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Yr 4 - PassMed Corrections > GOSH > Flashcards

GOSH Flashcards

1
Q

Describe the UK cervical screening programme

A

Aged 25-49 –> every 3 years

Aged 50-64 –> every 5 years

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2
Q

Screening for gestational diabetes in women with risk factors?

A

OGTT at 24-28 weeks gestation

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3
Q

Screening for gestational diabetes in women who have previously had gestational diabetes?

A

OGTT immediately after booking and at 24-28 weeks if the first test is normal.

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4
Q

Give 6 reasons for taking high dose folic acid

A

1) Obesity (BMI ≥30)

2) Woman is taking antiepileptic drugs

3) Woman has coeliac disease

4) Woman has diabetes

5) Woman has thalassaemia trait

6) Either partner has a NTD, they have had a previous pregnancy affected by a NTD, or they have a family history of a NTD

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5
Q

Why may uterine fibroids grow during pregnancy?

A

Due to increased oestrogen

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6
Q

Next steps if cervical smear results are HPV positive but normal cytology?

A

Repeat 12 months later.

If same again –> repeat 12 months later.

If same again –> refer for colposcopy

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7
Q

Next steps if cervical smear results are inadequate (i.e. inadequate sample)?

A

Repeat in 3 months

If still inadequate –> colposcopy

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8
Q

Mx if a woman with known placenta praevia goes into labour (with or without bleeding)?

A

Emergency c-section

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9
Q

Define blood loss in PPH

A

> 500ml after vaginal delivery

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10
Q

Mx of 1st degree perineal tears?

A

Usually no repair needed

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11
Q

Induction of labour if Bishop’s score is ≤6?

A

Vaginal prostaglandins or oral misoprostol

Mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean

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12
Q

Induction of labour if Bishop’s score is >6?

A

Amniotomy and IV oxytocin

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13
Q

What is the main complication of induction of labour?

A

Uterine hyperstimulation

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14
Q

What is 1st line management of postpartum thyroiditis?

A

Propanolol –> The hyperthyroid phase should be treated with beta blockers and NOT antithyroid drugs.

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15
Q

What terminology is used to describe the head in relation to the ischial spine?

A

Station

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16
Q

Sex hormone binding globulin concentration in PCOS?

A

Low

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17
Q

Which hepatitis is routinely screened for during pregnancy?

A

Hep B

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18
Q

What is the Abx of choice for GBS prophylaxis?

A

Benzylpenicillin

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19
Q

What are the 3 main types of ovarian cancer?

A

1) Epithelial cell tumour

2) Germ cell tumour

3) Sex cord tumour

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20
Q

Typical presentation of a germ cell tumour?

A

1) Younger age (<30)

2) May have FH of ovarian cancer

3) Possible signs:
- precocious puberty
- symptoms of pregnancy
- abnormal vaginal bleeding

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21
Q

Give 2 examples of a germ cell tumour

A

1) Teratoma (called a dermoid cyst when occurs at birth)

2) Choriocarcinoma

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22
Q

What 3 tumour markers are produced by germ cell tumours?

A

1) AFP

2) B-HCG

3) LDH

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23
Q

What is a choriocarcinoma?

A

A rare germ cell tumor of trophoblastic cell.

The abnormal cells start in the tissue that would normally become the placenta.

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24
Q

Typical mx of a germ cell tumour?

A

Platinum based chemotherapy

Monitoring for recurrence (tumour markers + physical exam)

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25
Q

What condition are teratomas particularly associated with?

A

Ovarian torsion

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26
Q

Typical presentation of sex cord/stromal tumours of the ovary?

A

1) Reproductive age

2) May have symptoms of:
- abnormal vaginal discharge
- hirsutism
- virilisation

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27
Q

What may sex cord/stromal tumours of the ovaries produce?

A

Ovarian steroid hormone production (e.g., androgens, estrogens, and corticoids).

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28
Q

What tumour markers should be obtained in suspected sex cord/stromal ovarian tumour?

A

1) Inhibin A & B
2) AFP
3) Oestrogen
4) Testosterone

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29
Q

Give 2 types of sex cord tumour

A

1) Granulosa cell (most common)

2) Sertoli-Leydig cell

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30
Q

What is a krukenberg tumour?

A

Refers to a metastasis in the ovary, usually from a GI tract cancer, particularly the stomach.

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31
Q

what is the characteristic sign of a krukenberg tumour in histology?

A

‘signet ring’ sign

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32
Q

What are the 2 types of VIN (vulval intraepithelial neoplasia)?

A

1) High grade –> related to HPV, seen in younger patients

2) Differentiated –> related to lichen sclerosus, seen in older patients

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33
Q

Which type of VIN is related to HPV infection?

A

High grade

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34
Q

Which type of VIN is associated with lichen sclerosus?

A

Differentiated

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35
Q

What is required to diagnose VIN?

A

Biopsy

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36
Q

What contraceptive method should be avoided in Wilson’s?

A

Copper coil

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37
Q

What type of condoms can be used in latex allergy?

A

Polyurethane condoms

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38
Q

What can damage latex condoms?

A

Oil based lubricants (more likely t tear)

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39
Q

What must be used with a diaphragm or cervical cap?

A

Spermicide

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40
Q

How long must a cervical cap/diaphragm be left in place for after sex?

A

6 hours

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41
Q

What COCP is recommended first line? Why?

A

A pill with levonorgestrel or norethisterone first line (e.g. Microgynon or Leostrin).

These choices have a lower risk of venous thromboembolism.

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42
Q

COCPs containing what are considered first-line for premenstrual syndrome?

Why?

A

Drospirenone

Drospirenone has anti-mineralocorticoid and anti-androgen activity, and may help with symptoms of bloating, water retention and mood changes.

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43
Q

COCPs containing what are considered in the treatment of acne and hirsutism?

Why?

A

Cyproterone acetate (i.e. co-cyprindiol)

Cyproterone acetate has anti-androgen effects.

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44
Q

What is potential risk in COCPs with co-cyprindiol?

A

Increased risk of VTE (usually only used for 3 months).

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45
Q

What UKMEC is a BMI > 35 for the COCP?

A

UKMEC 3

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46
Q

When switching between COCPs, what should you do?

A

finish one pack, then immediately start the new pill pack without the pill-free period.

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47
Q

When switching from a traditional progesterone-only pill (POP) to COCP, do you require extra protection?

A

They can switch at any time but 7 days of extra contraception (i.e. condoms) is required.

Exception –> if POP contains desogestrel (can switch with no additional contraception).

This differs from a traditional POP because desogestrel inhibits ovulation.

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48
Q

When is a ‘missed pill’ for desogestrel POPs?

A

12 hours

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49
Q

When is a ‘missed pill’ for norethisterone and levonorgestrel POPs?

A

3 hours

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50
Q

What is the missed pill window for drospirenone POPs?

A

24 hours

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51
Q

How do drospirenone POPs work? How are they different?

A

Inhibits ovulation and is taken daily (similar to other POPs), however 4 pills out of a 28-day pack are hormone-free placebos to allow for a break

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52
Q

When switching from a COCP to POP, when can a woman start the POP immediately without additional contraception? (2)

A

1) Have taken the COCP consistently for >7 days

2) Are on days 1-2 of hormone-free period following a full pack of the COCP

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53
Q

Where in the body is the contraceptive injection typically given?

A

IM into buttocks

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54
Q

What is the main action of progesterone only injection?

A

Inhibits ovulation

Also:
1) Thickening cervical mucus
2) Thins endometrium

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55
Q

What 2 side effects are unique to the progesterone only injection?

A

1) Osteoporosis

2) Weight gain

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56
Q

What can be taking alongside the progesterone only injection for three months when problematic bleeding occurs to help settle the bleeding

A

COCP

Or a short course (5 days) of mefenamic acid to halt the bleeding.

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57
Q

Between what ages is Nexpanon (implant) licensed for use?

A

18-40 y/o

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58
Q

What is added to Nexplanon so that it can be seen on xrays?

A

Barium sulphate

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59
Q

What test is typically performed before insertion of a coil?

A

Screening for chlamydia and gonorrhoea in women at increased risk of STIs (e.g. under 25 years old)

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60
Q

When the coil threads cannot be seen or palpated, what is the 1st line investigation?

A

US

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61
Q

In what condition is the copper coil contraindicated?

A

Wilson’s disease

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62
Q

What are the 2 methods of female sterilisation

A

1) Tubal occlusion (using ‘Filshie clips’)

2) Salpingectomy

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63
Q

After female sterilisation, how long is alternative contraception required?

A

Required until the next menstrual period, as an ovum may have already reached the uterus during that cycle, ready for fertilisation.

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64
Q

After male sterilisation, how long is alternative contraception required?

A

Alternative contraception is required for two months after the procedure.

Testing of the semen to confirm the absence of sperm is necessary before it can be relied upon for contraception.

Semen testing is usually carried out around 12 weeks after the procedure, as it takes time for sperm that are still in the tubes to be cleared. A second semen analysis may be required for confirmation.

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65
Q

How does levonorgestrel work?

A

Prevents/delays ovulation

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66
Q

Is levonorgestrel hamrful to the pregnancy if pregnancy does occur?

A

No

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67
Q

Can the COCP or POP be started immediately after taking levonorgestrel?

A

Yes

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68
Q

Single dose of levonorgestrel given as emergency contraception?

A

1.5mg as a single dose

3mg as a single dose in women above 70kg or BMI above 26

69
Q

How does ulipristal acetate work as an emergency contraception?

A

Ulipristal acetate is a selective progesterone receptor modulator (SERM) that works by delaying ovulation

70
Q

Can the COCP or POP be started immediately after taking ulipristal acetate?

A

No

Must wait 5 days

71
Q

What are 2 major contraindications with urlipristal acetate?

A

1) Severe asthma

2) Breastfeeding (milk should be expressed and discarded for 1 week)

72
Q

How soon after unprotected sex should the copper coil be inserted?

A

Can be inserted within 5 days of UPSI, or within 5 days of the estimated date of ovulation

73
Q

Next steps if patient has missed 1 vs 2 COCPs in last week of packet?

A

1 –> take missed pill, no further action

2 –> take missed pill, omit pill free period

74
Q

What BMI is a risk factor for pre-eclampsia?

A

> 30

75
Q

What age is a risk factor for pre-eclampsia?

A

> 40 y/o

76
Q

What pregnancy interval is a risk factor for pre-eclampsia?

A

> 10 years

77
Q

What are women with PCOS at particular risk of when undergoing IVF?

A

Ovarian hyperstimulation syndrome

78
Q

How long is aspirin indicated for in the prevention of pre-eclampsia?

A

From 12 weeks gestation until birth

79
Q

When should you consider referral regarding weight loss in babies in first week of life?

A

Weight loss >10%

If a breastfed baby loses > 10% of birth weight in the first week of life then referral to a midwife-led breastfeeding clinic may be appropriate

80
Q

Cone biopsy vs LLETZ for management of CIN II and III?

A

LLETZ is preferred

81
Q

What is the preferred method of smoking cessation in pregnant women?

A

Nicotine replacement therapy

82
Q

What is required following a medical termination of pregnancy?

A

Multi-level pregnancy test in 2 weeks

83
Q

Quadruple test results in Edward’s syndrome?

A

Oestriol –> low
Inhibin A –> normal
AFP –> low
hCG –> low

84
Q

What is the gold standard investigation in placenta praevia?

A

TV US

85
Q

Is further investigation needed in a suspected galactocele?

A

No

86
Q

Typical Mx of localised disease in endometrial cancer?

A

Hysterectomy and bilateral salpingo-oophorectomy with consideration of radiotherapy if high-risk

87
Q

Typical mx of endometrial cancer for frail patients that are not fit for surgery?

A

progestogen therapy

88
Q

What may an abdo exam reveal in uterine fibroids?

A

An enlarged, irregularly shaped uterus may be palpable. The uterus may feel firm and nodular.

89
Q

What may a speculum exam reveal in uterine fibroids?

A

May show an enlarged cervix or visible fibroids protruding into the vagina.

There may also be signs of heavy menstrual bleeding.

90
Q

What may a bimanual exam reveal in uterine fibroids?

A

Can confirm the presence of an enlarged, irregular uterus.

Individual fibroids may be palpable as firm, irregular masses separate from the ovary and distinct from the smooth contour of the uterus.

There may also be tenderness on palpation if the fibroids are degenerating or causing torsion of a pedunculated fibroid.

91
Q

When may a test of cure be indicated in chlamydia? (3)

A

1) pregnancy

2) rectal cases

3) where symptoms persist

92
Q

What are some potential pregnancy related complications of chlamydia?

A

1) Preterm birth

2) PROM

3) Low birth weight

4) Postpartum endometritis

5) Neonatal infection (conjunctivitis and pneumonia)

93
Q

What are 2 key presentations of neonatal infection with chlamydia?

A

1) conjunctivitis
2) pneumonia

94
Q

What is Lymphogranuloma venereum (LGV)?

A

A condition affecting the lymphoid tissue around the site of infection with chlamydia.

Most commonly presents in MSM (anal discharge and pain, or anyone presenting with rectal chlamydia).

95
Q

What does N. gonorrhoeae infect?

A

Mucous membranes w/ columnar epithelium e.g. pharynx, rectum, vagina.

96
Q

What class of Abx is ceftriaxone?

A

Cephalosporin

97
Q

What class of Abx is ciprofloxacin?

A

Fluoroquinolone

98
Q

What is disseminated gonococcal infection?

A

A complication of untreated gonococcal infection, where the bacteria spreads to the skin and joints.

99
Q

Features of disseminated gonococcal infection?

A

1) Various non-specific skin lesions

2) Polyarthralgia (joint aches and pains)

3) Migratory polyarthritis (arthritis that moves between joints)

4) Tenosynovitis

5) Systemic symptoms e.g. fever and fatigue

100
Q

What is the incubation period of syphilis (i.e. time from inital infection to symptom presentation)?

A

Approx 21 days

101
Q

What type of bacteria is Treponema pallidum?

A

A spirochete, a type of spiral-shaped bacteria.

102
Q

Congenital syphilis (i.e., present from birth) can be broken down into two stages.

What are these?

A

1) early –> presents <2 years old

2) late –> presents >2 years old

Most will develop symptoms by five weeks.

103
Q

What rash is almost pathognomonic for 2ary syphilis?

A

Widespread, non-pruritic maculopapular, involving palms and soles of feet.

104
Q

When does 3ary syphilis occur?

A

> 2 years after initial infection

105
Q

What are 3 key features of 3ary syphilis?

A

1) Neurosyphilis e.g. dementia, altered behaviour, headache, Argyll-Robertson pupil

2) Aortic aneurysms

3) Gummatous lesions (gummas are granulomatous lesions that can affect the skin, organs and bones)

106
Q

What is an Argyll-Robertson pupil?

A

It is a constricted pupil that accommodates when focusing on a near object but does not react to light.

They are often irregularly shaped.

A specific finding in neurosyphilis.

107
Q

What is an Argyll-Robertson pupil a specific finding in?

A

Neurosyphilis

108
Q

What is the mainstay of diagnosis of syphilis?

A

serology (i.e. antibody testing)

N.B. following successful treatment, parts of the syphilis serology will remain positive (can be lifelong).

109
Q

What 2 conditions can affect the interpretation of syphilis serology?

A

1) Pregnancy

2) Immunological medical conditions (e.g. SLE and HIV)

110
Q

What is the window period for syphilis?

A

12 weeks

111
Q

What is the window period for HIV?

A

4 weeks

112
Q

Mx of syphilis?

A

Single dose of IM benzathine benzylpenicillin

113
Q

Which sensory nerve ganglia is affected in cold sores?

A

Trigeminal nerve

114
Q

Which sensory nerve ganglia is affected in genital herpes?

A

Sacral nerve

115
Q

When is asymptomatic shedding (i.e. virus being shed when no symptoms are present) in HSV infection more common?

A

1) In first 12 months of infection

2) Where recurrent symptoms are present

116
Q

When is HSV-1 normally contracted?

A

In childhood (before five years)

117
Q

Give some features of HSV

A

Initial episode is often severe, and subsequent episodes are milder.

1) Cold sores

2) Genital sores

3) Neuropathic type pain (tingling, burning or shooting)

4) Flu-like symptoms (e.g. fatigue and headaches)

5) Dysuria

6) Inguinal lymphadenopathy

118
Q

How is HSV infection diagnosed?

A

PCR swab of lesions

The lesion should be BURST and a swab taken from the BASE of the ulcer.

119
Q

What is the main issue with genital herpes during pregnancy?

A

The risk of neonatal herpes simplex infection contracted during labour and delivery –> high morbidity and mortality

120
Q

What is HSV keratitis?

A

dendritic lesion on the cornea

121
Q

What is a herpetic whitlow?

A

a painful infection of the finger caused by the herpes virus.

122
Q

What risk factor is known to increase the risk of genital wart recurrence?

A

Smoking

123
Q

Mx of genital warts:

a) single keratinised wart

b) multiple non-keratinised warts

A

a) cryotherapy

b) topical podophyllum or topical imiquimod

124
Q

What is a key complication of genital warts?

A

Ano-genital cancer

125
Q

What type of organism is trichomonas vaginalis?

A

Parasite (protozoa)

126
Q

Describe cervix that can be seen in trichomonas infection

A

‘Strawberry cervix’ –> inflammation & punctate haemorrhages over the vagina and cervix.

127
Q

In what 2 gynae conditions is there a raised vaginal pH (>4.5)?

A

1) Bacterial vaginosis

2) Trichomonas vaginalis

128
Q

1st line investigation in trichomonas?

A

Charcoal swab, taken from posterior fornix of vagina (i.e. behind the cervix).

129
Q

Where is swab taken from in trichomonas?

A

Posterior fornix of vagina

130
Q

What is a key feature of mycoplasma genitalium?

A

Urethritis

131
Q

What is the gold standard investigation for mycoplasma genitalium?

A

NAAT swab

Women –> vulvovaginal
Men –> first catch urine

132
Q

1st line management of uncomplicated Mycoplasma genitalium?

A

1) Doxycycline 7 days

followed by

2) Azithromycin 2 days

133
Q

Management of complicated Mycoplasma genitalium?

A

Moxifloxacin (14 days)

134
Q

What is the protein on the surface of HIV that binds to CD4+?

A

gp120

135
Q

What CD4+ cell count is sufficient for a diagnosis of AIDS?

A

<200

136
Q

Give 7 examples of AIDS-defining illnesses

A

1) PCP

2) TB

3) Kaposi’s sarcoma

4) CMV infection

5) Lymphomas

6) Candidiasis (oesophageal or bronchial)

7) Toxoplasmosis

137
Q

What lymphoma is an AIDS-defining illness?

A

AIDS-related non-Hodgkin’s lymphoma

138
Q

What 4 conditions may be seen in AIDS patients with CD4 count between 200-500?

A

1) oral thrush (candidiasis)

2) shingles (herpes zoster)

3) hairy leukoplakia (EBV)

4) Kaposi sarcoma (HHV-8)

139
Q

What can EBV lead to in patients with HIV?

A

Hairy leukoplakia

140
Q

Describe hairy leukoplakia

A

White plaques on the lateral tongue which do NOT wipe off.

141
Q

What is the most common opportunistic infection in AIDS?

A

PCP

142
Q

When should patients with HIV receive PCP prophylaxis?

A

CD4+ <200

143
Q

What is a common complication of PCP?

A

Pneumothorax

144
Q

What is a key dermatological complication of HIV?

A

Kaposi’s sarcoma

145
Q

What is Kaposi’s sarcoma caused by?

A

HHV-8

146
Q

How does Kaposi’s sarcoma present?

A

Purple papules or plaques on the skin or mucosa (e.g. GI and respiratory tract).

Lesions may later ulcerate.

Respiratory involvement may cause massive haemoptysis and pleural effusion

147
Q

1st line management of Kaposi’s sarcoma?

A

Radiotherapy + resection

148
Q

What is a key ocular complication in HIV?

A

CMV retinitis

149
Q

How may CMV retinitis present?

A

Visual impairment eg. blurred vision

150
Q

Characteristic appearance of CMV retinitis on fundoscopy?

A

Retinal haemorrhages and necrosis

151
Q

1st line management of CMV retinitis?

A

IV ganciclovir

152
Q

What are 2 key neurological complications of HIV?

A

1) Toxoplasmosis (accounts for around 50% of cerebral lesions in patients with HIV)

2) Primary CNS lymphoma

153
Q

Symptoms of cerebral toxoplasmosis?

A
  • constitutional symptoms
  • headache
  • confusion
  • drowsiness
154
Q

1st line management of cerebral toxoplasmosis?

A

sulfadiazine and pyrimethamine

155
Q

What infection is primary CNS lymphoma in HIV patients associated with?

A

EBV infection

156
Q

What is the regimen of choice of ART?

A

1) A backbone of two nucleoside reverse transcriptase inhibitors (NRTIs) e.g. tenofovir disoproxil plus emtricitabine

Combined with either;
2) An integrase inhibitor (e.g. bictegravir) or;

3) A non-nucleoside reverse transcriptase inhibitor or;

4) A boosted protease inhibitor

157
Q

What are the 2 aims of ART therapy in HIV?

A

1) Achieve normal CD4+ count

2) Viral load undetectable

158
Q

What is PrEP a combination of?

A

Emtricitabine + tenofovir disoproxil (both NRTIs)

159
Q

How does viral load affect mode of delivery for pregnant women?

A

<50: normal vaginal birth

> 50: c-section considered

> 400: c-section recommended

160
Q

What is given as an infusion during labour and delivery if the HIV viral load is unknown or above 1000 copies/ml?

A

IV zidovudine (ART)

161
Q

What is it important to counsel new mothers with HIV about?

A

Avoid breastfeeding

Can still be passed to newborn even if viral load is low.

162
Q

What does standard STI screening consist of?

A

1) NAAT –> Chlamydia & gonorrhoea

2) Serology –> HIV & syphilis

163
Q

What is the tailored STI screen for MSM?

A

Standard STI screen

+

3 site testing for chlamydia & gonorrhoea (NAAT): urine, rectum & pharynx.

164
Q

What is Fitz-Hugh-Curtis syndrome?

A

A chronic manifestation of PID.

Inflammation of the liver capsule, without the involvement of the liver parenchyma, with adhesion formation.

Causes RUQ pain.

165
Q

When is a test of cure for gonorrhoea recommended?

A

Pregnancy

166
Q

What are 3 complications of gonorrhoea in males?

A

1) epididymo-orchitis

2) proctitis

3) disseminated gonorrhoea

167
Q

What are the 2 most common causes of non-gonococcal urethritis?

A

1) Chlamydia

2) Mycoplasma genitalium

168
Q

What symptom typically accompanies a chancre?

A

Local lymphadenopathy

169
Q
A

Yr 4 - PassMed Corrections (36 decks)

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