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YR 3 MED > repro revision > Flashcards

repro revision Flashcards

1
Q

4 phases of menstrual cycle

A

menstruation
follicular
ovulation
luteal

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2
Q

how is the menstrual cycle controlled by feedback systems??

A

level of oestrogen = negative / positive feedback of HPO axis

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3
Q

3 phases of ovarian cycle and what happens

A

follicular - theca (produce androgens) and granuloma (inhibin) cells, FSH production inhibited by oestrogen and inhibin

ovulation - LH surge after 12 hrs, day 14, after maturation of dominant follicle and ruptures, releasing oocyte

luteal - lasts for 14 days, formation of corpus luteum,
progesterone production

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4
Q

gold standard investigation for suspected endometriosis ??

A

laparoscopy

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5
Q

adenomyosis - definitive tx??

A

hysterectomy

occurs when the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus (myometrium)

Basically, ‘endometriosis but with the extra tissue being in the uterine wall only’

Can treat with hormonal therapy (eg, Mirena coil), tranexamic and mefanamic acid, uterine artery embolisation (fertility-sparing), or ablation/hysterectomy.

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6
Q

what meds can be used to reduce the size of fibroids before surgery??

A

GnRH

OR

ulipristal acetate for fibroids ≥3cm in diameter

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7
Q

USE OF Mefenamic acid VS Tranexamic acid

A

Mefenamic acid - to relieve the dysmenorrhoea. usually 2nd line after using IUS

3rd line - Tranexamic acid is used for heavy menstrual bleeding, rather than dysmenorrhoea (painful bleeding).

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8
Q

VIN

how long to turn into cancer??

A

Vulval intraepithelial neoplasia
pre-cancerous condition, will usually take over 10 yrs to turn into cancer

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9
Q

Lymph from the gonads drains to which lymph node group??

A

lumbar (caval/aortic)
para-aortic nodes

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10
Q

______ signals corpus luteum to secrete progesterone

A

hCG

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11
Q

what happens when you forget to take a pill (COCP)?? do you need any emergency contraception ??

A
  • fine if missed in middle of wk
  • if 1 pill has been missed and it is 48-72 hrs since the last pill in the current pack, or is 24-48 hrs late starting the new pack, MISSED PILL NEEDS TO BE TAKEN ASAP
  • remaining pills continued at usual time
  • if 2 pills have been missed, take most recent one. Barrier contraception until 7 consecutive pills are taken

emergency contraception not required unless pills were missed earlier or in last wk of previous pack

if COCP, implant, IUS, injection is started after day 5, need to use contraception for at least 1 week
IUD = immediately fine, no contraception needed
POP = 2 days

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12
Q

patient has menorrhagia with small subserosal fibroids. what is an appropriate form of contraception??

A
  1. IUS
  2. IF PATIENT DOES NOT WANT IUS, THEN MAYBE POP
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13
Q

IUS

IUD

A

IUS coil - up to 5 yrs, making menstrual periods lighter and shorter
invasive - risk of perforation, ectopic pregnancy

IUD - up to 10 yrs, making menstrual periods heavier and irregular
invasive - PID, perforation

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14
Q

Most likely embryonic explanation for 2 uteri

A

incomplete fusion of paramesonephric duct

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15
Q

in males, which structure develops to form the vas deferens (ductus deferens)?

A

mesonephric duct

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16
Q

in females, which structure develops to form the superior portion of the vagina ??

A

paramesonephric duct

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17
Q

how long do male lice live on average ??

A

22 days (3 wks)

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18
Q

what structures relax in pregnancy that may cause pelvic pain??

A

pelvic inlet
first sacral segment, ilium, and the pubis

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19
Q

what is a complete hydatidiform mole at risk of turning into? compared w partial moles

A

choriocarcinoma

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20
Q

Best contraception for 46 yr old, BMI of 42, smokes 20 a day, history of PID. Has multiple fibroid uterus including intramural and submucous fibroids

what is contraindicated in this?

A

POP

Difficult to fit Mirena w fibroid uterus.

COCP contraindicated in smoking and high BMI and aged above 40

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21
Q

vertex

A

area of foetal skull:
anterior and posterior fontanelle
and
parietal eminences

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22
Q

occipitofrontal diameter and biparietal

A

occipitofrontal - longer than wider

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23
Q

distance of the foetal head from the ischial spines is called the ________

A

station

negative number = the baby head is above the ischial spines
positive number = baby head is positive

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24
Q

placenta accreta vs placenta praevia vs placental abruption

A

accreta = attached to myometrium due to defective decidua basalis, previous C SECTIONS

praevia = vaginal painless bleeding, 3rd trimester

abruption = placenta separates from the uterus

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25
Q

PPH

A

-primary postpartum haemorrhage
-emergency
-4Ts causes, trauma, tissue, thrombin, tone

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26
Q

normal value for NT

A

<3.5mm
assessing the amount of fluid in neck of foetus

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27
Q

screening for Down’s

A

11+0 weeks and 13+6 weeks = combined test
bloods and USS

US = NT

Bloods = PAPP-A, aFP, beta-hCG

2ND STAGE OF SCREENING = 15-16 WEEKS, add in inhibin and oestriol

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28
Q

in downs, what are the levels of PAPP-A, aFP, beta-hCG and NT??

A

PAPP-A and aFP are low
beta hcg and nt are increased

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29
Q

when are foetal anomaly scans done??

A

18-20 weeks
20 week scan for every woman

30
Q

when is SFH measured??

A

from 24 weeks

31
Q

when is anti-d offered if neg?? 1st and 2nd dose

A

28 weeks
34 weeks

32
Q

what test can be done to check the right dose for anti-d sensitizing event by quantifying fetal red blood cells in mother’s blood??

to have maximal effect, when should anti-d be given by??

A

KLEIHAUER

within 72 hrs

33
Q

2 main diagnostic tests for fetal abnormality?? when can they be done??

A

CVS - between 11 and 13+6 wks
amniocentesis - after 15 wks

34
Q

NIPT - screening test (NOT diagnostic)

A

non-invasive prenatal test
more sensitive and specific than other screening tests
reduces the risk of miscarriage

35
Q

chorionicity is most determined by ________ using the shape and thickness of membrane

when is this done?? and why is this important??

A

USS

11 - 13+6 weeks

to pick up early signs of TTTS

36
Q

what is the mode of delivery for MCMA?? mode of delivery for BREECH BABIES

A

C-section due to higher risk for cord entanglement

C-section or ECV

37
Q

3 types of breech presentation, which one is the most risky??

A

complete breech - legs folded at bottom
footling breech - one or both feet point down
frank breech - both legs UP

FOOTLING - cord prolapse

38
Q

IN FOETAL HYPOXIA, umbilical artery __________ its resistance
MCA __________ its resistance

A
39
Q

definition of stillbirth and causes

A

baby born with no signs of life at or after 28 weeks gestation

labour complications, maternal infections and disorders, FGR

40
Q

hypertensive disorders of pregnancy - 3

A

pre-existing hypertension
gestational hypertension
pre-eclampsia

gestational hypertension develops after 20 wks but does not involve proteinuria/oedema unlike pre-eclampsia

41
Q

what happens if pre-eclampsia is not controlled ??

A

develop into eclampsia = characterised by grand Mal seizures

42
Q

gestational diabetes

A

polyhydramnios
glycosuria

43
Q

PPROM

A

pre-term prelabour rupture of membranes

if the latent period between rupture of membranes to onset of painful contractions is greater than 4hrs

44
Q

hydrops fetalis - what is this a late sign of ??

A
45
Q

placental praevia and vasa praevia

A
46
Q

infections in pregnancy

A
47
Q

_____ is the leading direct cause of maternal death??

what is the leading indirect cause of maternal death??

A
48
Q

SGA - has an estimated weight or abdo circumference below the _____ centile

A

10th

49
Q

large for dates fetus has an estimated fetal weight to be greater than the _____ centile

A
50
Q

what substance would you give for inducing labour ?

A

prostaglandin

51
Q

pregnant woman has confirmed DVT and suspected PE. Tx?

A

start low molecular weight heparin in suspected PE

CTPA and V/Q scan = confirm or rule out the presence of a thrombus

52
Q

1ST LINE AND 2ND LINE for management of hypertensive disorders in pregnancy.

A
  1. Labetalol (do NOT use in asthmatics)
  2. Nifedipine
53
Q

mx for severe pre-eclampsia, she has presented with moderate hypertension and also has symptoms of headache and vomiting

A

IV magnesium sulphate and plan
immediate delivery

54
Q

most common cause of antepartum haemorrhage??
second most common cause??

A
  1. placental rupture
  2. placental praevia
55
Q

prolonged labour - diagnosis

A

when cervical dilatation is of less than 2cm in 4 hours during active labour

56
Q

labour 3 stages

A

1 stage is divided into latent and active, latent = up to 4cm
active = 4-10cm

2nd = full dilatation to delivery (passive/active stage)

3rd = time between delivery of foetus and delivery of placenta and membranes (active/physiological mx)
active - need to use drugs

57
Q

in a nulliparous patient, delay is diagnosed when the active 2nd stage has reached ____ hrs??

in a multiparous patient, delay is diagnosed when the active 2nd stage has reached ____ hrs??

A

2

1

58
Q

what are the 7 steps of the mechanism of labour??

A

engagement

descent

flexion

internal rotation

extension

external rotation

expulsion

59
Q

caput succedaneum
cephalohaematoma
subgaleal haemorrhage

A

present at birth

develops several hrs after birth

at delivery and may progress rapidly

60
Q

pros and cons of operative vaginal delivery vs C-section

A

vag = shorter stay and quicker recovery

neonatal trauma, facial nerve palsy, postpartum haemorrhage, shoulder dystocia

C-section = no injury to cervix or tears

haemorrhage, TTN, risk of uterine rupture, venous thromboembolism

61
Q

IOL - most commonly used method of assessment?

what are the methods of inducing labour??

A

Bishop’s score

> 6 = most likely to predict labour

artificial rupture of membrane
drugs
mechanical - balloon catheter

62
Q

CEFM

A

continuous electronic fetal monitoring

associated w increased level of intervention without much improvement in low risk women, so usually for people with risk factors

63
Q

DR C BRAVADAO mnemonic - for interpreting CTGs

A
64
Q

amniotic fluid embolism

A
65
Q

CPR in pregnant woman

A
66
Q

uterine neoplasia / cancer

A
67
Q

endometrial carcinoma
endometrial sarcoma
carcinosarcoma
endometrial hyperplasia
myometrium abnormalities

A
68
Q

ovarian neoplasms/cancer

A
69
Q

benign tumours pathology
functional cysts
endometrioma
polycystic ovaries
theca lutein cyst
serous cystadenoma
mucinous cystadenoma
fibroma
sertoli/leydig
mature teratoma

A
70
Q

malignant tumours
epithelial
mucinous
endometrioid
clear cell
sex cord
germ cell

A
71
Q

cervical neoplasia

A

YR 3 MED (23 decks)

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