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passmed qs > 21/06 > Flashcards

21/06 Flashcards

1
Q

which cancers does COCP protect against

A

endometrial
ovarian
colorectal

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2
Q

which cancers does COCP increase risk of

A

breast
cervical

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3
Q

positive antiphospholipid antibodies (e.g. in SLE)

A

UKMEC 4 for cocp

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4
Q

when does cocp need to be taken for no extra precautions

A

first 5 days of cycle (otherwise 7 days condoms)

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5
Q

POP MOA

A

thickens cervical mucous

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6
Q

IUS MOA

A

prevents endometrial proliferation

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7
Q

restrating hormonal contraception after emergency contraception

A

levenorgestrel - straight away
ullipristal - 5 days

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8
Q

inter-pregnancy interval of less than 12 months

A

increased risk of preterm birth, low birth weight and small for gestational age babies

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9
Q

enlarged, boggy uterus

A

adenomyosis

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10
Q

adnomyosis invx

A

transvaginal USS

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11
Q

when is cervical screening delayed until if pregnant

A

3 months post partum

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12
Q

cervical intraepithelial neoplasia

A

Large loop excision of transformation zone (LLETZ)

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13
Q

primary dysmenorrhea tx

A

NSAIDs eg mefanemic acid and ibuprofen
COCP

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14
Q

2ndary dysmenorrhea

A

refer to gynae

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15
Q

medical mx of ectopic

A

methotrexate

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16
Q

most dangerous ectopic site

A

isthmus

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17
Q

cervical cancer tx

A

surgery
radiotherapy

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18
Q

endometrial cancer tx

A

surgery
post op radiotherapy if high risk

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19
Q

endometrial cancer if frail elderly women not suitable for surgery

A

progestogen

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20
Q

tx of simple endometrial hyperplasia without atypia

A

high dose progestogens with repeat sampling in 3-4 months. The levonorgestrel intra-uterine system may be used

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21
Q

tx of endometrial hyperplasia with atypia

A

hysterectomy

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22
Q

low-grade fever, pain and vomiting during pregnancy

A

?fibroid degeneration

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23
Q

menorrhagia tx does not require contraception

A

mefanemic acid or tranexamic acid

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24
Q

menorrhagia tx does require contraception

A

IUS first-line
combined oral contraceptive pill
long-acting progestogens

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25
Q

short-term option to rapidly stop heavy menstrual bleeding

A

Norethisterone 5 mg tds

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26
Q

HRT cancer risk

A

inc risk of breast and endometrial cancer

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27
Q

CXR aortic dissection

A

widened mediastinum

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28
Q

hyperemesis gravidarum diagnosis

A

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

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29
Q

hyperemesis gravidarum tx

A

antihistamines: oral cyclizine or promethazine
phenothiazines: oral prochlorperazine or chlorpromazine

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30
Q

complications of vaginal hysterectomy with antero-posterior repair

A

enterocele
vaginal vault prolapse

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31
Q

invx of infertility

A

semen analysis
serum progesterone 7 days prior to expected next period (>30 indicates ovulation)

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32
Q

hrt inc cancer risk

A

breast ovarian and endometrial

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33
Q

mx of vasomotor symptoms

A

fluoxetine, citalopram or venlafaxine

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34
Q

medical mx of miscarriage

A

vaginal misoprostol

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35
Q

ovarian cancer most common cause

A

epithelial - serous carcinoma

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36
Q

whirlpool sign

A

ovarian torsion

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37
Q

first line ovulation induction in PCOS

A

Letrozole

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38
Q

PID mx

A

oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole

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39
Q

first line hirsutism in PCOS

A

COCP

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40
Q

most common cause of postcoital bleeding

A

cervical ectropion

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41
Q

most common cause of post meno bleeding

A

vaginal atrophy

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42
Q

diagnosis of premature ovarianinsufficiency

A

elevated FSH levels should be demonstrated on 2 blood samples taken 4–6 weeks apart

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43
Q

when should anti-d be given in abortion

A

women who are rhesus D negative and after 10+0 weeks’ gestation

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44
Q

medical abortion

A

oral mifepristone
48 hrs later - vaginal prostaglandins

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45
Q

when is abortion legal

A

up to 24 weeks

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46
Q

urge incontinence

A

bladder-retraining
anti-muscarinics eg oxybutynin
mirabegron in elderly

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47
Q

stress incontince

A

pelvic floor muscle training
surgical procedures: e.g. retropubic mid-urethral tape procedures
duloxetine

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48
Q

thrush mx

A

oral fluconazole 150 mg as a single dose first-line
clotrimazole 500 mg intravaginal pessary as a single dose
vulval symptoms - topical imidazole

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49
Q

Offensive, thin, white/grey, ‘fishy’ discharge

A

BV

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50
Q

Offensive, yellow/green, frothy discharge

A

trichomonad

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51
Q

AST:ALT ratio 2:1

A

alcoholic hepatitis

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52
Q

venous ulceration is most commonly seen above the

A

medial malleolus

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53
Q

ejection systolic murmur, louder on performing Valsalva and quieter on squatting

A

HOCM

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54
Q

poor response to fluid challenge

A

acute tubular necrosis

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55
Q

partial seizures when child is asleep

A

benign rolandic epilepsy

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56
Q

myoclonic and generalised tonic-clonic seizures, typically occurring when the child is sleep-deprived and not during sleep itself

A

juvenile myoclonic epilepsy

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57
Q

A large hyperechoic lesion in the presence of normal AFP

A

haemangioma

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58
Q

Diabetic ketoacidosis: once blood glucose is < 14 mmol/

A

an infusion of 10% dextrose should be started at 125 mls/hr in addition to the saline regime

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59
Q

organophosphate poisoning

A

atropine

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60
Q

colles fracture nerve injury

A

median

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61
Q

unilateral undescended testicle

A

review at 3 months - if persistent refer

62
Q

LMWH

A

factor Xa

63
Q

exuberant callus formation

A

steroid induced osteoporosis

64
Q

where do the testes drain

A

para-aortic nodes

65
Q

placental abruption

A

separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space

66
Q

Pain over the pubic symphysis with radiation to the groins and the medial aspects of the thighs. A waddling gait may be seen

A

symphysis pubis dysfunction

67
Q

inc AFP

A

Neural tube defects
Abdominal wall defects
Multiple pregnancy

68
Q

dec AFP

A

Down’s syndrome
Trisomy 18
Maternal diabetes mellitus

69
Q

shock out of keeping with visible loss

A

placental abruption

70
Q

shock in proportion to visible loss

A

placenta praevia

71
Q

tx of nipple thrush

A

miconazole cream for the mother
nystatin suspension for the baby

72
Q

if med is required for suppressing lactation

A

cabergoline

73
Q

rarer breech that carries higher mortality

A

footling

74
Q

most common breech

A

frank - hips flexed and knees fully extended

75
Q

when should ECV be offered

A

36 weeks in nulliparous women and from 37 weeks in multiparous women

76
Q

loss of baseline variability

A

Prematurity, hypoxia

77
Q

Early deceleration

A

usually an innocuous feature and indicates head compression

78
Q

late deceleration

A

Indicates fetal distress e.g. asphyxia or placental insufficiency

79
Q

variable decelerations

A

May indicate cord compression

80
Q

skin scarring
eye defects (microphthalmia)
limb hypoplasia
microcephaly and learning disabilities

A

foetal varicella syndrome

81
Q

chorioamnionitis RF

A

PROM

82
Q

chorioamnionitis tx

A

Prompt delivery of the foetus
IV abx

83
Q

what is combined test and when is it offered

A

nuchal translucency measurement
serum B-HCG
pregnancy-associated plasma protein A (PAPP-A)

11-13+6 weeks

84
Q

what is offered instead of combined test if women book later

A

quadruple test 15-20 weeks

alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin A

85
Q

downs syndrome results

A

increased HCG and inhibin A
decreased PAPPA, AFP and unconjugated oestradiol

increased nuchal translucency

86
Q

edwards syndrome (trisomy 18) results

A

everything decreased

87
Q

neural tube defects results

A

increased AFP

88
Q

what will a women be offered if she has a higher chance

A

NIPT, CVS or amniocentesis

89
Q

reducing risk of hypertensive disorders in preg

A

high risk women - aspirin 75-150mg daily from 12 weeks gestation until the birth

90
Q

what should be monitored during magnesium sulphate delivery

A

urine output
reflexes
respiratory rate
oxygen saturations

91
Q

tx of mag sulphate induced resp depression

A

calcium gluconate

92
Q

sodium valproate defect

A

neural tube defects

93
Q

phenytoin defect

A

cleft palate

94
Q

safest anti epileptics

A

lamotrigine and carbamazepine

95
Q

diseases meaning 5mg of folic acid is needed

A

coeliac disease, diabetes, or thalassaemia trait

96
Q

galactocele

A

occlusion of a lactiferous duct -> cystic lesion
painless and usually occurs when recently stopped breast feeding

97
Q

women who have prev had GDM

A

OGTT @ booking and at 24-28 wks if first test is normal

98
Q

women with risk factors for GDM

A

OGTT @ 24-28 wks

99
Q

fasting plasma glucose level is < 7 mmol/l

A

trial of diet and exercise

100
Q

what insulin is GDM treated with

A

short acting

101
Q

if at the time of diagnosis the fasting glucose level is >= 7 mmol/l

A

insulin

102
Q

gestational thrombocytopenia > ITP

A

if the platelet count continues to fall as pregnancy progresses

103
Q

women whove had GBS in prev preg

A

offered intrapartum antibiotic prophylaxis (IAP) OR testing in late pregnancy and then antibiotics if still positive

104
Q

when should swabs for GBS be done

A

35-37 weeks or 3-5 weeks prior to the anticipated delivery date

105
Q

when should IAP be offered to women regardless of status

A

preterm labour
pyrexia >38 during labour

106
Q

GBS prophylaxis

A

benzylpenicillin

107
Q

HELLP

A

Hemolysis
Elevated Liver enzymes
Low Platelet

108
Q

babies born to mothers who are chronically infected with hepatitis B or to mothers who’ve had acute hepatitis B during pregnancy

A

complete course of vaccination + hepatitis B immunoglobulin

109
Q

which electrolyte abnormality predisposes to digoxin toxicity

A

hypokalaemia

110
Q

If after 28/40 weeks, if a woman reports reduced fetal movements and no heart is detected with handheld Dopple

A

ultrasound scan

111
Q

reducing vertical transmission of HIV

A

maternal antiretroviral therapy
mode of delivery (caesarean section)
neonatal antiretroviral therapy
infant feeding (bottle feeding)

112
Q

when can PLWH deliver vaginally

A

viral load less than 50 copies/ml at 36 weeks

113
Q

BP physiological changes in preg

A

falls in first trim -> 20-24 wks
then returns to pre-preg levels by term

114
Q

if the Bishop score is ≤ 6

A

vaginal prostaglandins or oral misoprostol

115
Q

if the Bishop score is > 6

A

amniotomy and an intravenous oxytocin infusion

116
Q

monitoring in labour

A

FHR monitored every 15min (or continuously via CTG)
Contractions assessed every 30min
Maternal pulse rate assessed every 60min
Maternal BP and temp should be checked every 4 hours
VE should be offered every 4 hours to check progression of labour
Maternal urine should be checked for ketones and protein every 4 hours

117
Q

stage 1 labour timeframe

A

latent phase = 0-3 cm dilation, normally takes 6 hours
active phase = 3-10 cm dilation, normally 1cm/hr

118
Q

stage 2 time frame

A

1 hour

119
Q

how long is lochia normal for

A

6 weeks after childbirth

120
Q

placenta accreta risk

A

PPH

121
Q

placenta praevia diagnosis

A

TVUS

122
Q

placenta praevia mx

A

final ultrasound at 36-37 weeks to determine the method of delivery
elective caesarean section for grades III/IV between 37-38 weeks
if grade I then a trial of vaginal delivery may be offered

123
Q

placenta abruption
fetus alive and <36w

A

fetal distress: immediate caesarean
no fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation

124
Q

placenta abruption
fetus alive and >36w

A

fetal distress: immediate caesarean
no fetal distress: deliver vaginally

125
Q

surgical mx PPH first line

A

intrauterine balloon tamponade

126
Q

first trim anaemia

A

<110

127
Q

second trim anaemia

A

<105

128
Q

post partum anaemia

A

<100

129
Q

raised bilirubin

A

intrahepatic cholestasis of preg

130
Q

raised ALT

A

acute fatty liver of preg

131
Q

PPROM invx

A

speculum exam
testing the fluid for placental alpha microglobulin-1 protein (PAMG-1) (e.g. AmniSure®) or insulin-like growth factor binding protein‑1

132
Q

PPROM mx

A

admission
regular obs
oral erythromycin should be given for 10 days
antenatal corticosteroids
delivery should be considered at 34 weeks

133
Q

most common cause of puerperal pyrexia

A

endometritis - iv abx till apyrexial for 24hrs

134
Q

when do nulliparous women experience fetal movements from

A

18-20 wks

135
Q

when do multiparous women experience fetal movements from

A

16-18 wks

136
Q

when to refer if not felt fetal movements

A

24 weeks

137
Q

cause of hyperechogenic bowel

A

cystic fibrosis
Down’s syndrome
cytomegalovirus infection

138
Q

extremely high serum PTH with moderately raised serum calcium

A

tertiary hyperparathyroidism

139
Q

halo appearance on mammography

A

breast cyst

140
Q

cheese like/green nipple discharge and slit like retraction of the nipple

A

duct ectasia

141
Q

breast cyst tx

A

aspiration
those which are blood stained or persistently refill should be biopsied or excised

142
Q

blood stained nipple discharge

A

duct papilloma

143
Q

Indication of breast cancer survival

A

nottingham prognostic index

144
Q

breast disorder assoc with smoking

A

periductal mastitis

145
Q

lateral epicondylitis

A

supination

146
Q

medial epicondylitis

A

pronation

147
Q

which pts are sensitive to non-depolarising agents

A

those with myaesthenia gravis

148
Q

subclinical hyperthyroidism

A

atrial fibrillation
osteoporosis
dementia

149
Q

fever, neuro signs, thrombocytopenia, haemolytic anaemia and renal failure

A

thrombotic thrombocytonpenic purpura

150
Q

what diabetes drug is contraindicated in heart failure

A

pioglitazone

passmed qs (18 decks)

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