Q

CIN1

A

1/3 (basal)

171
Q

CIN2

A

(2/3)

172
Q

CIN3

A

Full thickness

173
Q

If smear is inadequate then

A

repeat

174
Q

If smear is inadequate 3 times then

A

Colposcopy

175
Q

Low-grade dyskaryosis

A

repeat smear (6 months)

176
Q

If smear is abnormal or HPV positive

A

colposcopy and biopsy

177
Q

High grade dyskaryosis

A

Urgent colposcopy and biopsy

178
Q

CIN 1

A

repeat biopsy in 6 months

179
Q

CIN 2/ CIN3

A

LLETZ

Laser ablation

Cryotherapy

180
Q

Test for cure

A

Smear and HPV test

181
Q
  • Middle aged
  • Bleeding post sex, during cycle
  • Brown/ blood discharge
  • Pelvic pain
A

Cervical Cancer

  • Squamous cell carcinoma (majority)
  • Adenocarcinoma (glandular) - minority
182
Q

Staging for Cervical Cancer

A
  1. Confined to cervix (a= microscopic, b= visible)
  2. Local extension to adjacent organs
  3. Involves pelvic wall
  4. Distant mets/bladder
183
Q

Stage 1a cervical cancer Treatment

A

Biopsy

184
Q

Stage 1b cervical cancer treatment

A

Radical hysterectomy

185
Q

Stage 2+ cervical cancer treatment

A

Radiotherapy

Chemotherapy (Cisplatin)

186
Q

Vulvar intraepithelial neoplasia (cancerous warts on/in vagina)

A

Found in old woman most commonly

187
Q
  • Ivory-white plaques
  • Patches with glistening surface on vulva
  • Redness
  • Itching
A

Lichen scelrosus of vulva

188
Q
  • Glandular cancer (slow growing)
  • Crusting rash
  • Red, velvety area with white islands of tissue on the vulva
  • Post menopausal
  • To do with apocrine glands
A

Vulvar Paget’s Disease

189
Q

Uterine prolapse
Descent of uterus into the vagina

A
  • 1st degree: Cervix remains in vagina
  • 2nd degree: Cervix at vaginal orifice
  • 3rd degree: Cervix is outside the vagina
  • Uterine procidentia: Entirely outside the vagina
190
Q

Vaginal prolapse

Herniations of other pelvic organs through vagina wall

A
  • Cystocele (anterior)- bladder
  • Enterocele (middle/apical)- intestines
  • Rectocele (posterior)- rectum
191
Q
  • Pelvic lump
  • Dragging sensation
  • Incontinence
A

Prolapse

192
Q

Prolapsed uterus/vagina management

A
  • Weight loss / stop smoking
  • Pessaries
  • Sacrospinus fixation surgery
193
Q
  • Increased B-hCG
  • Grape-like clusters
  • Chorionic villi
  • Nausea and vomiting
  • Large mass in uterus
A

Molar pregnancy

194
Q

Snowstorm appearance on abdominal USS

A

Molar pregnancy

195
Q

Partial mole

A

1 egg and 2 sperm

196
Q

Egg with no DNA and 1 or 2 sperm

A

Complete mole

197
Q

Endometrial hyperplasia

A
  • >4mm post menopause
  • >16mm pre menopause
198
Q

Treatment for endometrial hyperplasia

A

IUS

Severe: Dilation and curettage

199
Q

Investigations for AUB bleeding

A

TVUS

200
Q

Endometritis

A
  • Abnormal bleeding
  • Fever
  • Abdo pain
201
Q

Uterine fibroids

A

Benign smooth muscle tumour in uterus

Leiomyoma

202
Q

Uterine fibroids presentation

A
  • Afrocarribean woman
  • Menorrhagia
  • Uterine mass
  • Pain
  • Infertility
  • Red degeneration pain of fibroid dying
203
Q

Treatment for uterine fibroids

A
  • Mirena
  • Hysterectomy

bed rest and analgesia for Red degeneration pain

204
Q

Adenomyosis

A

Endometrium is in the myometrium

205
Q

Risk factors for endometrial carcinoma

A
  • Oestrogen
  • PCOS
  • Lynch Syndrome
206
Q

Endometrial carcinoma staging

A
  1. Confined to uterus
  2. Cervical involvement
  3. Ovaries/tubes involvement
  4. Other organs invovled
207
Q

2 types of endometrial carcinomas

A
  • Endometrioid
  • Serous
208
Q

Endometrioid Carcinoma

A
  • Oestrogen driven
  • Endometrial hyperplasia is precursor
  • good prognosis
209
Q

Serous carcinoma

A
  • p53 driven
  • Worse prognosis
210
Q

Post menopause bleeding

A

Endometrioid cancer

211
Q

Treatment for Endometrioid and Serous Carcinomas

A

Hysterectomy and bilateral salpingo-oophrectomy

+ Radio/ chemo if needed

212
Q

Treatment for endometriosis

A
  • 1st: COC / Mirena
  • 2nd: GnRH agonist
  • Laparoscoptic ablation
213
Q
  • Dysmennorrhoea
  • Menorrhagia
  • Dyspareunia
  • Painful defecation
  • Pelvic pain is CYCLICAL
A

Endometriosis

Endometrial glands occur anywhere outside uterus, free blood causes irritation and fibrosis

214
Q

Treatment for painful periods

A

Mefenamic acid and ibuprofen

215
Q

Treatment for heavy period bleeding

A

Tranexamic acid

216
Q

Ovarian cysts

A
  • Follicular
  • Luteal
  • Endometriotic
217
Q

Chocolate cysts

A

Endometriotic cysts

218
Q
  • Amenorrhea
  • Obese
  • Insulin resistance- Diabetics
  • Hyperandrogenism- hirtuism, acne
  • Increased testosterone
  • Increased LH:FSH ratio (LH is massive, FSH normal)
  • Enlarged follicular cysts (>10ml) on USS
A

Polycystic ovarian syndrome

219
Q

Treatment for PCOS

A
  • Weight loss
  • Not wanting family: COC + metformin (to increase insulin resistance )
  • Wanting family: Clomifene citrate (ovarian stimulant) + metformin
220
Q

Risk factors of Ovarian cancers

A
  • BRCA 1/2
  • HNPCC gene (Lynch Syndrome)
  • Age
  • Late Menopause
  • Nulliparous
221
Q

3 subtypes of ovarian cancers

A
  • Epithelium: Serous, endometrioid, mucinous, clear cell
  • Germ cell: Teratoma (dermoid cyst)
  • Stroma: Granulosa cell, theca/leydig cell, fibroma
222
Q

Symptoms of ovarian cancer

A
  • Mass/swelling bloating
  • Decreased appetite
  • Urinary incontinence
  • Fatigue, malaise
  • Leg oedema
  • Similar presentation to IBS
223
Q

Yellow cyst means

A

benign

224
Q

Most common ovarian cancer

A

Serous

225
Q
  • Most common cancer <25
  • Produces T3 sometimes
  • Contains bones, teeth, fat etc
A

Teratoma (dermoid cyst)

226
Q

Oestrogen producing ovarian tumour

A

Granulosa

227
Q

Androgen producing ovarian tumour

A

Theca/leydig cell

228
Q
  • Ovarian tumour
  • Ascites
  • Pleural effusion
A

Meig’s syndrome

229
Q

Lynch syndrome

A
  • Colorectal cancer
  • Endometrial cancer
  • Ovarian cancer
  • More cancers
230
Q

Lynch Syndrome gene

A

HNPCC

231
Q

CA-125

A

Indicates ovarian cancer (serous)

232
Q

Treatment for Ovarian cancer

A

Surgery to remove + chemotherapy

233
Q

Ovarian cancers drain towards

A

Para-aortic lymph nodes

234
Q

Ovarian Cancer Staging

A
  1. a) 1 ovary b) 2 ovaries
  2. Invaded close by structures
  3. Invaded lymph nodes
  4. Distant
235
Q

Uterine cancers (fundus) drain to

A

Para-aortic lymph nodes

236
Q

Cervical cancer drains to

A

internal iliac nodes

237
Q

Levator ani is supplied by

A
  • Pudendal nerve (S2, 3, 4, 5)
  • Nerve to levator ani (S3, 4, 5)
238
Q

Pelvic pain line

A

Levator ani

239
Q

Supply to above the pelvic pain line

A
  • Visceral (Superior)- touching peritoneum
  • Sympathetics (T11-L2)
  • Visceral (Inferior)- not touching peritoneum
  • Parasympathetics (S2,3,4)
240
Q

Supply to below the pelvic pain line

A

Somatic: Pudendal nerve (S2, 3, 4)

241
Q

Spinal anaesthesia blocks

A

All 3 areas that supply the pelvis

242
Q

Pudendal nerve block is administered at

A

Ischial spine (4 or 8 o’clock)

243
Q

Spinal anaesthesia and Epidural are administered at

A

L3/4

244
Q

Epidural is administered in

A

epidural space

245
Q

Spinal anaesthesia is administered in

A

Subarachnoid space into CSF

246
Q

In pregnancy the placenta produces

A

Corticotropin-releasing hormone (CRH)

247
Q

CRH then stimulates

A

ACTH production in the pituitary

248
Q

ACTH then stimulates the production of

A
  • Aldosterone from zona glomerulosa
  • Cortisol from zona reticularis
249
Q

In pregnancy aldosterone

A

Increases blood pressure- causing pre-eclampsia

250
Q

In pregnancy cortisol

A

causes oedema and insulin resistance- gestational diabetes

251
Q

1st trimester

A

up to 12 weeks

252
Q

2nd trimester

A

28 weeks

253
Q

3rd trimester

A

40 weeks

254
Q

In the first trimester

A

BP decreases, HR increases

255
Q

Premature dates

A
  • Extreme pre-term: 24-28 weeks
  • Very preterm: 28-32 weeks
  • Preterm: 32-37 weeks
  • Term: 37-40
256
Q

Oestriol is a measure of

A

Foetal vitality

257
Q

At every pregnancy appointment check

A
  • Fundal height
  • BP
  • Proteinuria
  • Psych evaluation
258
Q

Screenings at 10 weeks

A
  • Booking visit with midwives
  • First blood tests
  • Urine culture
259
Q

Screenings at 10-13 weeks

A

Booking scan

260
Q

Screening at 11-13 weeks

A
  • Down Syndrome Scan (nuchal translucency)
261
Q

Screening at 16 weeks

A

Check for proteinuria

262
Q

Screening at 18-20 weeks

A

Anomaly scan

263
Q

Screening at 28 weeks

A
  • Second screening for anaemia + RBC alloantibodies
  • First Anti-D prophylaxis
264
Q

Screening at 34 weeks

A

Second Anti-D prophylaxis

265
Q

Screening at 36 weeks

A

External cephalic version

266
Q

Healthy Start Scheme Vitamins

A
  • Folic acid 400 micrograms
    (12 weeks before and after conception)
    5mg for Diabetics/ Epileptics
    Prophylaxis against neural tube defects
  • Vitamin D 10 micrograms
  • Vitamin C 70mg
267
Q

Take Vitamin C if you have

A

CF

Beware as it is teratogenic

268
Q

Food/behaviours to avoid in pregnancy

A
  • Delhi foods, cheese, tune, pate, liver, raw eggs
  • Alcohol
  • Smoking
    *
269
Q

Extra calories needed in pregnancy

A

250

270
Q

Breastfeeding should be encouraged for

A

6 months - 1 year

271
Q

Hyperemesis Gravidarum “Morning Sickness”

A
  • 1st trimester
  • Extreme sickness and vomiting
  • Loss in weight and reduced liver function
  • Caused by B-hCG
272
Q

Treatment for Hyperemesis Gravidarum

A

Cyclizine

Prochlorperazine

273
Q

Gestational Diabetes

A
  • Increase in insulin due to the increased exposure to glucose
  • Can lead to macrosomia, organomegaly, polyhydramnios

Tx: Decrease sugar intake immediately

274
Q

Pre-Eclampsia

A

HTN and proteinuria in pregnancy

  • 140/90 twice or 160/110 once after 20th week gestation
  • Oedema
  • Proteinuria >0.3g/l
275
Q

Notch sign on umbilical cord artery is a predictive sign of

A

Pre-eclampsia

276
Q

Prophylactic treatment for pre-eclampsia

A

Aspirin from week 12 onwards

277
Q

First line treatment for Pre-eclampsia

A

Labetalol

Contraindicated in asthmatics- use nifedipine

278
Q

Eclampsia is

A

Pre-eclampsia and a seizure

279
Q

Treatment for Eclampsia

A

Delivery baby via C-section

  • Magnesium sulphate (to control seizure)
  • If seizure persists then Diazepam

Post-partum (after delivery): use sytoncinin (oxytocin) to contract uterus

280
Q

Oxytocin causes

A
  • Uterine contractions
  • The uterine to fully contract in on itself after delivery
  • Bonding between mother and child
281
Q

Ergometrine

A

Contracts uterus

causes HTN

282
Q

Haemolysis

Elevated

Liver enzymes

Low

Platelets

A

HELLP Syndrome

Happens in some cases of pre-eclampsia

  • RUQ pain
283
Q

Braxton Hicks Contractions

A

Pre-labour contractions that train your uterus for labour

284
Q

Latent phase of Labour

A
  • 4-10cm dilated cervix
  • mild irregular contractions
  • last around 10s
285
Q

Active phase of labour

A
  • 4-10cm dilated cervix
  • foetus descends
  • rhythmic contractions 3-4 within 10 mins
  • last 45 seconds
286
Q

Second phase of labour

A
  • 10cm until delivery
  • Nullparis women (<2hr)
  • Multiparis women (<1hr)

If women have had an epidural then expect to add 1 hr

287
Q

Third phase of labour

A
  • Delivery until expulsion of the placenta
  • 5-10 mins (<30mins)
  • Active management: give syntometrin
288
Q

Syntometrin

A

Oxytocin and ergometrine

289
Q

Bishop’s Score

  • Dilated
  • Effacement (thin/ripe cervix)
  • Position
  • Station
  • Consistency (soft cervix)
A

Means it is safe to induce labour

  • <3 = induction will be unsuccessful (C-section)
  • < 5 = need induced
  • 9+ = labour will be spontaneous (normal)
290
Q

During labour

A

Oestrogen increases

Progesterone decreases

291
Q

The foetus secretes ACTH to the mother to produce

A

oxytocin which helps induce contractions

292
Q

Hyaluronic acid is responsible for

A

softening the cervix

293
Q

As progesterone decreases during labour

A

Prolactin increases

294
Q

Pelvic inlet

A

Transverse is wider than AP diameter

295
Q

Pelvic Outlet

A

AP is taller than the transverse width

“because P comes out”

296
Q

At the Pelvic inlet the baby’s head is

A

transverse and in line with the ischial spines

297
Q

After head is transverse and in line with ischial spines

A

Engagement

You can only feel 2/5ths of the baby’s head
(The rest is inferior)

298
Q

After engagement comes

A

Flexion of the neck (chin on chest)

299
Q

After flexion of the baby’s head in labour comes

A

Internal rotation

300
Q

After internal rotation comes

A

Extension of the neck at pelvic outlet

(Occipitoanterior)
“Baby’s hair is at pubic pair”

301
Q

After extension of the neck comes

A

Crowning of the baby’s head

302
Q

After crowning comes

A

external rotation when the head is fully out

303
Q

External rotation allows

A

posterior shoulder to be delivered first

304
Q

Once fully delivered you should

A
  • Allow skin to skin contact
  • Delay cord clamping for 3 mins (5 mins in premature)
305
Q

CTGs

A 
# Define 
Risk = Low/high?

Contractions: regular? how many in 10mins

Baseline
RAte: 110-160 HR?
Variation: 10-15bpm is goal
Accelerations: >15bpm
Decelerations: Early = fine, late = bad
Overall thoughts

306
Q

If there is failure to progress then do a USS doppler

A
  • Every 15 mins during active phase
  • Every 5 mins during second phase
307
Q

Treatment for pain in labour

A
  • Nitrous oxide (Entonox)
  • Pethidine injection (opioid)
  • Epidural
308
Q

Breech presentation management

A
  • Complete (2 feet down): C-section
  • Footling (1 foot down): C-section
  • Frank (bum down): External cephalic version at 36 weeks
309
Q

Transverse presentation management

A

C-section

310
Q

OP presentation management

A

C-section

311
Q

OA presentation management

A

Normal delivery

312
Q

3 P of foetal distress

A
  • Power: Contractions
  • Passage (shape of pelvis)
  • Passenger (wrong position)
313
Q

To increase contractions give

A

Syntocin (oxytocin)

314
Q

Normal Pelvis

A

Gynaecoid pelvis

315
Q

Pelvis with large AP length

“Easter egg-shaped”

A

Antrhopoid

316
Q

Triangle/heart shaped

A

Android shaped

“Androids do have hearts!”

317
Q

pH >7.25 in labour is

A

expected

318
Q

pH <7.2 is

A

C-section immediately

319
Q

If foetus is distressed

A
  • Stop syntocin (contractions)
  • Give terbutaline (stops contractions)
320
Q

If a baby is born pre-term give them

A
  • Steroids for lung maturation
  • Magnesium sulphate for neuro protection
321
Q

Types of Antepartum Haemorrhage (APH)

A
  • Miscarriage
  • Ectopic Pregnancy
  • Molar pregnancy
  • Chorionic haematoma
  • Placenta previa
  • Placenta accreata
  • Vasa previa
  • Placentra abruption
  • Uterine rupture
322
Q

Miscarriage presents with

A

More blood than pain

323
Q

Types of miscarriages

A
  • Missed
    (OS closed + no bleeding + no foetal HR/ empty sac)
  • Threatened
    (OS Closed + vaginal bleeding + foetal HR)
  • Inevitable
    (OS open + bleeding + products above OS)
  • Incomplete
    (OS open + bleeding and some products in vagina, some remain in uterus)
  • Complete
    (OS open + bleeding + all products in vagina)
324
Q

Ectopic pregnancy

A

More pain than blood

Shoulder and abdo pain (usually specific to one side)

325
Q

Ectopic pregnancy investigations

A
  • B-hCG is raised
  • USS shows empty sac
  • If ruptured: whirlpool effect
326
Q

Treatment of Ectopic pregnancy

A

Surgery (salpingectomy)

327
Q

Chorionic Haematoma

A
  • The pooling of blood between the chorion and the uterine wall
  • Self-resolving
  • Cramping pain
328
Q
  • Painless bleeding
  • Soft non-tender uterus
A

Placenta previa
Placenta is attached near OS

  • >2cm from os = vaginal delivery
  • <2cm from os = C-sectiom
329
Q

In placenta previa do not do

A

vaginal exam

330
Q

Investigations for AHP

A

TVUS

331
Q

Placenta accreta

A

Placenta is attached too deeply (into the myometrium)

  • Risk of severe bleeding when placenta is expelled at delivery
332
Q

Treatment of placenta accreta

A

Internal iliac balloon

333
Q

Vasa previa

A
  • Cord is overlying the OS
  • Painless bleeding
  • Has usually had a C-section in the past
334
Q

Treatment for Vasa Previa

A
  • C-section at 35-36 weeks
  • Admit at 32 weeks and give steroids
335
Q

Placental abruption

A

Placenta becomes detached from uterus

  • Sudden severe pain
  • ‘woody’, hard and tender uterus
  • vaginal bleeding
336
Q

Uterine wall rupture

A
  • Loss of contractions
  • Abdo pain and shoulder tip pain
  • Very tender
  • Collapsed patient
  • Excessive vaginal bleeding
337
Q

Classification of APH

A
  • <50ml: Minor
  • 50-1000ml: Major
  • >1000ml: Massive
338
Q

Classifications of Post-partum Haemorrhage

A
  • 500-1000ml : minor
  • >1000ml: Major
339
Q

Atonic uterus

A

Uterus won’t contract

Tx: Massage / oxytocin

340
Q

Sepsis in neonate is usually caused by

A

Group B strep

341
Q

Foramen ovale is between

A

Right atrium and left atrium

Closes at birth due to the increased pressure of the left atrium

342
Q

Ductus arteriosis is from

A

Pulmonary artery to the aorta

Closes at birth due to O2 in lungs and reduces prostaglandins

343
Q

Persistent pulmonary hypertension of the newborn (PPHN)

A

Pulmonary hypertension that causes hypoxemia secondary to right-to-left shunting of blood at the foramen ovale and ductus arteriosus

  • Upper limb has 10% more O2% than Lower limb
344
Q

Transient tachypnea of the newborn (TTN)

A

Respiratory problem that can be seen in the newborn shortly after delivery. It is caused by retained fetal lung fluid due to impaired clearance mechanisms

  • Common in C-sections
345
Q

Potter’s syndrome

A

Baby is born without kidneys

Dies in womb or within a few days

346
Q

Hemorrhagic disease of the newborn

A

Deficiency in Vitamin K

Tx: Vitamin K

347
Q

Meconium Ileus

A
  • Distention, pain
  • Common in CF

Tx: Enema or surgery

348
Q

Necrotising Enterocolitis

A

Leaky bowel wall

Tx: Antibiotics

349
Q

Phenylketonuria (PKU) is screened for at birth with

A

Guthrie card

350
Q

APGAR

A
  • Activity
  • Pulse
  • Grimace
  • Appearance
  • Respiration
351
Q

Normal healthy weight of a newborn

A

2.5-4kg

352
Q

Jaundice in newborn

A

<24hr : bad

>24hr: physiological

Can be prolonged for 2 weeks

3 weeks in preterms

353
Q

Neonates HR

A

100-160

354
Q

Neonate Resp Rate

A

40-60

355
Q

Neonate SpO2

A

>90%

356
Q

Neonate temperature

A

36.5 - 37.4

357
Q

Neonate BP

A
  • Term: 70/40
  • Pre-term: 45-60/30
358
Q

Small gestational age

A

<10th centile

359
Q

Investigations (USS doppler)

A

C-section at

  • ​Abnormal: 24-32 weeks
  • Normal: 32-37 weeks
360
Q

Large for gestational height

A

>2cm fundus height above predicted

361
Q

Gestational Diabetes Investigations

A

HbA1c: >6.5% is good

362
Q

Macrosomia

A

>90th centile

Inv: OGTT

363
Q

DCDA Twins

A

Dichorionic Diamniotic

Split day 1-3

364
Q

MCDA Twins

A

Monochorionic Diamniotic

Split days 4-8

365
Q

MCMA

A

Monochorionic Monoamniotic

Split days 8-12

366
Q

Conjoined twins

A

Split Day 13

367
Q

Polyhydramnios

A

Overproduction of amniotic fluid

Tx: Amniocentesis
Indomethacin

368
Q

Breast Pathology

A
  • Fibroadenoma
  • Fibroadenosis (Fibrocystic change)
  • Mammary Duct Ectasia
  • Duct Papilloma
  • Fat necrosis
  • Breast Abscess
  • Galactocoele
  • Mastitis
  • Sclerosing adenosis
  • Cyclical Breast Pain
  • Breast Cancer
369
Q
  • Grey/white
  • Mobile
  • Small
  • Non-tender
  • < 30s
  • Afro-carribean
A

Fibroadenoma

Tx: >3cm then excise

370
Q
  • Painful
  • Lumpy breasts
  • Middle-aged
  • Worse prior to menstruation
A

Fibroadenosis

  • Tx: Reassure or sometimes take out
  • Danazol- for pain (antioestrogen)
371
Q
  • Green discharge
  • Common around menopause
  • Lump around areola
  • Smoker
A

Mammary Duct Ectasia

Dilatation of large breast ducts

Staph aureus, Step pyogenes

372
Q
  • Middle-aged
  • Blood stained discharge
  • Sub-areolar duct proliferation
A

Intraduct Papilloma

373
Q
  • Obese
  • Hard irregular lump
  • Follows trauma
  • Yellow swelling
  • “Foamy macrophages” on biopsy
  • On warfarin
A

Fat Necrosis

374
Q
  • Ret, hot and tender collection of pus
  • Breastfeeding
A

Breast abscess

Usually due to Staph Aureus

375
Q
  • Painless lump
  • Milk filled cyst
A

Galactocele

Self limiting

376
Q

Painful, red, swollen breast from breastfeeding

A

Mastitis

Tx: Reassure and continue to breastfeed + Flucloxacillin

(if penicillin allergic then erythromycin)

377
Q

Cyclical Breast pain

A

Unknown cause

Tx: Bromocriptine (inhibits prolactin)

Cabergoline

378
Q

Sclerosing adenosis

A

Benign, disordered proliferation of acini and stroma that can cause a mass or calcification

379
Q

Gynaecomastia

A

enlargements of a man’s breasts

Tx: Tamoxifen

380
Q
  • Change in size or colour of breast
  • Nipple dimple
  • Lump
  • Clear or bloody discharge
  • Nipple change (pulling)
A

Breast Cancer

381
Q

Types of Breast Cancer

A
  • Invasive ductal carcinoma
  • Invasive lobular carcinoma
  • Medullary breast cancer
  • Mucinous (mucoid or colloid) breast cancer
  • Tubular breast cancer
  • Adenoid cystic carcinoma of the breast
  • Metaplastic breast cancer
  • Lymphoma of the breast
  • Basal type breast cancer
  • Phyllodes or cystosarcoma phyllodes
  • Papillary breast cancer
382
Q

Most common type of Breast Cancer

A

Invasive ductal carcinoma

383
Q

Lobular carcinoma

A
  • High risk of both breasts getting invaded
  • Epithelial cadherin protein problem
  • CDH1 gene
384
Q

Phyllodes tumours are

A

benign

  • Look like a leaf
385
Q

Paget’s disease of the breast

A
  • Breast cancer on/below nipple
  • Eczema on nipple
386
Q

Unexplained breast symptom without pain >30

A

Urgent referral

387
Q

Aromatase

A

Produces oestrogen from fat

388
Q

Breast Carcinomas are

A

Adenocarcinomas

389
Q

Atypical lobular hyperplasia

A

<50% of lobe affected

390
Q

Lobular carcinoma in situ

A

> 50% of lobe affected

391
Q

Risk factors for breast cancer

A

Increased oestrogen

BRCA 1 or 2

392
Q

1st degree relative with breast

A

doubles the risk of breast cancer

393
Q

Post-mastectomy radiotherapy

A

Involvement of more than 3 nodes
Positive surgical margins
Tumours larger than 5cm

394
Q

Treatment for breast cancer if oestrogen receptor positive (ER+)

A

1st: Tamoxifen
2nd: Letrozole (aromatase inhibitor)- for postmenopausal women
3rd: Gosrelin (GnRH inhibitor)

395
Q

Treatment for breast cancer if HER2+

A

Trastuzumab (monoclonal antibody)

“Trust HER”

396
Q

Breast screening

A

Age 50-70

Mammogram every 3 years

(Mediolateral oblique and Craniocaudal)

397
Q

Investigations for breast cancer

A

< 40s: USS

> 40s: USS + mammogram

If USS is solid then Fine/core needle aspiration

398
Q

Mastectomy

A

Removes all breast tissue

399
Q

Lumpectomy

A

Breast conserving surgery

Leave a 1mm margin aim for 1cm

400
Q

Neoadjuvant therapy is used

A

Before surgery

401
Q

Adjuvant therapy is used

A

after surgery

402
Q

Breast staging

A
  • T0: In situ
  • T1: <2cm
  • T2: 2-5cm
  • T3: >5cm
  • T4: Cancer has spread to surrounding structures
403
Q

Mastectomy is used when

A

Lesion is >4cm

Finals Club (Dundee Medicine Master Summary Deck) (8 decks)

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