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medicine year 3 > reproductive health > Flashcards

reproductive health Flashcards

1
Q

when does fertility come back post childbirth?

A

21 days after giving birth

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2
Q

is lactational amenorrhoea effective contraception?

A

yes, it is over 98% effective for up to 6 months after birth. for it to work women but be fully breastfeeding and amenorrhoeic.

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3
Q

how do oestrogen and progesterone work as contraceptives?

A

have a negative feedback effect on the hypothalamus and anterior pituitary, suppressing the release of GnRH, LH and FSH. Without the effects of LH and FSH, ovulation does not occur

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4
Q

when prescribing the COCP, which types are 1st line and why?

A

pill with either levonorgestrel or norethisterone
lower risk of VTE than the others

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5
Q

which COCP is first line for PMS?

A

ones containing drospirenone

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6
Q

which COCP is used for acne and hirsutism?

A

ones containing cyproterone (progestogen) -has anti-androgen effects

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7
Q

according to NICE, if you’re on the COCP and have a major operation planned what should you do?

A

stop the COCP 4 weeks before a major operation to reduce risk of thrombosis.

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8
Q

what is the one progesterone only pill that inhibits ovulation?

A

desogestrel

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9
Q

how long is the mirena licensed to stay inside you?

A

5 years for contraception
4 years for HRT

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10
Q

in a breastfed healthy term baby who was having minor growth faltering but all normal and no other red flags what would you do first?

A

take full breastfeeding history and encourage more frequent feeding.

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11
Q

if a breastfeeding woman develops a hot red lump on her breast what is the most common organism that would be causing it?

A

staph aureus

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12
Q

what is the only effective fertility treatment for large fibroids causing problems with fertility?

A

myomectomy

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13
Q

what is parametritis?

A

inflammation of the parametrium -connective tissue around uterus.

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14
Q

what is cervical motion tenderness?

A

severe pain on palpation of the cervix -may suggest pelvic inflammatory disease or ectopic pregnancy.

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15
Q

what is the firstline test for endometrial cancer

A

transvaginal USS

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16
Q

what happens if you use SSRIs in the third semester of pregnancy?

A

risk of persistent pulmonary hypertension of the newborn

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17
Q

what are the top 3 causes of big antepartum haemorrhage?

A

placenta praevia
placental abruption
vasa praevia

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18
Q

what is antepartum haemorrhage?

A

bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby.

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19
Q

what are the features of congenital zika syndrome?

A

microcephaly
foetal growth restriction
other intracranial abnormalities eg ventriculomegaly and cerebellar atrophy

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20
Q

what types of hormones does the patch have?

A

oestrogen and progesterone

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21
Q

how often do you change the contraceptive patch?

A

weekly

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22
Q

what forms does combined hormonal contraception come in?

A

COCP, transdermal patch, and vaginal rings

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23
Q

how long does each vaginal contraceptive ring last for?

A

3 weeks

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24
Q

when does full protection from female sterilisation kick in?

A

when next period starts after procedure

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25
Q

how long does the copper coil stay in?

A

5-10 years

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26
Q

what is the primary MOA of the copper coil?

A

decreases sperm motility and survival

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27
Q

what is the effectiveness of the withdrawal method?

A

22/100 will get pregnant within a year.

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28
Q

what is the effectiveness of condoms?

A

18% will get pregnant in a year with typical use
2% with perfect use

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29
Q

how effective is female sterilisation?

A

0.5% chance in 1 year

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30
Q

what is dilatation and curettage?

A

brief surgical procedure in which the cervix is dilated and a special instrument is used to scrape the uterine lining

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31
Q

what is Fitz-Hugh-Curtis syndrome?

A

rare complication of pelvic inflammatory disease (PID) involving liver capsule inflammation leading to the creation of adhesions.

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32
Q

what is a small risk of ondansetron if given for >5d in pregnancy?

A

cleft lip/palate

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33
Q

what drug is firstline for magnesium sulfate induced resp depression?

A

calcium glucanate

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34
Q

4 major direct obstetric killers of pregnant women?

A

haemorrhage
pre-eclampsia
sepsis
thrombosis

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35
Q

what position can help to put eclamptic women having seizures in?

A

left lateral position

36
Q

how common is vasa praevia and which situations is it usually associated with?

A

rare
usually occurs with an ARM or in labour

37
Q

what level of hCG rise is expected in normal pregnancy?

A

65-70% in 48 hours

38
Q

what is a varicocoele?

A

varicose veins in scrotum

39
Q

when is anti-D needed in a miscarriage/ectopic situation?

A

needed for surgical management of an ectopic pregnancy/miscarriage
not needed for spontaneous first trimester miscarriage or medical/expectant management of miscarriage/ectopic

40
Q

what do the different bishops scores mean?

A

8 or more -cervix is ‘ripe’, ready to dilate, and high chance of spontaneous labour.
less than or equal to 6 -unfavourable/unripe for induction
less than 5-labour unlikely to start on its own

41
Q

what is false labour?

A

occurs in last 4 weeks of pregnancy
contractions felt in lower abdomen-irregular occur every 20 mins, no cervical changes

42
Q

how far into the pregnancy should the booking visit be?

A

ideally <10 weeks

43
Q

what do you do if someone has reduced foetal movements and no heartbeat is detected with handheld doppler after 28 weeks?

A

immediate USS

44
Q

what do you do if there is reduced foetal movements but doppler finds a foetal heartbeat?

A

cardiotocography for at least 20 minutes

45
Q

when do foetal movements start getting recognised and increase?

A

18-20 weeks -start getting recognised (multiparous -from 16)
increase till 32w where they plateau off

46
Q

what is a worryingly low number of foetal movements to be getting (past 28 weeks)?

A

less than 10 in 2 hours

47
Q

how late in the pregnancy do they need referral because they haven’t felt foetal movements yet?

A

24 weeks

48
Q

if a woman is in labour what HR readings would prompt a transfer to consultant led care?

A

pulse over 120bpm on 2 occasions 30mins apart

49
Q

where is the fundus throughout pregnancy?

A

12w -pubic symphysis
20w-umblicus
37w-full height

50
Q

if a woman is in labour what BP readings would prompt transfer to consultant led care?

A

160/90 or more (either reading)
2 readings of 140/90 or more taken 30 mins apart

51
Q

in labour what foetal HR readings would prompt referral to consultant led care?

A

foetal HR below 110 or above 160
deceleration heard

52
Q

what is actually the contents of the cervical smear tests?

A

all of them get tested for high risk hpv
if positive get cytology (looking at cells under microscope), if negative do not.

53
Q

how do you manage a 1st episode of depression in a woman who is pregnant?

A

subtheshold/mild -referral for facilitated self help
mild but history of severe depression -TCA, SSRI, or SNRI
moderate to severe depression -1st line =CBT, 2nd line=TCA/SSRI/SNRI (1st line if she expresses preference). if not working can do combination.

54
Q

when should you be able to hear the foetal heart on doppler?

A

by 20 weeks
shouldn’t listen before 16 weeks-won’t hear anything and will just stress out mum

55
Q

what are the risks of interpregnancy interval of less than 12 months?

A

increased risk of preterm birth, low birthweight, and SGA babies.

56
Q

what supplement do you need to take if you’re breastfeeding?

A

vitamin d

57
Q

what do the different ACR levels mean?

A

3-30=microalbuminaemia
30+: proteinuria

58
Q

what is proteinuria on urine dip?

A

2+

59
Q

what are the rules for ACEis in pregnancy and why?

A

need to come off them straight away - especially in 2nd and 3rd trimesters
causes kidney issues in baby, PDA, oligohydramnios

60
Q

what can happen if you use benzodiazepines in pregnancy to baby?

A

neonatal withdrawal if used regularly
neonatal hypothermia

61
Q

What are the rules of NSAIDs in pregnancy and why?

A

don’t give at all - what they’re told in practise
after 30 weeks - risks closing DA early

62
Q

What is the rules on warfarin in pregnancy and why?

A

Don’t use in gen- causes miscarriage, LD, bones, brain bleeds
specialist led- can sometimes use with artificial heart valve

63
Q

What medication do you use for anti clotting in pregnancy?

A

LMWH- clexane (enoxaparin)

64
Q

what do you use for UTI in pregnancy?

A

nitrofurantoin
at term- amoxicillin if you know culture, if not clarithromycin
don’t use trimethoprim

65
Q

what is SGA and severe SGA?

A

foetus that measures below the 10th centile for gestational age
sevre =below 3rd

66
Q

what is LBW?

A

below 2500g

67
Q

which hormone increases in menopause?

A

FSH

68
Q

what is the classic presentation of turner’s?

A

short stature
webbed neck, widely spaced nippled, shield chest
primary amennorhoea
biscuspid aortic valve (15%) -ESM

69
Q

what is the genetic code for turner’s?

A

45, X0

70
Q

which combined HRTs are safe for VTE risk?

A

transdermal -no evidence of it increasing risk compared to general pop
(oral does-they think maybe something to do with oral metabolism vs skin)

71
Q

what cancer is tamoxifen a risk factor for?

A

endometrial (oestrogen antagonist in breast but agonist in endometrium)

72
Q

patients who have had LLETZ for CIN need what follow up?

A

smear in 6 months after

73
Q

what is the classic triad of vasa praevia?

A

rupture of membranes followed by painless vaginal bleeding and foetal bradycardia

74
Q

what is the classic presentation of vesicovaginal fistula?

A

continuous dribbling incontinence after prolonged labour if they didn’t get much antenatal care

75
Q

what imaging is best if they have bleeding in the first trimester?

A

transvaginal USS

76
Q

what do you do if they’re exposed to chickenpoxin pregnancy?

A

check for abs. if not immune:
VZIG: can give within 10 days of exposure
PO acycylovir: can give within 24h of sx if >20w.

77
Q

what counts as precocious puberty?

A

<8 in F, <9 in M

78
Q

what are the contraindications to VBAC?

A

1) normal vaginal birth contraindications eg placenta praevia
2) vertical scar f`rom previous c section
3) previous uterine rupture

79
Q

what is the success rate of VBAC?

A

about 75%

80
Q

what are 3 drugs that can stimulate ovulation used in subfertility treatment?

A

clomifene
letrozole
gonadotrophins

81
Q

what are 3 drugs that can stimulate ovulation used in subfertility treatment?

A

clomifene
letrozole
gonadotrophins

82
Q

when doing hormone testing for subfertility when do you collect each female hormone

A

LH and FSH -day 2-5 of cycle
progesterone -7 days before end of cycle eg day 21

83
Q

what sleeping position is associated with stillbirth?

A

sleeping on your back

84
Q

what can be used to suppress lactation after birth in a stillbirth?

A

dopamine agonists eg cabergoline

85
Q

what do you do with the COCP if they miss 2 pills in week 3 of the cycle?

A

finish pills in current pack and start new pack immediately, omitting pill free interval

medicine year 3 (21 decks)

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