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Year 3 > Sexual And Reproductive Health > Flashcards

Sexual And Reproductive Health Flashcards

1
Q

Describe endometrial polyps

A

Benign outgrowths from the endometrium
Can see on transvaginal ultrasound
Usually small and asymptomatic that don’t require treatment
Symptoms include blood, pain and subfertility
Can be removed surgically without general anaesthetic

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2
Q

Describe fibroids and risk factors

A

Common Benign tumours of myometrium
Intramural (most common), submucosal (into uterus) and subserosal

Risk factors: older age, obesity, black, nulliparity

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3
Q

Symptoms of fibroids

A

Depends on type
Intramural and submucosal likely cause heavy bleeding, pain and infertility
Subserosal more likely to impede other organs and cause bladder and bowel symptoms
Heavy/painful periods, abdo pain, lower back pain, urinary frequency, constipation, painful sex

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4
Q

Pathology of fibroids

A

Firm, round, white tumour with a spiral (whorled) structure

Cells are long spindle muscle cells arranged in interlacing bundles

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5
Q

Management of fibroids

A

Asymptomatic don’t require treatment
Medications for bleeding
Ulipristal acetate or GnRH (short term) can shrink fibroids
Hysterectomy is gold standard if fertility not wanted
Resection may be possible if <4cm
Myectomy (removing it) difficult because of complicated blood supply but can be done if fertility needed

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6
Q

Describe adenomyosis

A

Endometrial tissue is found in myometrium
Typically occurs in older women (40s) who have had children, will stop after menopause
Presents with HMB and dysmenorrhea, uterus will be symmetrically enlarged and tender
Treatment = Mirena coil/ NSAIDS, hysterectomy

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7
Q

What HPV strains are most associated with cervical cancer?

A

16 and 18

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8
Q

What strains of HPV cause genital warts?

A

6 and 11

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9
Q

What is the precursor to cervical cancer that is asymptomatic but can be picked up on smear?

A

Cervical intraepithelial neoplasia (CIN) precursor to SSC (90%)

CGIN is precursor to adenocarcinoma which is harder to detect

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10
Q

Smear HPV positive but cytology negative, do you do a colposcopy?

A

No, recall in 12 months, only do colposcopy if 3 consecutive positives for HPV

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11
Q

Smear HPV positive, cytology positive. When do you do a colposcopy?

A

Low grade within 8 weeks

High grade within 4 weeks

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12
Q

Describe how you would visualise abnormal cells in a colposcopy

A

Abnormal cells contain more protein and less glycogen than normal epithelium
Apply acetic acid, abnormal cells appear white

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13
Q

Symptoms of cervical cancer

A 
Post coital bleeding
Foul smelling, watery discharged
Intermenstrual bleeding
Pelvic pain
Menorrhagia

If advanced: backache, leg pain, haematuria, weight loss, anaemia, bowel changes

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14
Q

Describe HPV vaccination

A

Girls and boys ages 12-13 as 2 doses 6 months apart
Quadrivalent for HPV types 6, 11, 16 and 18
70% protection against cervical cancer

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15
Q

What are the most common types of cancer in cervix and uterus

A

In cervix, it’s squamous cell carcinoma

In uterus, it’s adenocarcinoma

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16
Q

What week is the cut off for a miscarriage and stillborn?

A

Before 24 weeks = miscarriage

After 24 weeks = stillborn

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17
Q

Describe the differences between a threatened miscarriage, an incomplete miscarriage and a complete miscarriage

A 
Threatened = bleeding with closed cervix
Incomplete = blood and products located at open cervix
Complete = cervix is closed, all products have passed through into the vagina
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18
Q

Describe type 1 ovulation disorder

A
  1. Hypothalamic pituitary failure, not producing enough GnRH -> low LH and FSH
    Causes, stress, low BMI, too much exercise, head trauma, drugs
    Treatment is with modifiable factors and pulsatile GnRH pump or daily injections of LH and FSH
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19
Q

Describe type 2 ovulation disorder and treatment

A

Mostly PCOS
Hormone levels mostly normal or maybe high
Associated with obesity, T2DM, hypertension
Treatment 1st line is Clomifene on day 2-6 of cycle, or Letrozole
2nd line is GnRH injections but risks multiple pregnancies
3rd line is laparoscopic ovarian diathermy which risks ovarian damage

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20
Q

Describe type 3 ovulation disorder

A

Essentially menopause before age 40
LH and FSH raised but low oestrogens
Causes, Turner syndrome, chemo/radiotherapy, autoimmune
Cannot stimulate egg production
Treat with combined HRT and look into egg donor/ other child options

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21
Q

In pregnancy with does Human Placental Lactogen / human chorionic somatomammotropin (HPL/HCS) do?

A

Produced from week 5
Helps with growth - causes protein tissue formation
Decreases maternal insulin sensitivity so baby gets more glucose
Breast development

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22
Q

What does progesterone do during pregnancy?

A

Rises throughout
Development of decidual cells
Decreases uterus contractility
Helps prepare for lactation?

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23
Q

What do oestrogens do during pregnancy?

A

Rise throughout

Enlargement of uterus, breasts, relaxes ligaments to prepare for labour

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24
Q

What does Human Chorionic Gonadotrophin (HCG) do during pregnancy?

A

Prevents involution of corpus luteum
Sex development
Levels double every 48hrs in early pregnancy then fall at week 12-14

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25
Q

What cardiovascular changes happen during pregnancy?

A

Increase in HR by about 10-20bpm and rise in CO (30-50% more)
BP drops in 2nd trimester (approx. 15mmHg) then rises again
ECG changes, murmurs, extra heart sounds are all normal
All are exaggerated with multiple pregnancies

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26
Q

Describe pre-eclampsia

A

After 20 weeks of pregnancy, characterised by hypertension, proteinuria and oedema
Multi-system disease with diffuse vascular endothelial dysfunction

Stage 1 = abnormal placental perfusion cos of trophoblast invasion
Stage 2 = mum responds causing systemic disease

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27
Q

Symptoms of Pre-eclampsia

A

Hypertension
Proteinuria
Oedema

Headaches
Visual disturbances
Upper abdominal pain
Involuntary movements
N+V
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28
Q

What is eclampsia

A

Tonic clonic seizures on top of symptoms of pre-eclampsia

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29
Q

What is HELLP syndrome?

A

Crisis in pre-eclampsia

Haemolysis - cos of endothelial damage resulting in tiny thrombi which damage RBCs
Elevated liver enzymes
Low platelets

Symptoms of epigastric pain, N+V, jaundice
If over 34 weeks then deliver baby!

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30
Q

Broad ligament

A

Double layer of peritoneum separating uterus from lateral walls and floor of pelvis
Contains uterine tubes and proximal part of round ligament
Keeps uterus in midline position

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31
Q

Round ligament

A

Attaches to lateral part of uterus and the superficial tissue of perineum
Passes through DEEP inguinal ring
Is an embrylogical remnant of the gubernaculum

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32
Q

Why is sampled during a smear?

A

Squamocolumnar junction (transformation zone)

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33
Q

What is the nerve supply to levator ani muscles?

A

Sacral plexus S3, 4, 5 and pudendal S2, 3, 4

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34
Q

What levels do the breasts originate?

A

Rib level 2 - 6

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35
Q

What gives boobs movement separate from the pecs?

A

Retromammary space

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36
Q

Lymph supply to the breast

A

75% to axillary nodes leading to supraclavicular

Rest to parasternal nodes

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37
Q

Blood supply to breast

A

Medial mammary arteries from internal thoracic which is a branch of subclavian
Lateral mammary arteries from lateral thoracic artery which is a branch of axillary

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38
Q

Tunica vaginalis

A

Sac inside the scrotum that the testis and distal end of epididymis sit in
Where fluid collects with a hydrocele

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39
Q

Describe journey of sperm

A

Produced in seminiferous tubules
Pass to rete testis then head of epididymis
Epididymis becomes vas deferens
Vas deferens passes superiorly through the deep inguinal ring in the spermatic cord
Travels posteriorly over bladder and back down
Joins with duct from seminal glad to form ejaculatory duct
Left and right join together within prostate gland and drain into urethra

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40
Q

What helps control the temp of testis?

A

Dartos muscle

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41
Q

Describe the erectile tissue in penis

A

Left and right Corpus cavernosum which carries deep arteries of penis
Corpus spongiosum carries spongy urethra and expands to form glans of penis

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42
Q

Blood supply to penis and scrotum

A

Penis - Deep arteries of penis from internal pudendal from internal iliac
Scrotum - internal pudendal from internal iliac, and branches from external iliac

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43
Q

Pelvic diaphragm

A

Levator ani muscles = Puborectalis, pubococcygeus and iliococcygeus
+ Coccygeus muscle
(These are listed deep to superficial)

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44
Q

What type of epithelium is the nipple?

A

Thing, highly pigmented, keratinised stratified squamous epithelium

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45
Q

What happens to the breasts during the menstrual cycle?

A

In the luteal phase, epithelial cells increase in height and the lumina of the ducts become enlarged
There is a small amount of secretions but these are only detectable histologically

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46
Q

Describe fibrocystic changes to the breast

A

Benign
Caused by exaggerated responses to hormones
Mostly occurs in pre-menopausal women
Presents as lumpiness of the breast and is PAINFUL
Histology would show cysts with intervening fibrosis
Treatment: Rule out malignancy and reassure

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47
Q

Describe fibroadenoma

A

Commonest benign tumour of breast
Mostly young women
Presents as single small lump that is firm and mobile. PAINLESS
Histology would show connective tissue and epithelium
Treatment: Reassure, only remove if symptomatic

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48
Q

Describe fat necrosis of breast

A

Occurs due to trauma (seatbelt/surgery) or warfarin therapy
NEcrotic fat with lipid rich macrophages, giant cells and goes on to fibrosis
Can mimic carcinoma so need to rule that out
Generally goes away on its own

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49
Q

Describe duct ectasia of the breast

A

Chronic inflammatory condition associated with ectasia of ducts/cystic dilation
Often women who are peri-menopausal and smoking
Symptoms: Mostly affects sub-areolar ducts, painful, episodic changes, bloody/purulent discharge, fistulation, nipple retraction and distortion
Treatment: treat acute infections, exclude malignancy, smoking cessation, surgery if bad enough

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50
Q

Describe duct papilloma of the breast

A

Benign tumour of duct system (can happen anywhere but breast most common)
Solitary or multiple lumps, discharge from nipple which may be blood stained
Discharge will show benign epithelial cells
Treatment: Remove surgically and histologically examine as can develop cancer

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51
Q

What defects does a maternal rubella infection cause?

A

Microcephaly
Patent ductus arteriosus
Cataracts
Deafness

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52
Q

What maternal infection is the leading non-genetic cause for sensorineural deafness?

A

Cytomegalovirus
Risk higher in 1st trimester or if its primary infection
Refer to a specialist

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53
Q

What conditions does fetal parvovirus (slapped cheek) infection cause?

A 
Severe anaemia
Heart failure
Hydrops fetalis
High risk if before 20 weeks
Refer to specialist
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54
Q

Why are pregnant women more prone to UTIs

A

Progesterone causes sphincters to relax

Incidence of pyelonephritis is also increased.

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55
Q

Describe Ductal Carcinoma in Situ (DCIS)

A

Cells lining the ducts show malignancy but haven’t yet invaded the stroma
The focal calcification can be detected on mammogram
Can cause Paget’s Disease of the Nipple

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56
Q

Describe Paget’s Disease of the Nipple

A

Inflammatory eczema-like changes on nipple and maybe the surrounding areola
Caused by high grade DCIS that has extended along the ducts and is now at the nipple

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57
Q

How would you treat DCIS and Pagets?

A

Surgery probably with radiotherapy afterwards

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58
Q

Describe Infiltrating Ductal Carcinoma

A

Commonest form of breast cancer
Presents as firm hard lump
Microscope will show cords of tumour cells, dense collagenous stroma and occasional acinar formation

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59
Q

What is the most common benign breast tumour?

A

Fibroadenoma

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60
Q

Most common type of malignant breast cancer?

A

Infiltrating Ductal Carcinoma

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61
Q

Describe infiltrating Lobular carcinoma

A

10% of breast cancers
Possibly multifocal and/or bilateral
Microscope will show infiltration as single files of malignant cells

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62
Q

Risk factors for breast cancer

A

Prolonged oestrogen exposure (starting early, finishing late, never been pregnant)
Age
BRCA 1 and BRCA2
Smoking
Alcohol
Lack of exercise/obesity results in increased oestrogen

Breast feeding reduces risk as it inhibits menstruation

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63
Q

How does receptor status effect the prognosis of breast cancers?

A

Check oestrogen, progesterone and HER2 receptor status

ER+ and/or PR+, HER2- have the best prognosis

HER2+ but ER- and PR- have a poorer prognosis
Triple negative cancers have the worst prognosis

64
Q

How can you reduce the risk of ER+ cancers returning?

A

Anti-oestrogen therapy

If pre-menopausal, should given Tamoxifen for at least 5 years
Tamoxifen is an ER receptor antagonist

If post-menopausal, Aromatase inhibitors are thought to be better

65
Q

What type of breast cancers would trastuzumab and herceptin treat?

A

HER2+ cancers

They are a monoclonal antibody

66
Q

Why do mammograms take longer than other x-rays?

A

Low energy as high would not show breasts

67
Q

Screening programme for breast cancers

A

Ages 50-70 every 3 years

68
Q

How long after sex can a copper coil be used for contraception?

A

5 days

69
Q

Describe Nexplanon Implant

A

Progesterone only
Less hormonal side effects than oral cos it secretes a low an d stable level of hormones
Can cause prolonged bleeding

70
Q

Contraindication to POP

A

Current breast cancer

71
Q

POP: pill is more than 12hrs late, what to do?

A

Take missed pill even if it means taking 2 pills in one day

Use other contraception for next 2 days

72
Q

COCP: Missed 2 or more pills, what to do?

A

Take last missed pill, even if you take 2 in one day
Use extra contraception for next 7 days
May also need emergency contraception if this happened in the first week of a new pack

73
Q

Desogestrel is…

A

The progesterone only pill (POP)

74
Q

Contraindications for Depo injection?

A

The injections suppress oestrogen and so this can affect bone mass

  • > dont give to teens who are still building bone mass
  • > dont give close to menopause as theyll be losing bone mass
75
Q

Contraceptives suitable for someone on anti-epileptic drugs

A

IUS, IUD, DMPA (injections) and barriers

76
Q

2 most common clauses of Offenses against the person act that allow abortion

A

Clause C: 24 weeks gestational limit, risk of physical or mental health of pregnant woman and children/family

Clause E: No gestational limit, risk that child would be born with physical and mental abnormalities that they would be seriously handicapped

77
Q

Medical abortion

A

Mifepristone (progesterone antagonist) orally, followed by Misoprostol (prostaglandin) sublingually or vaginally
Misoprostol causes the uterus to contract and expel the pregnancy
May need more misoprostol if longer gestation

Low sensitivity pregnancy test 2 weeks after (HCG level wont have fallen yet so cant use normal ones)

78
Q

Pathogenesis of HIV

A

Infection of mucosal CD4 T helper cells and these transport virus to regional lymph nodes
-> permanent infection, virus infected CD4 cells enter blood stream
Infection is established within 3 days of entry
There is reduced circulation CD4 cells and proliferation of CD4 cells
-> reduced activation of CD8 cells
-> reduced antibody class switching
-> chronic immune activation

79
Q

Definition of AIDS-defining condition

A

Opportunistic infection: an infection caused by a pathogen that doesn’t normally produce disease in a healthy individual

80
Q

3 AIDS-defining cancers

A

Kaposi’s Sarcoma: vascular tumour caused by herpes virus
Non-Hodgkins Lymphoma: frequently extra-nodal, often involves the brain
Cervical Carcinoma: caused by oncogenic HPV, annual cervical screening needed

81
Q

Why is ano-receptive sex more likely to spread HIV?

A

More lymphoid tissue in rectum

Anal sex more likely to cause microabrasions

82
Q

Describe what you look for in HIV test

A

P24 antigen - not positive until 6 weeks of infection
Antibody not positive until 3 months after infection
-> can have HIV and test negative

83
Q

Treatment for candida infection

A

‘Azoles’
Topical clotrimazole pessary or cream (can get over-the-counter)
Or oral fluconazole
Non-albicans (5%) are more likely to be resistant to azoles, try topical nystatin

These treatments can damage latex condoms and stop spermicide from working so ned alternative contraceptives for 5 days after use

84
Q

Symptoms of candida infection

A 
Vulval itching/burning
Thick, white, vaginal discharge
External dysuria
Superficial dyspareunia
White curdy plaques seen on vaginal walls with speculum examination
85
Q

What does gonorrhoea look like microscopically?

A 
Gram negative (pink)
Diplococcus
86
Q

Symptoms of gonorrhoea in men and women

A

Men: Anterior urethritis with purulent discharge and dysuria

Women: increased vaginal discharge, dysuria, post-coital or intermenstrual bleeding and lower abdo pain

87
Q

Test for gonorrhoea and where to take swabs

A

NAAT (nucleic acid amplification tests) have better sensitivity than culture
Need to culture before giving any treatment cos antimicrobial resistance is really common

Men: first void urine or urethral swabs. MSM maybe need rectal or pharyngeal swabs
Women: vulvo-vaginal or endocervix swabs (FVU not as sensitive)

88
Q

Treatment for gonorrhoea

A

Need to culture and refer to SARH before any treatment given
IM ceftriazone possibly with azithromycin
Need follow-up “test of cure”

89
Q

Incubation period of gonorrhoea

A

Men: 2-5 days
Women: 2-14 days

90
Q

Most common STI in UK

A

Chlamydia

91
Q

Incubation period of chlamydia

A

7-21 days

92
Q

Symptoms of chlamydia in men and women

A

Women: increased vaginal discharge, dysuria, post-coital or intermenstrual bleeding
Men: urethritis with milky discharge and dysuria

93
Q

Test and swab area for chlamydia

A

NAAT test of choice
Men: first void urine or urethral swab
Women: vulvovaginal or endocervix swabs

94
Q

Treatment of chlamydia

A

7 days doxycycline, if cant take then use azithromycin instead
Recommend no sex for a week after treatment to prevent infecting others or re-infecting yourself

95
Q

Symptoms of bacterial vaginosis

A

Increased vaginal discharge with fishy odour and creamy texture, may be frothy
Raised vaginal pH (>4.5)

96
Q

How to diagnose bacterial vaginosis

A

Can be clinical diagnosis with symptoms and raised vaginal pH
Most accurate is by microscopy (clue cells on gram stained vaginal fluid)

97
Q

Bacterial vaginosis under microscope

A

Gram stained vaginal fluid will have clue cells

Clue cells are epithelial cells that have bacteria stuck inside them, usually gardnerella vaginalis

98
Q

Treatment of bacterial vaginosis

A

Metronidazole

99
Q

Test and swab for genital herpes

A

PCR test by swabbing deroofed blister

Serology igG only tells you if a person has ever been in contact with HSV (which most people have been)

100
Q

Treatment of genital herpes

A

Oral aciclovir

If painful can consider topical lidocaine, saline bathing or analgesia

101
Q

Test for syphilis

A

PCR tests or serological to look at antibodies in blood test
Doesnt gram stain and cant be grown
Can diagnose with dark field microscopy

102
Q

Treatment for syphilis

A

Long-acting penicillin injections
Even if someone is allergic you need to desensitize them first
Nothing else works as well

103
Q

Symptoms of primary stage of syphilis infection

A 
10-90 days after infection (usually 3 weeks)
Painless ulcers (primary chancre) that heal within 2-6 weeks, may go unnoticed
104
Q

Symptoms of secondary stage of syphilis infection

A 
6-10 weeks after primary chancre
Snail track ulcers
Red, non-itchy rash on palms and soles
Malaise
Generalised Lymphadenopathy
Anterior uveitis
Fever
Sore throat
105
Q

Contraindications to HRT

A

History of breast cancer, coronary artery disease, TIA or stroke
Unexplained vaginal bleeding
Active liver disease

106
Q

Who gets what HRT?

A

If person has a uterus and no coil then give oestrogen and progesterone
If they have had a hysterectomy or have a mirena coil then only need to give oestrogen

Need progesterone with the oestrogen to stop endometrial hyperplasia that could lead to cancer

107
Q

Symptoms and treatment of vulvo-vaginal atrophy

A 
Thinning, drying and inflammation of vaginal walls caused by lack of oestrogen
Dryness
Soreness
Dyspareunia
Urge incontinence

Treat with topical oestrogen which has little risks and can be used as often as needed

108
Q

What is lichen sclerosis and who tends to get it?

A

Inflammatory, scarring dermatitis of ano-genital skin
Usually pre-pubertal girls or post-menopausal women, can occur in males but rare
Linked with other autoimmune conditions
80% affected have extra cellular matrix protein-1 (ECM-1) antibodies

109
Q

Symptoms of lichen sclerosis

A 
Itch
Pain
Dyspareunia
Constipation
White papules and plaques on external skin
Ecchymosis (bruising)
Erosions and fissures

Can develop into vulval SCC

110
Q

Treatment of lichen sclerosis

A

Genital skin care advice/emollients

Super potent topical steroid with a step-down regime

111
Q

Which lymph nodes does ovarian cancer drain to first?

A

Para-aortic / lumbar

112
Q

Which lymph nodes does cervical cancer go to first?

A

Pelvic lymph nodes /internal iliac arteries

113
Q

What do cells of endothelium look like?

A

Pseudostratified columnar with tubular glands

114
Q

Cells of cervix

A

Stratified squamous cells

115
Q

Cells of ovary

A

Cuboidal cells

116
Q

Cells of vagina

A

Glycogen-containing stratified squamous cells

117
Q

Cells of Fallopian tubes

A

Columnar ciliated cells

118
Q

What lymph nodes do the testes drain to?

A

Para-aortic / lumbar nodes

119
Q

What’s the primary method of action of the COCP?

A

Prevents ovulation

120
Q

What’s the primary mode of action of the POP?

A

Thickens cervical mucus

Unless it’s the desogestrel then it prevents ovulation

121
Q

What’s the primary mode of action of the depo injection?

A

Inhibits ovulation

Also thickens cervical mucus

122
Q

What’s the primary mode of action of the rod (etonogestrel)?

A

Prevents ovulation

Also thickens cervical mucus

123
Q

What’s the primary mode of action of the interuterine device (copper coil?)?

A

Decreases sperm motility and survival

124
Q

What’s the primary mode of action of the interuterine system (hormonal coil)?

A

Prevents endometrial proliferation

Also, thickens cervical mucus

125
Q

How does HPV lead to cancer?

A

It produces two proteins that inhibit the tumour suppressor genes, p53 and pRb

126
Q

What staging system is used for cervical cancer?

A

FIGO (international federation of gynaecology and obstetrics)
Stage 1: just cervix
Stage 2: in uterus or upper 2/3 of vagina
Stage 3: pelvic wall or lower 1/3 of vagina
Stage 4: invading bladder, rectum etc.

127
Q

What do “signet ring’ cells on ovarian histology mean

A

It is a metastasis from somewhere else = Krukenberg tumour

128
Q

What structure is an ovarian mass likely to affect?

A

Obturator nerve
It passes lateral to the ovaries
Causes referred hip or groin pain

129
Q

Investigation for ovarian cancer before referral?

A

CA125 blood test (>35IU/ml is significant)

130
Q

What is bacterial vaginosis?

A

Lack of lactobacilli in the vagina. This is ‘good bacteria’ that produces lactic acid that makes the pH <4.5
Lack of this bacteria makes the vagina more alkaline which allows anaerobic bacteria to multiply
Most commonly, Gardnerella vaginalis

131
Q

What will microscopy of PID look like

A

It may have pus cells. It doesnt necessarily mean it is PID but the absence of pus cells will rule out PID

132
Q

Treatment for PID

A

Outpatient: Oflaxacin and metronidazole for 2 weeks
Inpatient: IV ceftriaxone, IV metronidazole and PO doxycycline (can sub doxy with IV azithromycin)
Inpatient allergic to penicillin: IV clindamycin and IV gentamicin with a step down to oral doxycycline and metronidazole

133
Q

What does a “strawberry cervix” indicate?

A

Trichomoniasis

Causes tiny haemorrhages across the cervix from inflammation

134
Q

Symptoms of trichomonas vaginalis

A 
Discharge: frothy, yellow-green, may smell fishy
Itching
Dysuris
Dyspareunia
Balanitis (glans inflammation)
Raised vaginal pH
135
Q

Swab and treatment for trichomonas

A

Swab should be from the posterior fornix but can take a low vaginal swab
Men should have a urethral swab or first-catch urine

Treat with metronidazole and refer to GUM

136
Q

What is Sheehan Syndrome

A

After a postpartum haemorrhage or shock, there could have been lack of blood flow to parts of the brain causing necrosis of the anterior pituitary.
Presents with lack of pituitary ly noticeable by lack of lactation.

137
Q

What pathogen causes syphilis?

A

Treponema pallidum

138
Q

Medical name for foreskin

A

Prepuce

139
Q

Where does lymph from the scrotum and penis drain to?

A

Superficial inguinal lymph nodes

140
Q

Treatment for mastitis

A

Oral flucloxacillin

141
Q

Treatment for nipple thrush in a breastfeeding mother?

A

Topical anti fungal cream (miconazole) for breasts and for baby’s mouth (though this is an off-license use)

142
Q

Drug for emergency contraception

A

Ullipristal acetate (EllaOne)
Can be taken within 120hrs
Selective-progesterone receptor modulator
Inhibits ovulation

143
Q

How to diagnose if suspected gestational diabetes

A

Oral glucose tolerance test

144
Q

Describe the combined test for Down’s syndrome screening

A

Between 11 and 14 weeks gestation
Ultrasound - Nuchal thickness >6mm
Maternal blood tests - high beta-HCG and low PAPPA

145
Q

Describe the triple test for Down’s syndrome screening

A 
Between 14 and 20 weeks gestation
Maternal blood tests only
High beta-HCG
Low alpha-feta protein (AFP)
Low serum oestriol
146
Q

Describe chorionic villus sampling and amniocentesis

A

Fetal cells used for Karyotyping

CVS uses ultrasound-guided biopsy of placental tissue
Done before 15 weeks

Amniocentesis uses ultrasound-guided aspiration of amniotic fluid using a needle and syringe.
Done in later pregnancy once there is enough amniotic fluid to make it safer.

147
Q

Describe non-invasive prenatal testing

A

Maternal blood test that will contain fragments of DNA, some of which come from placental tissue and represent fetal DNA

148
Q

How to manage hypothyroidism in pregnancy

A

Levothyroxine dose needs to be increased by 30-50% because it can cross the placenta and provide thyroid hormone to the foetus.
Titrate for a low-normal TSH level

149
Q

What hypertension medications should be stopped during pregnancy?

A

ACEi
ARBs
Thiazide diuretics e.g. indapamide

150
Q

Anti-epileptic medications that are safe in pregnancy

A

Lamotrigine
Levetiracetam
Carbamazepine

DONT use sodium valproate as it causes neural tube defects and dont use phenytoin as it causes cleft lip and palate

151
Q

What immunosuppressants are safe during pregnancy?

A

Hydroxychloroquine
Sulfasalazine
Corticosteroids

DONT use methotrexate

152
Q

Why are NSAIDS contraindicated for pregnancy

A

They block prostaglandins that are needed
Prostaglandins maintain the ductus arteriosus and soften the cervix and stimulate contractions at time of delivery
If used in the 3rd trimester they can cause premature closure of the ductus arteriosus and delay labour

153
Q

Antibiotics for a UTI during pregnancy

A

7 days of antibiotics
Nitrofurantoin - avoid in 1st trimester - neonatal haemolysis
Amoxicillin if you know sensitivities
Cefelexin

NOT trimethoprim - folate antagonist

154
Q

Placenta Praevia

A

Placenta is over the cervical os

155
Q

Vasa praevia

A

Fetal vessels travel over the cervical os

156
Q

Placenta Accreta

A

The placenta implants deeper past the endometrium and is hard to separate after delivery of the baby

Year 3 (10 decks)

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