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Phase 4 > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

1
Q

What is cystocele?

A

defect in the anterior vaginal wall, allowing the bladder to prolapse backwards into the vagina

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2
Q

what is a grade 1 cystocele?

A

mild - the bladder droops only a short way into the vagina

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3
Q

what is grade 2 cystocele?

A

medium - bladder sunk to reach opening of vagina

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4
Q

what is grade 3 cystocele?

A

advances - bladder bulges out through opening of vagina

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5
Q

what are 7 risk factors for pelvic organ prolapse?

A

advanced age and post menopause low oestrogen
overweight
childbirth - vaginal delivery
constipation and straining
heavy lifting
chronic cough
previous pelvic surgery

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6
Q

What are 6 symptoms of cystocele?

A

pelvic heaviness/fullness
bluge in vagina
aching/pressure in lower belly/pelvis/back that get worse with standing/lifting/coughing
frequent UTIs and LUTS
pain during sex
constipation

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7
Q

What are 6 symptoms of pelvic organ prolapse?

A

pelvic heaviness/fullness
bluge in vagina
urinary incontinance
constipation
pelvic/back/abdo pain
sexual dysfunction

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8
Q

What is the conservative management for pelvic organ prolapse?

A

physio - pelvic floor exercise
weight loss
lifestyle changes
symptom treatement
vaginal oestrogen cream

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9
Q

what are the 5 different types of pessaries that can be used for vaginal prolapse?

A

Ring
shelf/gellhorn - flat disc with stem
Cube
Donut
Hodge - rectangularish

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10
Q

what should be given with pessaries to protect from vaginal irritation?

A

oestrogen cream

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11
Q

what is the difinitive treatment for pelvic organ prolapse?

A

surgery

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12
Q

What is rectocele?

A

defect in the posterior vaginal wall, allowing the rectum to prolapse forwards into the vagina.
particularly associated with constipation
can develop faecal loading and urinary retention

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13
Q

what is uterovaginal prolapse?

A

where the uterus +/- the vagina itself descends out of the vagina

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14
Q

what is urge incontinence?

A

caused by overactivity of detrusor muscle meaning people feel the sudden need to pass urine

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15
Q

what is stress incontinance?

A

due to weakness of the pelvic floor and sphincter muscles urine to leaks at times of increased pressure on the bladder like laughing , coughing or surprise

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16
Q

what is overflow incontinence?

A

occurs with chronic urinary retention (more common in men) and without the urge to pass urine can be due to anticholinergic meds, fibroids, pelvic tumours and neuro conditions

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17
Q

what are 6 risk factors for urinary incontinance in women?

A

increased age
pregnancy
obesity
pelvic organ prolapse
Neurological disorder
FHx

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18
Q

what are 4 investigations for urinary incontinance in women?

A

urinalysis
urodynamic tests
bladder diary
post void residual bladder volume

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19
Q

what is the gold standard investigation of urinary incontinence?

A

urodynamic testing

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20
Q

what are 3 differential of urinary incontinance?

A

UTI
pregnancy
urogenital fistula

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21
Q

what are 4 lifestyle managements of stress incontinance

A

avoid caffine
avoid smoking
weight loss
reduce fluid intake

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22
Q

What is the first line medication to manage stress incontinance?

A

Duloxetine

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23
Q

What are 3 contra-indications to duloxetine?

A

hepatic impairment
severe renal impairement (<30 creatinine clearance)
Uncontrolled hypertension

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24
Q

what are 4 surgeries for stress incontinance?

A

tension-free vaginal tape
autologous sling
colosuspension
intramural urethral bulking

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25
Q

what is the management of urge incontinance?

A

bladder retraining
anticholinergic medication

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26
Q

what are 3 examples of anticholinergic medications for urge incontinance?

A

Oxybutynin
tolterodine
darifenacin

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27
Q

what are 4 anticholinergic side effects?

A

dry mouth and eyes
constipation
urinary retention
cognitive decline

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28
Q

what are 4 invasive options for urge incontinance?

A

Botulinum toxin type A - botox - injection in bladder wall
percutaneous sacral nerve stimulation
augmentation cystoplasty
urinary diversion

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29
Q

what is one non-anticholinergic that can be used to treat urge incontinance?

A

Mirabegron

CAN CAUSE HYPERTENSIVE CRISIS!!

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30
Q

Where do renal stones commonly get stuck?

A

vesico-uteric junction

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31
Q

what are 2 key complications of kidney stones?

A

obstruction => AKI
infection

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32
Q

what is the most common composition of kidney stones?

A

calcium oxalate

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33
Q

what are th 2 types of clacium renal stones?

A

calcium oxalate
calcium phosphate

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34
Q

what are 3 non-calcium kidney stones?

A

struvate - related to UTI
uric acid - fluid loss related
cystine - due to autosomal recessive cystinuria

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35
Q

what type of renal stones aren’t visible on x-ray?

A

uric acid stones are radiolucent

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36
Q

what are 4 risk factors for renal stones?

A

dehydration
FHx
obesity and diet
UTIs

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37
Q

what are 5 symptoms of renal stones?

A

acute severe ‘loin to groin’ pain
nausea/vomiting
urinary frequency/urgency
haematuria
testicular pain

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38
Q

what is the gold standard investigation of renal stones?

A

Non-contrast CT kidneys ureters and bladder (within 24 hours!)

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39
Q

what are 4 investigations for renal stones?

A

Urinalysis - ?haematuria
bloods - ?infection ?hypercalcaemia ?kidney function
abdo X-ray - shows calcium based stones
ultrasound KUB

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40
Q

What are the symptoms of hypercalcaemia?

A

Renal Stones
Painful Bones
Abdominal Groans
Psychic Moans

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41
Q

What is the management of renal stones?

A

NSAIDs - ibruprofen/diclofenac
Antiemetics - metoclopramide
antibiotics - if infective
watchful waiting
tamsulosin - alpha blocker - can aid passage
surgery

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42
Q

what size of renal stones require surgery?

A

> 10mm

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43
Q

what 4 types of surgical intervention are there for renal stones?

A

extracorporeal shock wave lithotripsy
uteroscopy laser lithtripsy
percutaneous nepholithotomy
open surgery - rare

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44
Q

what are 4 lifestyle changes to prevent further renal stones?

A

increase fluid intake
add lemon juice to water
reduce salt intake
avoid carbonated drinks

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45
Q

what are 2 medications that increase risk of renal stones?

A

potassium citrate
thiazide diuretics

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46
Q

what are 6 risk factors for vaginal fistula?

A

childbirth
injury
surgery
infection
radiation
IBD

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47
Q

what is a vesicovaginal fistula?

A

urinary bladder and vagina fistula

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48
Q

what is an enterovaginal fistula?

A

opening between small intestine and vagina

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49
Q

what are 4 investigations of vaginal fistulae?

A

Dye test - into bladder and rectum to check for leakage
Imaging - USS, CT, MRI
conoloscopy
cystourethroscopy

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50
Q

What is tripple assessment of breat lumps?

A

clinical assessment - Hx and exam
imaging - USS, mamography
histology - fine needle/core biopsy

each scored 1-5 from normal to malignant

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51
Q

what is fibroadenoma?

A

most common cause of breast mass
normally more likely in early reproductive years
painless, smooth, round, firm, well defined, mobile, usually <3cm

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52
Q

what is phyllodes tumour?

A

can be benign or malignant breast lumps
rapidly growning painless breast lumps

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53
Q

what are 8 clinical features of breast cancer?

A

hard, irregular, painless, fixed lumps
lumps tethered to skin or chest wall
nipple retraction
skin dimpling - peau d’orange
nipple discharge
rash, crusting or scaling around nipple
change in shape/size of breast
auxillary lymphadenopathy

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54
Q

what is a fibrocystic breast ?

A

usually in pre/perimenopausal women
mobile with dystinct borders - lumpy breasts
sometimes tender
fluctuate with mentruation

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55
Q

what do breast fat necrosis lumps present with?

A

hard, fixed masses
very like malignancy and require biopsy

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56
Q

what is breast papilloma?

A

breast lump usually in ducts
usually benign but can be associated with cancer
bloody nipple discharge is typical

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57
Q

what are breast abscesses?

A

breast lump typical in breastfeeding
ruptured sub-areolar ducts leak into periductal space
must be differentiated from inflammatory breast cancer

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58
Q

what is breast lipoma?

A

benign tumours of adipose tissue
soft, painless, mobile, no skin changes

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59
Q

what is galactocele?

A

occur in lactating women often after stopping
breast milk filled cysts due to lactiferous ducts being blocked
firm mobile, painless lump beneath areola

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60
Q

what is the most common type of breast cancer?

A

invasive ductal carcinoma

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61
Q

what is the most common causative pathogen of infective mastitis?

A

staphylococcus aureus

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62
Q

what is mastitis?

A

inflammation of breat with or without infection
common with breast feeding

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63
Q

what are breast absecesses?

A

a localised area of infection with a walled off collection of puss - with or without mastitis

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64
Q

what are 5 symptoms of mastitis?

A

fever
decreased milk outflow
breast warmth, tenderness, swelling, redness
breast pain
flu like symptoms

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65
Q

what are 3 investigations for breast abscess?

A

breast ultrasound
needle aspiration drainage
cystology of nipple discharge/aspiration

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66
Q

what are 3 investigations for mastitis?

A

milk/aspirate/discharge/biopsy culture and sensitivity
histopathological exam of biopsy
pregnancy test

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67
Q

what lifestyle treatment is there for breastfeeding mastitis?

A

continue breastfeeding/expressing milk
heat packs
warm showers
simple analgesia

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68
Q

what is the treatment of suspected infective mastitis?

A

Abx - flucloxacillin or erythromyacin (in allergy) for 10 days if still symptomatic 12-24 hours after 1st presentation with lifestyle management

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69
Q

what is the treatment of breast abscess?

A

surgical drainage

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70
Q

What are 6 risk factors for breast cancer?

A

Female
increased oestrogen exposure - OCP and HRT
more dense breast tissue
obestiy
smoking
FHx

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71
Q

What chromosome is BRACA1 on?

A

chromosome 17

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72
Q

what cancers does BRACA1 increase risk of?

A

breast - 70% BY 80yo
ovarian - 50%
prostate and bowel

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73
Q

what chromosome is BRACA2 on?

A

chromosome 13

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74
Q

what is ductal carcinoma in situ?

A

pre-cancerous or cancerous epithelial cells of breast ducts
localised
good prognosis

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75
Q

what is lobular carcinoma in situ?

A

precancerous
usually asymptomatic and undetectable on mammogram
increased risk of invasive breast cancer in future
often managed with close managing

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76
Q

what is invasive ductal carcinoma?

A

originates in cells of breast ducts
80% of invasive breast cancers
seen on mamograms

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77
Q

what is invasive lobular carcinoma?

A

10% of invasive breast cancers
from breast lobules
not always visible on mammograms

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78
Q

what is inflammatory breast cancer?

A

1-3% of breast cancer
similar to breast abscess or mastitis
swollen, warm, tender breat with peau d’orange
doesnt respond to antibiotics
worse prognosis

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79
Q

what is pagets disease of the nipple?

A

loosk like eczema of nipple
erythematous, scaly rash
indicates breast cancer of niple
may be DCIS or invasive breast cancer
requires biopsy, staging and treatment

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80
Q

when is breast cancer screening offered?

A

aged 50-70 every 3 years mammogram

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81
Q

what medications can be used as chemoprevention of breast cancer in those with high risk?

A

tamoxifen - premenopause
anastrozole - postmenopausal

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82
Q

what are 4 investigations for breast cancer?

A

mammogram
biopsy and histology
breast MRI
breast ultrasound

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83
Q

what are 2 investigations needed of confirmed breast cancer?

A

hormone receptor testing - oestrogen and progesterone receptor status
HER2 testing

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84
Q

what medication can be used in HER2 positive breast cancer?

A

trastuzamab (herceptin)

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85
Q

what is the usual management for breast cacinoma in situ?

A

lumpectomy + radiotherapy

tamoxifen/aromatase inhibitors can be used in high risk patients

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86
Q

what is pagets disease of the breast?

A

eczema like changes to skin of nipple and areola - sign of breast cancer
dark scaly rash - often sore and inflamed

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87
Q

what is ductal ectasia?

A

benign condition of milk duct due to walls thickening and getting blocked
more common in women approaching menopause
often asymptomatic but can cause discharge from breast, lumps under nipple or rarely breast pain
can be surgically treated

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88
Q

What causes peau d’orange?

A

blocked lymphatic drainage causes superficial oedema with sweat ducts making small dimples

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89
Q

What is the name of the extention of breast tissue to the axilla?

A

tail of spence

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90
Q

what is the name of a breast milk filled cyst caused by lactiferous duct blockage?

A

galactocele

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91
Q

what chemical has a inhibitory effect on prolactin?

A

Dopamine

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92
Q

what enzyme in adipose tissue converts androgens to oestrogen?

A

aromatase

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93
Q

what type of tumour can cause gynacomastia due to oestrogen secretion?

A

leydig cell tumour - testicular cancer

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94
Q

which common heart meds can cause gynaecomastia?

A

digoxin and spiro

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95
Q

what is intraductal papilloma?

A

a benign wart like lump that develops in one or more of the milk ducts in the breast
can cause a lump, nipple discharge and pain or discomfort

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96
Q

what is bacterial vaginosis?

A

overgrowth of anaerobic bacteria in vagina that causes unusual fishy smelling, grey-ish white thin discharge

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97
Q

what percentage of women with BV have no symptoms?

A

50%

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98
Q

What symtoms are not related to BV?

A

Soreness or itching

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99
Q

What are 4 risk factors for BV?

A

multiple sexual partners
recent Abx
IUD - copper coil
excessive vaginal cleaning

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100
Q

what are 2 complications of BV?

A

small chance of premature birth/miscarriage
Inceased risk of STI

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101
Q

What is the first line antibiotic for BV?

A

Metronidazole 400mg BD 5-7days
intravaginal gel 0.75% OD 5 days

Clindamycin gel 2% OD 7 days 2nd choice
SAFE FOR PREGGOS!

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102
Q

What is the healthhy bacteria in the vagina?

A

lactobilli - produce lactic acid and reduce pH of vagina (<4.5)

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103
Q

What is the most common cause of BV?

A

Gardnerella vaginalis

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104
Q

what are 3 common pathogenic causes of BV?

A

gardnerella vaginalis (most common)
Mycoplasma hominis
prevotella species
ALL ANAEROBIC

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105
Q

What is normal vaginal pH?

A

3.5-4.5

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106
Q

What is the is the gold standard investigation for BV?

A

high or low vaginal swab
should also swab for STIs

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107
Q

What cells are found under a microscope in BV?

A

clue cells

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108
Q

Which antibiotic shoudl you avoid alcohol whilst on?

A

Metronidazole - causes nausea, vomiting, flushing and sometimes shock

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109
Q

what is the most common cause of vaginal thrush?

A

Candida albicans

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110
Q

What are 4 risk factors for thrush?

A

increased oestrogen (pregnancy)
poorly controlled diabetes
immunosuppresion
Broad spectrum ABx

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111
Q

what are the symptoms of vaginal thrush?

A

thick white discharge
vulva and vaginal itching and irritation

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112
Q

What are 6 complications of vaginal thrush?

A

erythema
fissures
oedema
pain during sex (dyspareunia)
dysuria
excoriation

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113
Q

what is one test that can be used to distiguish between trush and BV/trichomonas?

A

vaginal pH swab
>4.5 in BV and Trichomonas
<4.5 in candidiasis

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114
Q

what swab is used for vaginal MCS?

A

charcoal swab - for BV, candidiasis, gonorrhoea, trichomonas, other bacteria

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115
Q

What is the management for thrush?

A

antifungal cream - clotrimazole 5g 10% single dose
antifungal pessary - clotrimazole 500mg single dose
Oral antifungal - fluconazole 150mg single dose

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116
Q

what should you tell patients using antifungal creams?

A

can degrade latex condoms and prevent spermacides from working => use other forms of birth control for at least 5 days

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117
Q

how is trichomonas spread?

A

sexual activity

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118
Q

what does trichomonas infection increase risk of?

A

HIV contraction (due to vaginal mucosa damage)
BV
cevical cancer
PID
pregnancy complications

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119
Q

What does the discharge look like in trichomonasis?

A

frothy, yellow-green fishy smelling discharge

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120
Q

on pelvic examination what can be found in someone with trichomoniasis?

A

strawberry cervix (colpitis macularis) caused by inflammation causing tiny haemorrhages on cerviix surface

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121
Q

how is trichomoniasis diagnosed?

A

charcoal microscopy swab from posterior fornix of vagina
vaginal pH >4.5
Urethral or first catch urine in men

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122
Q

What is the treatment for trichomoniasis?

A

refer to GUM for contact tracing
metronidazole 2g single dose (NOT IN PREGGOS)
OR
400-500mg TD 5-7days

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123
Q

what are 4 causes of balantitis?

A

exzema/dermatitis, allergy, psoriasis etc
gonorrhoea
candidosis
penile neoplasm

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124
Q

what are 4 risk factors for balantitis

A

poor hygiene
over washing
HPV
uncircumsised

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125
Q

what are 2 investigations for balantitis?

A

swab for microbiology and PCR
viral swab

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126
Q

What bacteria causes chancroid?

A

coccobacillus haemophilus ducreyi

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127
Q

What STI is an important cofactor in HIV transmision?

A

Chancroid

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128
Q

what are 2 symptoms of chancroid?

A

genital papules/ulcers
lymphadenitis and buboes

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129
Q

what STI causes genital ulcers?

A

chancroid

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130
Q

What is the treatment for chancroid?

A

azithromycin 1g one off dose

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131
Q

What bacteria causes chalmydia?

A

Gram negative chlamydia trachomatis

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132
Q

what is the most common STI in the UK?

A

Chlamydia

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133
Q

what percentage f menand women are asymptomatic with chlamydia?

A

men - 50%
women - 75%

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134
Q

what is nucleic acid amplification test swabbing used for?

A

chlamydia and gonorrhoea

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135
Q

what are 5 chlamydia symptoms in women?

A

Abnormal vaginal discharge
pelvic pain
abnormal vaginal bleeding
painful sex
dysuria

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136
Q

what are 4 symptoms of chlamydia in men?

A

urethral discharge/discomfort
painful urination
epididymo-orchitis
reactive arthritis

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137
Q

what is the 1st line treatment for chlamydia?

A

Doxycycline 100mg BD 7 days

NOT IN PREGGOS

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138
Q

what are 8 complications of chlamydia?

A

PID
chronic pelvic pain
infertility
ectopic pregnancy
epididymo-orchitis
conjunctivitis
lymphogranuloma venereum
reactive arthritis
chorioamnionitis

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139
Q

what are 5 complication of chlamydia in pregnancy?

A

preterm deliivery
premature rupture of membranes
low birthweight
post partum endometritis
neonatal infection - conjunctivitis and pneumonia

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140
Q

what are the stages of lymphogranuloma venereum?

A

primary - painless ulcer on genitals
secondary - lymphadenitis
tertiary - inflamation of rectum leading to anal pain, change in bowel, tenesmus and discharge

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141
Q

what is the treatment of lymphogranuloma venereum?

A

Doxycycline 100mg BD 21 days

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142
Q

What bacteria causes syphilis?

A

Treponema pallidum
spirochete

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143
Q

what is the incubation period for syphilis?

A

9-90 days

average 21 days

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144
Q

what are the 5 stages of syphilis?

A

primary
secondary
latent
tertiary
neurosyphilis

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145
Q

what are 2 symptoms of primary syphilis?

A

painless genital ulcer (chancre)
local lymphadenopathy
tends to resolve in 3-8 weeks

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146
Q

what are 6 symptoms of secondary syphilis?

A

maculopapular rash - trunks, palms, soles
condylomata lata - grey warts around genitals and anus
low grade fever and lymphadenopathy
oral lesions - snail trail ulcers
alopecia
3-12 weeks long

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147
Q

what are 3 symptoms of tertiary syphilis?

A

gummatous lesions - granulomatous lesions on skin, organs and bone
aortic aneurysms
neurosyphilis
Argyll-Robertson pupil - accommodates but does not react

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148
Q

what are 8 symptoms of neurosyphilis?

A

headache
altered behaviour
tabes dorsalis - demyelination of posterior columns of spinal cord
ocular syphilis
paralysis
sensory impairment
Argyll-robertson pupil (prostitutes pupil - accommodates but does not react)

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149
Q

How do you diagnoses syphilis?

A

antibody testing for T.pallidum antibodies
dark field microscopy
PCR

rapid plasma reagin - non-specific but sensitive
veneral disease research laboratory test - non-specific but sensitive

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150
Q

What is the 1st line treatment for syphilis?

A

Deep IM benzathine benzylpenicillin 1.8g single dose

SAFE IN PREGGOS

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151
Q

What can trichomoniasis in pregnancy cause?

A

premature birth
low birthweight

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152
Q

what can syphilis in pregnancy cause?

A

congenital syphilis
miscarriage
still birth
early death

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153
Q

What is the treatment for chlamydia in preggos?

A

Azithromycin 1g once then 500mg OD for 2 days

Erythromycin 500mg QD for 7 days
Amoxicillin 500mg TD 7 days

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154
Q

what are the complications of chlamydia during pregnancy?

A

pre-term labour
bleeding in pregnancy
PID + fertility problems
ectopic pregnancy
congenital chlamydia - eye or chest infection

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155
Q

what is a complication of spriocete (syphilis) infection after antibiotic treatment that can can cause premature labour?

A

Jarisch-herxheimer reaction - fever, headach, myalgia, fetal distress

also lymes + other spirocete

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156
Q

Which ganglia is genital herpes usually latent in?

A

sacral nerve ganglia

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157
Q

Which ganglia is genital herpes usually latent in?

A

sacral nerve ganglia

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158
Q

what are 5 manifestations of HSV?

A

Cold sores
Genital herpes
aphthous ulcers (in mouth)
herpetic whitlow (painful skin lesions on fingers)
herpes keratitis - inflammation of cornea

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159
Q

what are 5 presentations of herpes?

A

ulcers
neuropathy
flu like symptoms
dysuria
inguinal lymphadenopathy

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160
Q

what pathogen causes genital warts ?

A

Human papillomavirus
HPV6 and 11 most commonly

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161
Q

what is the treatment for genital warts?

A

imiquimod
podephylltoxin
cryotherapy

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162
Q

What bacteria causes gonorrhoea?

A

Neisseria gonorrhoeae
Gram -ve diplococci

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163
Q

what are 4 symptoms of gonorrhoea?

A

odourless purulent discharge (can be green/yellow)
Dysuria
pelvic pain
testicular pain

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164
Q

How do you diagnose gonorrhoea?

A

Nucleic Acid Amplification Test

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165
Q

What is the treatment for gonorrhoea?

A

IM ceftriaxone 1g (also in preggos)
Oral Ciprofloxacin 500mg
Single dose

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166
Q

What are 5 complications of gonorrhoea?

A

PID
Infertility
Prostatitis
Septic arthritis
Conjunctivitis

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167
Q

What is the first line medication for oestrogen receptor +ve breast cancer if premenopausal women?

A

tamoxifen - 5 years

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168
Q

What is the first line medication for oestrogen receptor +ve breast cancer in post-menopausal women?

A

Aromatase inhibitors
e.g. anastrozole

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169
Q

What medication is used in HEr2 +ve breast cancer?

A

Trastuzamab
3 weekly injections for a year after surgery

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170
Q

what are 9 risk factors for ectopic pregnancy?

A

Prev ectopic
tubal surgery
Hx of STD
Smoking
IVF
IUD pregnancy
Black ethnicity
age <18 first intercourse
age >35 at time of presentation

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171
Q

when does ectopic pregnancy usually present?

A

6-8 weeks

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172
Q

what hCG level will mean pregnancy is visible on USS?

A

> 1500 IU/L

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173
Q

what are the 6 criteria for expectant management of ectopic pregnancies?

A

available for follow up
unruptured
mass <35mm
no heart beat
no significant pain
HCG <1500 IU/L

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174
Q

what drug is used for medical management of ectopic pregnancies?

A

IM methotrexate

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175
Q

what is the criteria for medical management of ectopic pregnancies?

A

HCG levels <5000 IU/L
Confirmed absence of intrauterine pregnancy on US
<35mm
minimal pain
no heart beat

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176
Q

What embrionic structure does the female genital system develop from?

A

paramesonephric (mullerian) ducts

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177
Q

what are 4 abnormal female organ formations?

A

bicornuate uterus - heart shaped
imperforate hymen
transverse vaginal septae - septum in vagina
vaginal hypoplasia and agenesis - abnormally small/absent vagina

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178
Q

what is androgen insensitivity syndrome?

A

a condition where cells are unable to respond to androgen hormones due to a lack of androgen receptors. X-linked recessive genetic condition, caused by a mutation in the androgen receptor gene on the X chromosome. Extra androgens are converted into oestrogen, resulting in female secondary sexual characteristics despite XY genetics

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179
Q

what are the complications of androgen insensitivity syndrome?

A

slightly taller than average female
no pubic or facial hair
increased risk of testicular cancer unless removed from abdomen
infertility

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180
Q

what is the usual presentation of androgen insensitivity syndrome?

A

inguinal hernias
primary amenorrhoea

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181
Q

What is menopause?

A

no periods for 12 months due to the end of menstruation

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182
Q

what is premature menopause?

A

Menopause before 40 years

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183
Q

What cells secrete oestrogen?

A

ganulosa cells

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184
Q

What are 8 perimenopausal symptoms?

A

Hot flushes
emotional lability/low mood
reduced libido
premenstrual syndrome
irregular periods
joint pain
heavier/lighter periods
vaginal dryness and atrophy

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185
Q

What are 4 conditions menopause increases the risk of?

A

CVD and stroke
osteoporosis
pelvic organ prolapse
urinary incontinance

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186
Q

what is the management of perimenopausal symptoms?

A

HRT
tibolone - synthetic steroid
clonidine - reduces hot flushes
CBT
SSRIs
testosterone gel for libido
vaginal oestrogen/moisturisers

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187
Q

what is adenomyosis?

A

Endometrial tissue inside the myometrium
More common with mutiparous

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188
Q

What are 5 presetations of adenomyosis?

A

Dysmenorrhoea
menorrhagia
dyspareunia (pain in intercourse)
Infertility
Enlarged/tender (boggy) uterus but softer than w/ fibroids

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189
Q

what is the 1st line investigation for adenomyosis ?

A

TV ultrasound

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190
Q

What is the gold standard investigation for adenomyosis?

A

histological exam after hysterectomy

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191
Q

what are 2 non-contraceptive treatments for mennhoragia?

A

Tranexamic acid - when no pain (antifibrinolytic reduces bleeding)
Mefenamic acid - with pain (NSAID - reduced bleeding and pain)

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192
Q

What are 3 contraceptive managements options for mennorhagia?

A

IUS
COCP
cyclical oral progestogens

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193
Q

what are 4 specialist managements of menorrhagia?

A

GnRH analogues to induce meno-pause like state
endometrial ablation
uterine artery embolisation
hysterectomy

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194
Q

what are 9 complications of adenomyosis in pregnancy?

A

infertility
miscarriage
preterm birth
small gestation
preterm premature rupture of membranes
malpresentation
c-section
PPH

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195
Q

What is asherman’s syndrome?

A

where adhesions form in uterus following damage

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196
Q

What are 3 risk factors for ashermans syndrome?

A

dilation and curettage (after retained products of conception)
uterine surgery
pelvic infection

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197
Q

what are 4 presentations of asherman’s syndrome?

A

secondary amenorrhoea
light periods
dysmenorrhoea
infertility

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198
Q

What are 4 investigations for asherman’s syndrome?

A

hysteroscopy
hysterosalpingography
sonohysterography
MRI

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199
Q

What is lichen sclerosus?

A

a chronic inflamatory autoimmune skin condition causing patches of shiny white skin on labia, perineum and perianal skin most commonly as well as axilla and thighs. can also affect men

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200
Q

what is lichen planus?

A

autoimmune condition causing chronic inflammation with shiny purplish flat top raised areas with white lines across surface called wickhams striae

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201
Q

what are 7 presentations of lichen sclerosus?

A

white skin patches
itching
soreness
skin tightness
painful sex
erosions
fissures

202
Q

what is the management for lichen sclerosus?

A

topical steroids - dermovate - clobetasol propionate 0.05%
emollients

203
Q

what is a key complication of lichen sclerosus?

A

5% risk of developing squamous cell carcinoma of the vulva

204
Q

what is atrophic vaginitis?

A

atrophy of the vaginal mucosa due to lack of oestrogen

205
Q

What are 5 presentations of atrophic vaginitis?

A

itching
dryness
dyspareunia (painful sex)
bleeding (due to inflammation)
recurrent UTIs, Stess incontinance, prolapse

206
Q

what are 6 signs of atrophic vaginitis on examination?

A

pale mucosa
thin skin
reduced skin foldes
erythema and inflammation
dryness
sparse pubic hair

207
Q

what is the management of atrophic vaginitis?

A

topical oestrogen - cream, pessaries, ring
estradiol tablets

208
Q

What is the most commmon types of vulval cancer?

A

squamous cell carcinoma - 90%

209
Q

what are 4 risk factors for vulval cancer?

A

advanced age (>75)
immunosuppression
HPV
lichen sclerosis

210
Q

what is the premalignant form of vulval cancer?

A

vulval intraepithelial neoplasia

211
Q

what type of vulval intraepithelial neoplasia is associated with younger people?

A

high grade squamous intraepithelial lesion - associated w/ HPV infection

212
Q

What type of vulval intraepithelial neoplasia is associated with older people?

A

differentiated VIN associated w/ liches sclerosis

213
Q

what are 6 presenttions of vulval cancer/

A

vulval lump
ulceration
bleeding
pain
itching
lymphadenopathy of the groin

214
Q

What is the most common type of cervical cancer?

A

Squamous cell carcinoma

215
Q

what is the second most common type of cervical cancer/?

A

adenocarcinoma

216
Q

What is the most common cause of cervical cancer?

A

Human papilloma virus (HPV)

217
Q

what cancers is HPV associated with?

A

Cervical
Anal
Valval
Vagina
Penile
Mouth and throat

218
Q

what 2 strains of HPV are responsible for 70% of cervical cancers?

A

16 and18

219
Q

How does HPV promote cancers?

A

Inhibits tumour suppressor genes (P53 and pRb)

220
Q

what increases your risk of catching HPV? (5)

A

early sexual activity
Increased number of sexual partners
sex work
not using condoms

221
Q

What are 6 risk factors for cervical cancer?

A

increased risk of catching HPV
non-engagement with screening
smoking
HIV
COCP >5 years
family history

222
Q

what are 4 cervical appearances that may suggest cancer?

A

ulceration
inflammation
bleeding
visible tumour

223
Q

what are 4 presentations of cervical cancer?

A

abnormal vaginal bleeding - intermenstrual, postcoital, post menopausal
vaginal discharge
pelvic pain
dyspareunia (painful sex)

224
Q

what is the premalignant form of cervical cancer?

A

cervical intraepithelial neoplasia (CIN)

225
Q

How is CIN diagnosed?

A

colposcopy

226
Q

when does cervical screening take place?

A

every 3 years 25-49
Every 5 years 50-64

227
Q

what biopsy techniques are used for cervical cancer?

A

large loop excision or punch biopsy during colposcopy

cone biopsy - also Tx of v early stage cervical Ca

228
Q

What MAB can be used in cervical cancer treatment?

A

Bevacizumab - target vascular endothelial growth factor A

229
Q

what are the 4 parameters to measure ‘normal’ menstruation by?

A

Frequency
regularity
duration
volume

230
Q

what are 4 risk factors for abnormal uterine bleeding?

A

Extremes of reproductive age
PCOS
endocrine disorders - hypothyroid, hyperprolactinoma
obesity

231
Q

what is the emergency management of excessive uterine bleeding?

A

1st - hormone therapy - 25mg IM conjugated oestrogens

2nd - Tranexamic acid, Surgery

Blood products and fluids if haemodynamically unstable

232
Q

what type of cancer is 80% of endometrial cancer?

A

adenocarcinoma

233
Q

which hormone stimulates the growth of endometrial cancer?

A

oestrogen

234
Q

what is the precancerous version of endometrial cancer?

A

endometrial hyperplasia

235
Q

what are the two types o fendometrial hyperplasia?

A

hyperplasia without atypia
atypical hyperplasia

236
Q

what is the treatment for endometrial hyperplasia?

A

progestogens - IUS or continuous oral progestogens

237
Q

what are 9 risk factors for endometrial cancer?

A

increased age
earlier onset of menstruation
late menopause
oestrogen only hormone replacement
no/few pregnancies
obesity
PCOS
Tamoxifen
Diabetes T2

238
Q

what are 4 protective factors for endometrial cancer?

A

COCP
MIrena coil
Increased pregnancies
smoking

239
Q

what are 7 presentations of endometrial cancer?

A

post menopausal bleeding
postcoital and instermenstrual bleeding
menorrhagia
Abnormal discharge
haematuria
anaemia
raised platelets

240
Q

what are 3 investigations for endometrial cancer?

A

TV USS for endometrial thickness
pipelle biopsy - highly sensitive
hysteroscopy with endometrial biopsy

241
Q

what is a normal endometrial thickness post menopause?

A

<4mm

242
Q

What are the stages of endometrial cancer?

A

1 - confined to uterus
2 - invades cervix
3 - invades ovaries, fallopian tubes, vagina or lymph nodes
4 - invades bladder, rectum or beyond pelvis

243
Q

What is the treatment for endometrial cancer?

A

total abdominal hysterectomy with bilateral salpingo-oophorectomy
Radial hyterectomy
radiotherapy
chemo
progesterone tx

244
Q

what are 5 risk factors for endometrial fibroids?

A

increasing age
high BMI
hypertension
tamoxifen
HRT (with high oestrogen)
Afro-Caribbean Ancestry

245
Q

what are 7 presentations of uterine fibroids?

A

Menorrhagia
Prolonged menstruation
Abdominal pain, worse during menstruation
Bloating or feeling full in the abdomen
Urinary or bowel symptoms due to pelvic pressure or fullness
Deep dyspareunia
Reduced fertility

246
Q

what are endometriomas seen in the ovaries often called?

A

chocolate cysts (from endometriosis)

247
Q

what are some possible cause of endometriosis?

A

retograde menstruation through fallopian tubes into abdomen
embryonic cells
lymphatic spread
metaplasia

248
Q

what are 7 presentations of endometriosis?

A

cyclical abdomina or pelvic pain
deep dyspareunia
dysmenorrhoea
subfertility
fixed retroverted uterus
palpable mass - endometrioma
painfull pooping

249
Q

what is the gold standard investigation for endometriosis?

A

laproscopic surgery + biopsy

250
Q

what is the medical management of endometriosis?

A

1 - NSAIDs
2 - COCP or Progesterone only, depo, implant or IUS
3 - GnRH analogous

251
Q

what are 4 risk factors for fibrids?

A

increased patient weight
40+
black ethnicity
low vit D

252
Q

What is a complete mole in a molar pregnancy?

A

when 2 sperm cells fertalise an ovum with no genetic materium and combine genetically to form a tumour

253
Q

what is a partial mole in a molar pregnancy?

A

when 2 sperm fertilise a normal ovum at the same time causing a haploid cell (3 sets of chromosomes which divides and multiplies to form a partial mole. there may be csome foetal material

254
Q

what are 6 possible indications of molar pregnancy compared to normal pregncncy?

A

severe morning sickness
vaginal bleeding
increased enlargement of uterus
abnormally high hCG
thyrotoxicosis

255
Q

what is a sign of molar pregnancy on USS?

A

snow storm appearance

256
Q

what is the management of molar prregnancy?

A

evacuation of uterus
histology
referal to gestational trophoblastic disease centre
hCG level monitoring

257
Q

what can be a complication of molar pregnancy?

A

metastasis

258
Q

what are 6 presentations of prolactinoma?

A

amenorrhoea/oligomenorrhoea
infertility
galactorrhoea
lowered libido
erectile dysfunction
visual deterioration (bilateral temoral hemianopia)

259
Q

what is the most common type of pituitary tumour in women?

A

prolactinoma - 50%

260
Q

what is the 1st line medical treatment of prolactinoma?

A

dopamine agonist - carbergoline 0.5mg once weekly

(2nd line OCP in premeno women)

261
Q

what is the surgical management of prolactinoma?

A

tras-sphenoidal surgery

262
Q

what is the most common type of ovarian tumour?

A

epithelial cell tumour

263
Q

what are beingn ovarian tumours?

A

dermoid cysts
germ cell tumours

teratomas. particularly associated with ovarian torsion

264
Q

what are 6 risk factors for ovarian cancer?

A

Age (highest incidence >60)
BRACA1 and 2 genes (FHx)
Increased number of ovulations
obesity
smoking
recurrent use of clomifene

265
Q

what factors increase the number of ovulations (and therefore ovarian cancer risk)?

A

early onset periods
late menopause
no pregnancies

266
Q

what are 4 protective factors for ovarian cancer?

A

combined oral contraceptive pill
breastfeeding
pregnancy

267
Q

what are 8 presentations of ovarian cancer?

A

abdominal bloating
early satiety/loss of apetite
pelvic/hip and groin pain
urinary symptoms
weight loss
abdominal/pelvic masses
ascites

268
Q

what is the tumour marker for ovarian cancer?

A

CA125

269
Q

what are 3 tumour markers for rarer ovarian germ cell tumours?

A

alpha-fetoprotein
HCG
lactate dehydrogenase

270
Q

What are the 3 diagnostic features for PCOS diagnosis (rotterdam criteria)?

A

Anovulation/oligoovulation
Hyperandrogenism (hirsutism and acne)
Polycystic ovaries on USS

2 features = diagnosis

271
Q

What are 5 potential presentations of ovarian cysts?

A

pelvic pain - w/ torsion, rupture or haemorrhage
bloating
fullness in abdomen
palpable pelvic mass (V large cysts)

272
Q

what are functional cysts?

A

follicular cysts for developing follicles can sometimes fail to rupture and release the egg and therefore persist for a short while

273
Q

what is the most common type of ovarian cyst?

A

functional (follicular) cysts

274
Q

what type of cysts are often seen in early pregnancy?

A

corpus luteum cysts - may cause pelvic discomfort pain or delayed menstruation

275
Q

What are 5 types of ovarian cysts?

A

serous cystadenomas
Mucinous cystadenoma
Endometriomas
dermoid cysts
sex cord stromal tumours (can be benign or malig)

276
Q

what are 2 possible surgical managements of ovarian cysts?

A

ovarian cystectomy
oophorectomy

277
Q

What is Meig’s syndrome?

A

ovarian fibroma (benign ovarian tumour)
pleural effusion
Ascites

typically in older women. removal of tumour results in complete resolution of symptoms.

278
Q

when is ovarian torsion more likely?

A

In pregnancy
with a mass >5cm
before menarche and women of reproductive age

279
Q

what are 4 featrue of ovarian torsion?

A

unilateral sudden onset severe pain
nausea and vomiting
palpable mass
localised tenderness

280
Q

How is ovarian torsion definitively diagnosed?

A

Laparoscopy

281
Q

what are 3 STDs that can cause PID?

A

Neisseria gonorrhoea
Chlamydia trachomatis
Mycoplasma genitalium

282
Q

What are non STDs that can cause PID?

A

Gardenerella vaginalis (associated with BV)
Haemophilus influenzae
Escheriachia coli

283
Q

what are 6 presentations of PID?

A

pelvic/low abdomen pain
abnormal discharge
abnormal bleeding
dyspareunia
fever
dysuria

284
Q

what 4 things may be found on a PID examination?

A

pelvic tenderness
cervical motion tenderness
cervicitis
purulent discharge

285
Q

What are 7 investigations for PID

A

NAAT swabs for gonorrhoea, chlamydia, mycopasma genitalium
HIV test
Syphilis test
High vag swab for BV, candidiasis, trichomoniasis
Look for pus cells on microscope (absence excludes PID)
Pregnancy test (?ectopic)
Inflammatory markers

286
Q

What are 6 complications of PID?

A

Se[sis
abscess
infertility
chronic pelvic pain
ectopic pregnancy
Fiz-hugh-curtis syndrome

287
Q

what is fiz-hugh-curtis syndrome?

A

inflammation and infection of liver cpsule causing adhesions between liver and peritoneum => RUQ pain

288
Q

What is the treatment for PID?

A

IM Ceftriaxone 1g (for gonorrhoea)
Doxycycline 100mg BD 14 days (chalmidia, MG)
Metronidazole 400mg BD 14 days (anaerobes)

if have coil => leave in unless not responding after 72 hours

289
Q

what are 8 non-diagnostic features that may be present in PCOS?

A

insulin resistance and diabetes
acanthosis nigricans
CVD
hypercholesterolaemia
endometrial hyperplasia and cancer
Obstructive sleep apnoea
depression and anxiety
sexual problems

290
Q

what are 4 hormonal blood tests for PCOS?

A

Raised LH
raises LH to FSH ratio
raised testosterone
Raised insulin

291
Q

What can be seen on USS of PCOS?

A

‘string of pearls’ appearance

> 12 cysts on a single ovary or >10cm3 ovarian volume => diagnostic criteria

292
Q

what test can be used for diabetes in PCOS?

A

Oral glucose tolerance test

293
Q

What medication can be given for weight loss that impairs lipid absorption?

A

Orlistat

294
Q

What can be used to reduce risk of endometrial cancer in people with PCOS?

A

cyclical progesterone or COCP to induce withdrawl bleed
Mirena coil

295
Q

what 2 medications can be used to treat hirsutism?

A

co-cyprindiol
topical elfornithine

296
Q

What are the baby blues?

A

transient mood disturbance in the 1st week post partum
crying, fatigue, sensitivity, anxiety, irritability, helplessness, low mood and mood swings

297
Q

What is postnatal depression?

A

low mood, anhedonia and low energy typically affecting mothers around 3 months post natally

298
Q

what scoring system is used for post natal depression?

A

Edinburgh postnatal depression scale

299
Q

What is pueperal psychosis?

A

typically onset 2-3 weeks postnatal with mother experiencing psychotic symptoms (delusions, hallucinations, depression, mania, confusion, thought disorder)

300
Q

what is the treatment for puerperal psychosis?

A

admission to mother and baby unit
CBT
medications - antidepressants, antipsychotics, mood stabilisers
electroconvulsive therapy

301
Q

what is the surgical management of ectopics?

A

laproscopic salpingectomy or salpingotomy

when there is pain, mass >35mm, visible heartbeat or HCG >5000

302
Q

what medication do you need to give Rhesus -ve women in surgical ectopic removal?

A

anti rhesus D

303
Q

What counts as a miscarriage?

A

<24 weeks gestation
early <12 weeks
late 12-24 weeks

304
Q

what is a missed miscarriage?

A

when the foetus is no longer alive but no symptoms have occurred

305
Q

what is a threatened miscarriage?

A

vaginal bleeding with closed cervix and alive foetus

306
Q

what is an inevitable miscarriage?

A

vaginal bleeding and open cervix

307
Q

what is an incomplete miscarriage?

A

retained products of conception remain in uterus after miscarriage

308
Q

what is a complete miscarriage?

A

a full miscarriage has occurred with no products remaining

309
Q

what is anembryonic pregnancy?

A

a gestational sac is present but contains no embryo

310
Q

what are 3 features looked for on ultrasound to confirm pregnancy?

A

mean gestational sac diameter
foetal pole and crown rump length
foetal heart beat

311
Q

what is the management of a miscarriage <6 weeks?

A

expectant management
Repeat urine pregnancy test after 7-10 days

312
Q

what is the management for miscarriage >6 weeks?

A

referral to eArly pregnancy assessment unit
USS for location and viability

313
Q

what is expectant management of miscarriage?

A

repeat urine pregnancy test 3 weeks after bleeding and pain settle to confirm complete miscarriage

314
Q

what is medical management of miscarriage?

A

Misoprostol (prostaglandin analogue to stimulate cervical ripening and uterine contractions)

315
Q

what are 4 side effects of misoprostol?

A

heavier bleeding
pain
vomiting
diarrhoea

316
Q

what is the surgical management of miscarriage?

A

manual vacuum aspiration (LA) <10 weeks
electric vacuum aspiration (GA)
+ misoprostol
+ anti D to -ve women

317
Q

what is the management of incomplete miscarriage?

A

medical - misoprostol
surgical - evacuation under GA

318
Q

What are the 2 legal documents for abortion?

A

1967 abortion act
1990 human fertilisation and embryology act

319
Q

what are the legal requirements for abortion?

A

2 medical practitioners sign to agree abortion is indicated
must be carried out by registered medical practitioner in NHS hospital or approved premise

320
Q

what are 3 indications for abortion post 24 weeks?

A

continuing pregnancy risks life of woman
Termination prevents grave permanent injury to physical or mental health of the woman
substantial risk of physical or mental abnormalities in the child

321
Q

what 2 medications are used in a medical abortion?

A

mifepristone (anti-progestogen)
misoprostol (prostaglandin analogue) 1-2 days later

322
Q

What is an USS signs of diamniotic dichorionic twins?

A

lambda or ‘twin peak’ sign

323
Q

what is an USS sign of monochorionic diamniotic twins?

A

T sign

324
Q

what are 7 risks to the mother with multiple pregnancy?

A

anaemia
polyhydramnious
HTN
malpresentations
spont preterm labour
instrumental delivery/caesarian
PPH

325
Q

what are 7 risks to the foetuses in multiple pregnancy?

A

Miscarriage
Stillbirth
foetal growth restriction
prematurity
twin-twin transfusion syndrome
twin anaemia polycythaemia sequence
congenital abnormalities

326
Q

what is twin-twin transfusion syndrome?

A

only monochorionic multiples
Abnormal connection between blood supply of babies causing shunting of blood to one foetus (recipient) and away from the other (donor)
The recipient gets overloaded and therefore HF and polyhydramnios.
The donor gets growth restricted, anaemic and oligohydramnios
Tx - laser seperation

327
Q

what is twin anaemia polycythaemia sequence?

A

similar to twin to twin but less acute
one twin becomes anaemic whilst the other develops polycythaemia

328
Q

whenis the monitoring for anaemia in multiple pregnancy?

A

booking
20 weeks
28 weeks

329
Q

what is the scan monitoring for monochorionic twins?

A

every 2 weeks from 16 weeks

330
Q

what is the scan monitoring for dichorionic twins?

A

every 4 weeks from 16 weeks

331
Q

when is birth planned for monochorionic monoamniotic twins?

A

32-34 weeks
Must be sectioned

332
Q

when is birth planned for monochorionic diamniotic twins?

A

36-37 weeks

333
Q

when is birth planned for dichorionic diamniotic twins?

A

37-38 weeks

334
Q

when is birth planned for triplets?

A

before 35+6 weeks

335
Q

What are 6 things obesity increases risk of in pregnancy?

A

Gestational diabetes (screen BMI >30)
Pre-eclampsia and HTN (BMI >35)
VTE (BMI > 30)
mental health problems
inaccurate symphysis fundal height measurements
PPH

336
Q

what causes gestational diabetes?

A

due to insulin resistance and relative glucose intolerance in pregnancy

337
Q

what are 7 risk factors for gestational diabetes?

A

prev. gestational diabetes
prev. macrosomic baby
BMI>30
Ethnic origin

FHx of diabetes (1st degree relative)
Advanced maternal age
PCOS

338
Q

what counts as a macrosomic baby?

A

> 4.5kg (9lb 12oz)

339
Q

what test is use for gestational diabetes?

A

glucose tolerance test between 24-28 weeks

340
Q

what are 3 indications of gestational diabetes?

A

large for date foetus
polyhydramnios
Glu on dipstick

341
Q

what is a normal fasting GTT level?

A

<5.6 mol/L

342
Q

what is the normal 2 hour GTT level?

A

<7.8 mmol/L

343
Q

what is the initial management of gestational diabetes?n (3)

A

1 - diet and exercise
2 - metformin (if not under control after 2 weeks)
3 - Insulin
(fasting >7 mmol/L)

344
Q

what is the fasting glucose target for pregnant women?

A

<5.6 mmol/L

345
Q

what is the 1 and 2 hour post prandial glucose target for pregnant women?

A

1 hour - 7.8mmol/L
2 hours - 6.4 mmol/L

346
Q

when is delivery planned for those with complicated diabetes in pregnancy?

A

between 37-38+6 weeks

347
Q

what is the maximum gestation diabetic women can give birth up to?

A

40+6 weeks

348
Q

when is retinal screening performed for diabetics in pregnancy?

A

at booking and at 28 weeks

349
Q

what is the post-natal management of mothers with gestational diabetes?

A

HbA1c at 13 weeks then annually

350
Q

what is the maternal risk in pre-existing diabetes?

A

miscarriage
pre-eclampsia risk increased
infection - uti, resp, endometrial. andwound
increased c-section rate

351
Q

what are 6 risks to the baby of a diabetic mother?

A

neonatal hypoglycaemia
neonatal jaundice
congenital abnormalities - heart, skeletal, neural tube
shoulder dystocia
polycythaemia
childhood obesity

352
Q

When is a variable rate insulin infusion (sliding scale) started intrapartum?

A

with 2 BMs >7

353
Q

What is the target intrapartum blood glucose level?

A

4-7 mmol/L

354
Q

what is given preconception. to pregnant women. to prevent neural tube defects?

A

Folic acid 400microg till 12 weeks unless there are risk factors for neural tube defects or obesity

355
Q

can ACEI or ARBs be taken in pregnancy?

A

NO
cause oligohydramnios, miscarriage, hypocalvaria (malformation of skull), renal failure in neonate, hypotension in neonate

356
Q

what is the 1st line management of severe hypertension in pregnancy <37 weeks?

A

labetalol (>160 systolic but also for consideration >140)

357
Q

what is the management of gestational hypertension >37 weeks?

A

delivery (+labetalol if >160/110)

358
Q

what is pre-eclampsia?

A

New-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy, AND 1 or more of proteinuria
or organ involvement

359
Q

what are 5 high risk factors for pre-eclampsia?

A

pre-existing HTN
Prev. HTN in pregnancy
autoimmune consitions
diabetes
CKD

360
Q

what are 6 moderate risk factors for pre-eclampsia?

A

> 40 years
BMI >35
10+ years since prev. pregnancy
multiples
first pregnancy
FHx of pre-eclampsia

361
Q

what are 8 symptoms of pre-eclapsia?

A

headache
visual disturbance/blurring
nausea and vomiting
upper abdo/epigastric pain
oedema
reduced urine output, proteinuria
brisk reflexes
RUQ/Epigastric pain

362
Q

what is needed for a diagnosis of pre-eclampsia?

A

blood pressure >140/90
+
Proteinuria OR
Organ dysfunction (^creatinine, ^liver enzymes,seizures, thrombocytopenia, haemolytic anaemia) OR
Placental dysfunction (foetal growth restriction or abnormal dopplers)

363
Q

what blood test can be used to test for pre-eclapsia?

A

placental growth factor (between 20-35 weeks)

364
Q

what is the prophylaxis treatment for pre-eclampsia?

A

Aspirin from 12 weeks-birth

women with 1 high risk or 2 moderate risk factors

365
Q

what is the management for gestational hypertension?

A

aim 135/85 mmHg
Urine dip every week
bloods weekly - FBC U+E LFTs
Serial growth scans
PlGF test once (20-35 weeks)

Admit if >160/110 mmHg

366
Q

How often are scans with pre-eclapsia?

A

every 2 weeks

367
Q

what is the medical management of pre-eclapsia?

A

1st line - labetalol
2nd line - nifedipine
3rd line - methyldopa

368
Q

what can be given in severe pre-eclampsia or eclapsia?

A

IV hydralazine

369
Q

what is the management in labour of pre-eclamptics?

A

IV magnesium sulphate (prevent seizures)
Fluid restriction to avoid fluid overload

370
Q

what is the post delivery management of pre-eclampsia?

A

1st line - enalapril
1st line in black afro or Caribbean people - Nifedipine/amlodipine
3rd line labetolol or atenolol

371
Q

what is HELLP syndorme?

A

complication of pre-eclapsia and eclapsia

Haemolysis
Elevated liver enzymes
Low Platelets

372
Q

what are 8 complications of pre-eclampsia?

A

foetal growth restriction
eclampsia
pulmonary oedema
stroke
placental abruption
CVD
renal failure
still birth

373
Q

what are the levels for anaemia in pregnacy?

A

<110 g/L 1st trimester
<105 g/L 2nd/3rd trimester

374
Q

why does anaemia occur in pregnancy?

A

blood volume increases naturally in pregnancy to a greater extent than red cell mass

375
Q

What are 12 risk factors for VTE in pregnancy?

A

smoking
Para >3
Age >35
BMI >30
reduced mobility/immobility
Multiples pregnancy
pre-eclampsia
gross varicose veins
FHx of VTE
Thrombophilia
IVF pregnancy

376
Q

what are the guidelines for starting VTE prophylaxis in pregnancy?

A

from 28 weeks with 3 risk factors
from booking with 4+ risk factors

377
Q

what prophylaxis is given for VTE in pregnancy?

A

LMWH - Dalteparin (5000 units)
also enoxiparin or tinzaparin

Given until 6 weeks postnatal

378
Q

what are 5 presentations of DVT?

A

unilateral calf/leg swelling (>3cm difference)
dilated superficial veins
tender calf
oedema
colour changes to leg

379
Q

what are 8 presentations of PE?

A

SOB
cough/haemoptysis
pleuritic chestr pain
hypoxia
tachycardia
tachypnoea
low-grade fever
haemodynamic instability

380
Q

what is the gold standrd investigation for DVT?

A

doppler uss

381
Q

what is the gold standard investigation for PE?

A

CT pulmonary angiogram (CTPA)

382
Q

what are 3 conditions that group b strep infection of the newborn can cause?

A

meningitis
sepsis
pneumonia

383
Q

what increases baby’s risk of GBS infetion from mother?

A

preterm birth
previous baby with GBS
signs of infection during labour
+ urine or GBS swab in pregnancy
ROM >24 hours before birth

384
Q

which antibiotic is used for intrapartum antibiotic prophylaxis in group B strep?

A

IV benzylpenicillin 3g (+1.5g 4 hourly until delivery)

385
Q

which antibiotic is given intrapartum for GBS in women with penicillin allergy?

A

Vamcomycin 1g every 12 hours (in severe beta-lactam allergy)

Cephlasporins can be used in non sever penicillin allergy

386
Q

What test is used for Group B strep in pregnancy?

A

enriched culture medium test at 35-37 weeks

387
Q

what is the treatment for BV in pregnANCY?

A

oral metronidazole 400mg BD 5-7 days
OR
Intravaginal metronidazole gel 0.75% OD 5 days

388
Q

what are the 3 different types of puerperal infection?

A

endometritis (most common)
myometritis
parametritis (supporting tissue around uterus)

389
Q

what are 6 signs of puerperal infection?

A

pain below waist/in pelvic area
pale clammy skin due to blood loss
foul smelling vaginal discharge
raised HR
fever/chills/aches
Loss of appetite

390
Q

what bacteria most commonly causes puerperal infection?

A

Group B strep (or other streps)

391
Q

what are 5 risk factors for puerperal infection?

A

caesarean
many VEs
delay of birth after ROM
retained tissues
meconium in liquor
use of balloon for induction

392
Q

what is the treatment for trichomonas in pregnancy?

A

metronidazole 400-500mg TD 5-7days

CANNOT DO 2g SINGLE DOSE

393
Q

What does UTI in pregnancy increase the risks of ?

A

preterm delivery
posibly - low birth weight, pre-eclampsia

394
Q

what would be seen on a dipstick of someone with a UTI?

A

Nitrites
Leukocytes
?blood

395
Q

what is the management of uti in pregnancy?

A

Nitrofurantoin (trimester 1+2)
Amoxicillin
Cefalexin

396
Q

can nitrofurantoin be used in pregnancy?

A

Yes but NOT IN THIRD TRIMESTER
Risk of neonatal haemolysis

397
Q

Can trimethoprim be used in pregnancy?

A

NOT IN FIST TRIMESTER

folate antagonist => risk of neural tube defects and congenital malformations

398
Q

what 4 things can congenital rubella cause?

A

deafness
congenital cataracts
congenital heart disease
learning disabilities

399
Q

Can pregnancy women get the MMR vaccine?

A

NO - live vaccine

400
Q

what complications can varicella zoster cause in pregnant mothers?

A

varicella pneumonitis
hepatitis
encephalitis

401
Q

what are 5 features of congenital varicella syndrome?

A

foetal growth restriction
microcephaly, hydrocephalus and learning disability
limb hypoplasia
cataracts and eye inflammation

402
Q

what kind of bacteria is listeria?

A

gram pos bacilli

403
Q

what can listeria cause in pregnancy?

A

miscarriage or foetal death
sever neonatal infection

404
Q

what are 6 complications of congenital cytomegalovirus?

A

foetal growth restriction
microcephaly
hearing loss
vision loss
learning disability
seizures

405
Q

where does toxoplasma gondii come from?

A

parasite from cat poo

406
Q

what is the classical triad of congenital toxoplasmosis?

A

intracranial calcification
hydrocephalus
chorioretinitis (eye inflamation)

407
Q

what are the complications of parovirus B19 in pregnancy?

A

miscarriage or foetal death
severe fetal anaemia
hydrops fetalis (foetal heart failure)
maternal pre-eclampsia like syndrome

408
Q

what are 3 signs of congenital zika syndrome?

A

microcephaly
foetal growth restriction
intracranial abnormalities

409
Q

what is the management of varicella zoster in pregnancy?

A

IV varicella immunoglobulins as prophylaxis after exposure in unexposed mother

410
Q

what hormone causes uterine contraction?

A

oxytocin

411
Q

what are 6 risk factors for atonic uterus?

A

primiparity/grand multiparity
Multiples
high BMI
foetal macrosmia
polyhydramnios
uterine fibroids

412
Q

what is oligohydramnios?

A

too little amniotic fluid below the 5th centile

413
Q

what is the aprox average amount of amniotic fluid at term?

A

500ml

414
Q

what are 7 causes of oligohydramnios?

A

preterm ROM
placental insufficiency (too much blood to brain rather than abdo and kidneys)
renal agenesis
non-functional foetal kidneys
obstructive uropathy
genetic/chromosomal abnormalities (neuropathies)
viral infections

415
Q

what are 7 causes of polyhydramnios?

A

conditions stopping foetal swallowing
anaemia or foetal hydrops
twin-twin transfusion
maternal DM
maternal lithium ingestion (causes foetal DI)
macrosomia
idopathic (most common)

416
Q

what are 5 complications of polyhydramnios?

A

congenital malformations or abnormalities
increased risk preterm labour
increased risk atony and PPH
increased risk malpresentations
increased risk cord prolapse

417
Q

what are the 3Ps of labour?

A

Power (uterine contractions)
Passenger (size/position/presentation of baby)
Passage (shape/size of pelvis)

418
Q

what is the latent phase of labour?

A

from 0-3cm dilation
irregular contractions

419
Q

is the active phase of labour?

A

4-10cm dilation
Strong regular contractions

420
Q

What is. the second stage of labour?

A

from 10cm to delivery

421
Q

what is the 3rd stage of labour?

A

delivery of baby to delivery of placenta

422
Q

How long should delivery of the placenta take with active management?

A

30 mins

423
Q

how long should delivery of the placenta take without intervention?

A

60 mins

424
Q

what is active management of the 3rd stage of labour?

A

IM oxytocin
Controlled cord traction

425
Q

what are the 3 different types of breech presentation?

A

extended breech
flexed breech
footling breech

426
Q

what are 6 risk factors for malpresentation?

A

multparity
uterine malformations/fibroids
placenta praevia
macrosomia
polyhydramnios
multiples/prematurity

427
Q

what are 5 complications. of malpresentation?

A

foetal head entrapment
premature ROM
birth asphyxia
intracranial haemorrhage
cord prolapsd

428
Q

what are 7 risk factors for uterine rupture?

A

prev c section
prev uterine surgery
increased BMI
High parity
increased age
Induction of labour
use of oxytocin

429
Q

what are 5 signs of uterine rupture?

A

abdo pain
vag bleeding
ceasing of contractions
hypotension
tachycardia
collapse

430
Q

what is. an incomplete uterine rupture?

A

when. the perimetrium remains intact

431
Q

what is classed as premature?

A

<37 weeks

432
Q

what are 2 prophylaxis for preterm labour?

A

vaginal progesterone
cervical cerclage (stitch)

(<25mm on TV USS 16-24 weeks)

433
Q

what 2 proteins can be tested for to check ROM?

A

insulin like growth factor binding protein 2
Placental alpha-microglobin-2

434
Q

what is the management of preterm ROM?

A

prophylactic Erythromycin 250mg QDS for 10 days/until labour

induction of labour from 34 weeks

435
Q

what are 5 management options for preterm labour?

A

foetal monitoring
Suppression of labour with nifedipine or terbutaline
maternal corticosteroids (<35 weeks)
IV Mag sulphate (<34 weeks for brain protection)
Delayed cord clamping and milking

436
Q

what are 3 signs of magnesium toxicity?

A

reduced resp rate
reduced BP
absent reflexes

437
Q

what is the management for cord prolpase?

A

emergency caesarean section

438
Q

what are the 2 causes of foetl hypoxia in cord prolapse?

A

cord compression
arterial vasospasm (cold air)

439
Q

what are 5 risk factors for cord prolapase?

A

breech
unstable lie
artificial rupture of membranes
polyhydramnios
prematurity

440
Q

what are 4 indications for instrumental delivery?

A

failure to progress
foetal distress
maternal exhaustion
control of head position

441
Q

what are 5 risks of instrumental delivery to the mother?

A

PPH
episiotomy/tears
injury to anal sphincter
incontinance of bladder/bowel
nerve injury

442
Q

what 2 nerves can be damaged in instrumental delivery?

A

obturator or femoral

443
Q

what are 5 risks of instrumental delivery to the baby?

A

cephalohaematoma w/ ventouse
facial nerve palsy w/ foreceps
skull fracture
subgaleal haemorrhage
spinal cord injury

444
Q

what is obstructed labour?

A

when a physical blockage prevents childbirth - too small pelvis, too big baby, fibroids, malpresentation

more common in asia and africa

445
Q

what is placenta accreta?

A

where placenta implants into the myometrium but not beyond

446
Q

what is placenta increta?

A

where the placenta attaches deeply into the myometrium

447
Q

what is placenta percreta?

A

when the placenta invades past the myometrium and perimetrium into the abdomen

448
Q

what are 6 risk factors for placenta accreta?

A

prev accreta
prev endometrial curettage
prev c-section
multigravida
increased maternal age
low lying/placenta praevia

449
Q

how does placenta accreta present?

A

bleeding in 3rd trimester
antenatal uss
At birth

450
Q

when is a baby with placenta accreta induced?

A

35 to 36+6 weeks
reduce risk of spont labour
given steroids antenatally

451
Q

what are 3 options for placenta accreta management?

A

hysterectomy
uterus preserving surgery
expectant management

452
Q

what are 4 causes of antepartum haemorrhage?

A

placenta praevia
placental abruption
vasa praevia
placenta accreta

453
Q

what are 3 possible causes of minor pv spotting in pregnancy?

A

cervical ectropian
infection
vaginal abrasion

454
Q

what are 6 complications of placenta praevia?

A

antepartum haemorrhage
emergency c-section
emergency hysterectomy
maternal anaemia and transfusions
preterm birth and low birth weight
still birth

455
Q

what is classed as a low lying placenta?

A

within 20mm of internal cervical os

456
Q

what are 6 risk factors for placenta praevia?

A

prev c-section
prev placenta previa
IVF
older maternal age
maternal smoking
structural uterine abnormalities

457
Q

what is the management for placenta praevia?

A

elective c-section at 36-37 weeks

458
Q

what are 10 risk factors for placental abruption?

A

prev. placenta abruption
pre-eclampsia
bleeding in early pregnacy
trauma
multiples
foetal growth restriction
multigravida
increased maternal age
smoking
cocaine or amphetamine use

459
Q

what is the presentation of placental abruption?

A

sudden onset sever continuous abdo pain
vaginal bleeding
shock
CTG abnormality
woody uterus on palpation

460
Q

what is classed as a minor antepartum haemorrhage?

A

<500ml

461
Q

what is classed as a major antepartum haemorrhage?

A

500-1000ml loss

462
Q

what is classed as a massive antepartum haemorrhage?

A

> 1000ml blood loss
OR
signs of shock

463
Q

what is the management of massive antepartum haemorrhage?

A

senior review
2x grey canula
blods - FBC, UE, LFT. Coag
cross match 4 units of blood
Flood and blood resus as required
CTG monitor foetus
close monitoring. ofmother

464
Q

what connective tissue in the umbilical cord protects the blood vessels?

A

whartons jelly

465
Q

what are the two types of vasa praevia?

A

1 - foetal vessels exposed as cord inserts into membranes outside placenta
2 - vessels exposed as travel to accessory placental lobe from placenta

466
Q

what are 3 risk factors for vasa praevia?

A

low lying placenta
IVF
multiples

467
Q

what are 3 presentations of vasa praevia?

A

antenatal scan
antepartum haemorrhage in 2nd/3rd trimester
bright red blood on ROM in labour or foetal vessals seen on VE

468
Q

what is the management for vasa praevia?

A

corticosteroids from 32 weeks
elective c-section 34-36 weeks

469
Q

what is classed as a minor PPH?

A

500-1000ml

470
Q

what is classed as a major PPH?

A

1000ml+

471
Q

what is a primary PPH?

A

bleeding within 24 hours of birth

472
Q

what is a secondary PPH?

A

24 hours -12 weeks after birth

473
Q

what are the 4 Ts of PPH?

A

tone (atony)
trauma (tears)
tissue (retained placenta)
thrombin (bleedin gdisorder)

474
Q

what are 12 risk factors for PPH?

A

previous PPH
grandmultiparity
obesity
macrosomnia/polyhydramnios
prolonged labour
pre-eclampsia
placenta accreta
placenta praevia
retained placenta
instrumental delivery
pre-existing anaemia
induction

475
Q

what are 4 preventative measures for PPH?

A

Tx anaemia antenatally
give birth with empty bladder
active management of 3rd stage
IV tranexamic acid during section in high risk patients

476
Q

what are 2 mechanical managements of PPH?

A

fundal massage
catheterisation

477
Q

what are 5 medical managements of PPH?

A

IV/IM oxytocin
IV/IM ergometrine (without Hx hypertension)
IM carboprost (without Hx asthma)
Misoprostol sublingual
Tranexamic acid

478
Q

what are 4 surgical managements of PPH?

A

interuterine balloon tamponade
B-lynch suture (braces)
Uterine artery ligation
Hysterectomy

479
Q

what is antepartum haemorrhage?

A

bleeding PV from 24 weeks

480
Q

what does rhesus disease cause in the new born?

A

haemolysis

481
Q

what is the prophylaxis for rhesus disease of the newborn?

A

anti-D IM injection in negative mothers
prevents sensitasation in the mother given at 28 weeks

482
Q

when is anti-d given?

A

28 weeks
Birth (if baby +ve)
sensitisation events

483
Q

what test is used to titrate the dosage of anti-D?

A

Kleinhauer test

484
Q

what does the kleinhauer test check?

A

how much foetal blood has passed into the maternal circulation during a sensitisation event after 20 weeks

485
Q

what is low birth weight?

A

<2500g

486
Q

what is placental insufficiency?

A

when o2 and nutrients cannot sufficiently supplu placenta and foetus due to insufficient spiral arteries

487
Q

what are 6 risk factors for placental insufficiency?

A

Pre-eclampsia/hypertension
smoking, drinking, drugs
Advanced maternal age
primiparity
prev IU growth restriction baby
medications - cancer, antiepileptics

488
Q

what 2 medications can be given for placental insufficiency?

A

aspirin
heparin

489
Q

what is the combined test?

A

11-14 weeks gestation
uss - nuchal translucency >6cm
bloods - bHCG and PAPPA - increased HCG and low PAPPA

Screening for downs

490
Q

what physiological changes in pregnancy are there in relation to maternal fluid retention?

A

Increased total plasma volume (30-50%)
Decreased plasma oncotic pressure

491
Q

How long does the corpus luteum produce progesterone for in pregnancy?

A

10 weeks

492
Q

what are 6 physiological hormonal changes in pregnancy?

A

Increased ACTH which causes an increase in steroid hormones (cortisol and aldosterone)
Increased prolactin - suppresses FSH and LH
Increased melanocyte stimulating hormone causes hyperpigmentation - linea nigra, melasma
Increase in T3 and T4
Increase in progesterone and oestrogen
increase then slow fall in HCG after 12 weeks

493
Q

what is the change in the size of the uterus in pregnancy?

A

from around 100g to around 1.1kg

494
Q

what hormone allows break down of collagen in the cervix to prepare for effacement?

A

prostaglandins

495
Q

what are 7 physiological cardiac changes in pregnancy?

A

Increased blood volume
increased plasma volume
increased cardiac output - increased stroke volume and HR
decreased peripheral vascular resistance
decreased BP (early and mid pregnancy)
varicose veins
peripheral vasodilations (can cause flushing and hot sweats)

496
Q

what are 2 physiological respiratory changes in pregnancy?

A

increased tidal volume
increased resp rate

497
Q

what are 5 physiological renal changes in pregnancy?

A

increased blood flow to kidneys
increased GFR
increased aldosterone => increased Na+ and water
increased protein excretion
dilation of the ureters and collecting system - physiological hydronephrosis (R>L)

498
Q

what are 3 nutrients that are in higher demand in pregnancy?

A

iron
folate
B12

499
Q

what are the side effects of tamoxifen and aromatase inhibitors?

A

hot flushes
nausea
vaginal bleeding
thrombosis
endometrial cancer

500
Q

what medication can be used in pre-menopausal woman with ovarian sensitive breast cancer?

A

GNFR inhibitors

Phase 4 (19 decks)

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