Clinical Management Flashcards
(266 cards)
1
Q
How do you calculate RMI?
A
= ultrasound score x menopausal score = Ca125
2
Q
What RMI score should warrant referral to the MDT?
A
> /= 250 (NICE), but a score >200 is recommended by RCOG to treat as highly suspicious of cancer
3
Q
What is the current recommended HbA1c in pregnancy?
A
= 48
4
Q
At what HbA1c should a woman be advised not to get pregnant?
A
> 86
5
Q
What proportion of women have the classic ‘frothy’ discharge of TV?
A
Only 20%
Only 2% get cervicitis - i.e. strawberry cervix
6
Q
What is the 1st line treatment of TV?
A
Metronidazole 400-500mg BD for 5-7 days. Also 1st line in pregnancy. BASHH recommend 500mg BD for 7 days in concurrent HIV infection
7
Q
Which 3 disease should be screened for antenatally?
A
1) HIV; 2) Hep B; 3) Syphillis
8
Q
What is the tubal infertility rate following 1 episode of PID?
A
12.5%
9
Q
What is the tubal infertility rate following 3 episodes of PID?
A
50%
10
Q
What are the 3 different utertonics?
A
1) Oxytocin; 2) Prostaglandins - misoprostal being the most commonly used; 3) Ergometrine
11
Q
What is the 1st-line uterotonic?
A
Oxytocin
12
Q
What is the half-life of oxytocin?
A
5 minutes
13
Q
What is the half-life of ergometrine?
A
30-120 minutes
14
Q
What is the half life of misoprostal?
A
40 minutes
15
Q
What type of receptor does oxytocin bind to?
A
G-protein coupled receptor requiring Mg2+ and cholesterol
16
Q
What is syntometrine?
A
Combination oxytocin and ergometrine
17
Q
What are uterotonics?
A
Drugs that aid uterine contraction
18
Q
What is the most important process necessary for cervical ripening??
A
Degradation of type 1 collagen by interstitial collagenase
19
Q
What is the cervical screening frequency?
A
Age 25-49 = every 3 years
Age 50-64 = every 5 years
20
Q
What is the new style (2019) cervical screening?
A
If HPV -ve = routine recall
If HPV +ve –> cytology triage. If cytology normal, re-screen in 12 months, if abnormal, colposcopy
Pt’s whom are HPV +ve with normal cytology may be re-screened every 12 months for 2 cycles. If at the 3rd test, i.e. 2 years from the 1st HPV +ve result and the pt is still HPV +ve but with normal cytology, they then need to go for colposcopy like abnormal cytology would do
21
Q
What is the most common cancer of the vagina?
A
Squamous cell
22
Q
What is the most common cancer of the cervix?
A
Squamous cell
23
Q
What is the most common cancer of the vulva?
A
Squamous cell
24
Q
What is the most common cancer of the ovary?
A
Epithelial (85%), of which 75% are serous
25
What is the most common cancer of the endometrium?
Endometroid carcinoma
26
What is the LFT monitoring regime in OC?
Every 1-2 weeks during pregnancy and at least 10 days postnatally.
If a pregnant patient is itching - this may occur before derranged LFTs - if LFTs normal int eh first instance, check again in 1-2 weeks.
27
What does OC increase the risk of?
1) Passage of meconium
2) Pre-term delivery
3) Fetal distress
4) C-section delivery
5) PPH
28
How long must a woman wait to become pregnant whom has received chemo for gestational trophoblastic disease?
1 year post-completion of treatment
29
What is the frequency of molar pregnancy?
1/1000 pregnancies
30
In what proportion of molar pregnancies is hCG high enough to trigger hyperthyroidism?
3%
31
What is choriocarcinoma?
= a malignant tumour of the trophoblast, 70% occur after a molar pregnancy (20% after TOP, 10% after a normal pregnancy)
32
How do ovarian cancers metastasise?
Transcoelomic route
33
How do choriocarcinomas metastasise?
Haematogenous route
34
When should platelets be administered?
When = 75 give x1 pool
35
When should fibrinogen be administered?
When =2 give x2 pools of cryoprecipitate
36
When should FFP be administered?
If ongoing haemorrhage, after 4 units of blood and no haemostatic tests yet available - give 4 units FFP
If prolonged APTT/PT and haemorrhage ongoing, give 12-15ml/kg of FFP
37
What is a WHO group I ovulation disorder?
Hypothalamic pituitary failure (Stress, anorexia, exercise induced)
38
What is a WHO group II ovulation disorder?
Hypothalamic-pituitary-ovarian dysfunction (PCOS)
39
What is a WHO group III ovulation disorder?
Ovarian failure
40
How do you manage a WHO group I ovulation disorder with regards to fertility?
Increase BMI >19, reduce high levels of exercise, pulsatile GnRH to induce ovulation
41
How do you manage a WHO group II ovulation disorder with regards to fertility?
Weight reduction if BMI <30; clomiphene (1st line); metformin (1st line) - may also be used together; 2nd line = laparoscopic drilling or gonadorophins
42
What is the risk of fetal laceration in CS?
2%
43
What is the average blood loss in a cycle?
35-40ml, max. normal blood loss = 80ml
44
What are the 2 types of endometrial hyperplasia?
1) Hyperplasia without atypia
| 2) Atypical hyperplasia
45
How should endometrial atypical hyperplasia be managed?
Hysterectomy
| IUS or oral progesterone's for those that decline surgery
46
How should endometrial hyperplasia w/out atypia be managed?
IUS first-line with 6 monthly endometrial surveillance
47
What is the progression rate to cancer of endometrial hyperplasia w/out atypia?
<5% over 20 years
48
What is used to inhibit Galactopoiesis and Lactogenesis?
Dopamine
49
After how long do you SUSPECT delay in multips/nullips?
```
Multips = inadequate progress in active 2nd stage after 30 mins
Nullips = inadequate progress in active 2nd stage after 1 hour
```
50
What can you do if you SUSPECT delay in labour?
If membranes intact, may offer amniotomy
51
Is lamotrigine an enzyme inducer?
No
52
What contraceptives may be used with lamotrigine?
Progesterone only
53
Why can't combined contraception be used when a pt is taking lamotrigine?
The oestrogen component has been shown to reduce lamotrigine levels and therefore increases the risk of seizure.
54
What is St Anthony's fire?
= ergotism, i.e. posioning by ergot compounds. Ergometrine is an ergot alkaloid
Erogtism causes convulsions and gangrene, the gangrene being due to prolonged vasospasm
55
What is the only UKMEC 4 condition for POP?
Breast cancer within the last 5 years
56
What produces superior images during hysteroscopy - distension with saline or CO2?
Saline
57
What type of hysteroscopes should be used in outpatient setting?
Miniature hysteroscopes - 2.7mm
58
Which nerve roots does the brachial plexus consist of?
C5-T1
59
What nerve roots are damaged in Erb's palsy?
C5-C6
60
What is the most common cause of Erb's palsy?
Shoulder dystocia
61
What is the prevalence of endometriosis?
2-3%
62
How is stage I endometriosis defined?
Superficial lesions & filmy adhesions
63
How is stage II endometriosis defined?
Deep lesions at cul-de-sac (space between the uterus and the rectum)
64
How is stage III endometriosis defined?
As above + ovarian endometriomas
65
How is stage IV endometriosis defined?
As above + extensive adhesions
66
What are the risks in laparoscopy?
Risk of 'serious' complication = 2/1000
Risk of bowel injury = 0.4/1000
Risk of vascular injury = 0.2/1000
Risk of death = 5/100,000
67
What are your first-line treatments for hyperthyroidism in pregnancy?
Propylthiouracil - as crosses the placenta less readily than carbimazole
Then carbimazole
Radioiodine is contraindicated
68
What are the risk factors for acute fatty liver of pregnancy?
1) Male fetus; 2) Obesity; 3) Nulliparous; 4) Multiple pregnancy
69
What is the cause of acute fatty liver of pregnancy?
Fetal deficiency of long-chain 3-hydroxyl-CoA dehydrogenase (LCHAD) - causes accumulation of toxic products of impaired fatty acid metabolism which then accumulate in the maternal circulation
70
What is the risk of VIN progressing to SCC?
15%
71
What are the histological features of lichen sclerosis?
1) Epidermal atrophy
2) Hydropic degeneration of the basal layer (sub-epidermal hyalinisation)
3) Dermal inflammation
72
What are the histological features of lichen simplex?
1) Epithelial thickening
| 2) Increased mitosis in basal and prikle layers
73
What are the histological features of VIN?
1) Epithelial nuclear atypia
2) Loss of surface differentiation
3) Increased mitosis
74
What would be the cause of a tender nodule during PV exam?
Endometriosis of the uterosacral ligament (sign specific to this)
75
How far back do individuals need to contact trace when diagnosed with an STI?
Men - 4 weeks if was symptomatic, 6 months if were asymptomatic at diagnosis
Women - 6 months
76
Which women would you give 5mg folate to daily?
1) On AEDs
2) Coeliac's
3) DM
4) Prev. neural tube defect
5) FHx neural tube defects
6) On methotrexate
7) Sickle Cell
77
What is the risk cut off at which CVS would be offered?
>1/150
78
In whom should cell salvage be used?
In those whom >1500ml blood loss is anticipated
79
What intra-abdominal pressure is required to insert the primary trocar?
20-25mmHg
80
What intra-abdominal pressure should be maintained once the trochar is inserted?
12-15mmHg
81
What is significant proteinuria?
Significant proteinuria = urinary protein:creatinine ratio >30 mg/mmol
or 24-hour urine collection result shows greater than 300 mg protein
82
What is the Abx regime in medical abortion?
Dual (unless tested -ve for chlyamydia in which case metronidazole PR only) - either azithromycin + metronidazole PR, or doxycycline + metronidazole PR
83
When does the luteoplacental shift occur?
6-8 weeks
84
When should simple ovarian cysts have follow-up?
When they are 50-70mm in daimeter there should be annual USS F/U
85
What is the maternal and fetal mortality rate of acute fatty liver of pregnancy?
20%
86
What is the definition of placenta accreta?
Chorionic villi attached to myometrium rather than decidua basalis
87
What is the definition of placenta increta?
Chorionic villi invade into the myometrium
88
What is the definition of placenta percreta?
Chorionic villi invade through the myometrium and into serosa
89
What proportion of birthing brachial plexus injuries are permanent?
<10%
90
What is the most common form of fibroid degeneration?
Hyaline
91
What is the most common form of fibroid degeneration in pregnancy?
Red
92
What are the Rotterdam criteria for PCOS?
1) Polycystic ovaries (either 12 or more peripheral follicles or increased ovarian volume (greater than 10 cm3)
2) Oligo-ovulation or anovulation
3) Clinical and/or biochemical signs of hyperandrogenism
93
What is the histological feature indicative of serous ovarian cancer?
Psammoma bodies
94
What is the histological feature indicative of mucinous ovarian cancer?
Mucin vacuoles
95
What proportion of pregnancies are choriocarcinoma?
1/45,000
96
How long do afterpains go on for post-delivery?
2-3 days
97
How long does it take for the uterus to involute?
4-6/52
98
How long does it take for vaginal tone to return?
4-6/52
99
How long does lochia flow for?
3-6/52
100
What proportion of women are asymptotic of gonorrhoea?
50%
101
At what gestation does a fetus start to urinate?
Weeks 8-11
102
At what gestation does a fetus start to swallow?
Week 12
103
Which COCP is used in hirsutism?
Dianette (co-cypindriol). It should be discontinued 3-4/12 after resolution of hirsutism. If the hirsutism relapses after discontinuation of Dianette consider use of Yasmin
104
What is the risk of serious neonatal infection in PROM?
1/100
105
When is it reasonable to induce labour in PROM?
When >34/40 and >24 hours post-rupture
| If <34/30, induction shouldn't be performed unless obstetric indication e.g. infection
106
What proportion of women with PROM will go into labour within 24 hours?
60%
107
What are the changes in blood composition in pregnancy?
Platelet count reduced
| Increased ESR, coagulation factors and fibrinogen
108
Should routine episiotomy be performed after previous 3rd/4th degree tears?
No
109
What are the contraindications to ARM?
1) High presenting part (risk of cord prolapse)
2) Preterm labour
3) Known HIV carrier
4) Caution is taken with polyhydramnios or any malposition or malpresentation
5) Placenta praevia
6) Vasa praevia
110
What are the USS features of partial molar pregnancy?
1) Enlarged placenta
2) Fetus with severe structural abnormality
3) Oligohydramnios or deformed gestational sac
111
What are the USS features of complete molar pregnancy?
1) Snowstorm
2) Bunch of grapes - represents swelling of trophoblastic villi
3) No identifiable fetal tissue or gestational sac
112
How long may a tocolytic prolong a pregnancy by?
7 days
113
What proportion of individuals whom are allergic to penicillin will also be allergic to cephalosporins?
0.5-6.5%
114
What are the 1st line choices for OAB after bladder training/treatment of vaginal atrophy?
1. Oxybutynin
2. Tolterodine
3. Darifenacin
115
What are the 2nd line choices for OAB/adjuvant treatments?
2nd line = mirabegron
| Adjuvants = desmopressin if struggling with nocturia; duloxetine if unsuitable for/declines surgery
116
What ABx should given to women with suspected UTI (don't wait for the culture results, start empirical treatment)?
1. Nitrofurantoin 50 mg QDS (or 100 mg MR BD) for 7 days
2. Trimethoprim 200 mg twice daily, for 7 days - give folic acid 5 mg OD if it is the 1st trimester
3. Cefalexin 500 mg BD (or 250 mg 6qds) for 7 days
117
At what gestation should CTG be performed for RFM?
28/40+
118
What should not be used to diagnose BV?
Positive vaginal culture for Gardnerella vaginalis - since can be positive in 50 % of women w/out BV
119
What Hb levels define anaemia in pregnancy?
1st trimester <110
2nd-3rd trimester <105
Postnatal <100
120
At what gestation does amniotic fluid peak?
35/40
121
What is the relative risk of VTE in pregnancy?
4-6x fold increase
122
What is the absolute risk of VTE in pregnancy?
1-2/1000 pregnancies
123
At what gestation may bleeding be defined as APH?
24/40
124
Which clotting factors reduce during pregnancy?
Factors XI and XIII
125
What are the risks of hysteroscopy?
Serious complications = 0.2%
Uterine perforations = 0.13%
Risk of death (under GA) = 8/100,000
126
By what percentage can prophylactic oxytotics reduce the risk of PPH in the 3rd stage?
60%
127
What proportion of women with gonorrhoea will develop PID?
15%
128
What proportion of women are asymptomatic of TV?
50%
129
In whom are polymorphic eruptions of pregnancy more common?
1) Multiple gestation pregnancies
2) Excessive maternal weight
3) Rh +ve blood type
130
When should women whom have previously had GDM be tested in subsequent pregnancies?
As soon as possible after booking
| Otherwise if risk factors alone = week 24-28 pregnancy
131
What tumour markers should you measure in women <40 with a complex ovarian mass and why?
AFP, hCG, lactate
| The reason being to exclude germ cell tumours
132
What us Zavanelli manoeuvre?
Replacement of the baby's head prior to emergency CS
133
What percentage of parasited red blood cells in a pregnant woman can indicate severe malaria?
2%
134
Which Abx is used to treat P vivax, P malariae and P ovale?
Chloroquine
135
Which Abx is used to treat P falciparum?
Clindamycin and quinine (used in combination)
136
How should severe infection with P falciparum be treated?
IV artesunate
137
What is type 1 FGM?
Partial or total removal of the clitoris
138
What is type 2 FGM?
Partial or total removal of clitoris and labia minora (with or w/out excision of the labia majora)
139
What is type 3 FGM?
Narrowing of the vaginal orifice, with or w/out the excision of the clitoris
140
What is type 4 FGM?
All other harmful procedures to the female genitalia including pricking, incising, scraping, piercing and cauterisation
141
What is the correct position for the ventouse cup?
On the sagittal suture line, approximately 3 cm anterior (in front) of the posterior fontanelle
142
What is the risk of uterine perforation in hysteroscopy?
1%
143
Administration of oxytocin reduces the risk of PPH by what percentage?
60%
144
What is the minimum number of sperm in a normal ejaculate?
39x10(6)
145
What is the volume of the female bladder?
400-600ml
146
What is the max. flow rate of urine?
18ml/sec
147
What is the max. normal residual bladder volume?
10ml
148
What are a) the early filling pressure of the bladder; b) micturition prompting pressures; c) max. urethral closing pressure
a) 10
b) 25-40
c) 60
149
In pregnancy are hydroureter and hydronephrosis more common on the R or the L, and it is seen in what proportion of pregnancies?
More common on the R
| Seen in 80% of pregnancies
150
Which oestrogen is secreted predominantly post-menopausally?
Oestrone
151
What happens to testosterone levels post-menopause?
Fall
152
How can OHSS present to an ED/AMU?
Thromboembolic events - preference for upper limb sites and the arterial system
153
In which trimester does obstetric cholestasis usually occur?
3rd trimester
154
What proportion of pregnancies are affected by OC?
0.7%
155
What are tocolytic agents?
Agents used to suppress contractions
156
What are the different tocolytic agents available?
1) B2 agonists - e.g. ritodrine; terbutaline; fenoterol
2) Oxytocin antagonists - e.g. atosiban
3) Ca2+ channel blockers
4) NSAIDs
5) Nitric oxide donors
6) Magnesium sulphate
157
What are the 1st and 2nd choice tocolytics?
1st - nifedipine
| 2nd - atosiban
158
Which women are most likely to benefit from tocolytics?
1) Pre-term labour
2) Those that need transfer to hospitals with neonatal units
3) Those that have not yet completed steroids
159
What is the most significant factor in slowing down drug metabolism in pregnancy?
Progesterone effect on gastric motility
160
What is the lifetime prevalence of fibroids?
30%
161
What type of drug is Levonelle?
Synthetic progesterone
162
What type of drug is EllaOne?
Selective progesterone receptor modulator
163
Can women using enzyme inducers - e.g. phenytoin - use hormonal EC?
Yes - double dose of ullipristal. Copper IUS preferred
164
What is the incidence of obstetric anal sphincter injuries (OASIS)?
2.9%
165
What is the incidence of OASIS in primips?
6.1%
166
What is the incidence of OASIS in multips?
1.7%
167
What percentage of women with OASIS will be asymptomatic at 12 months post-delivery?
60-80%
168
What type of stitch is used in the anorectal mucosa?
Continuous interrupted suture
| 3-0 vicryl (braided)
169
What type of stitch is used in the external anal sphincter?
End-to-End sutures
| Either 3-0 PDS (monofilament) or 2-0 vicryl (braided)
170
What type of stitch is used in the internal anal sphincter?
Interrupted mattress
| Either 3-0 PDS (monofilament) or 2-0 vicryl (braided)
171
What are the risks of abdominal hysterectomy?
```
Overall serious complications = 4%
Haemorrhage requiring transfusion = 2.3%
Bladder/ureter injury = 0.7%
Return to theatre = 0.7%
VTE = 0.4%
Pelvic abscess/infection = 0.2%
Bowel injury = 0.04%
Risk of death w/in 6/52 = 0.03%
```
172
What is the risk of serious complication in abdominal hysterectomy?
4%
173
What is the risk of haemorrhage requiring transfusion in abdominal hysterectomy?
2.3%
174
What is the risk of bladder/ureter injury in abdominal hysterectomy?
0.7%
175
What is the risk of returning to theatre in abdominal hysterectomy?
0.7%
176
What is the risk of VTE in abdominal hysterectomy?
0.4%
177
What is the risk of pelvic abscess/infection in abdominal hysterectomy?
0.2%
178
What is the risk of bowel injury in abdominal hysterectomy?
0.04%
179
What is the risk of death w/in 6/52 in abdominal hysterectomy?
0.03%
180
What are the constituents of breast milk?
Fat 4%; Protein 1%; Sugar 7%
181
What is the risk of placenta accreta/increta/percreta?
1.7/10,000 deliveries
182
What is the mode of action of tranexamic acid?
Inhibits plasminogen activation
| Can reduce flow by 50%
183
What is the mode of action of mefenamic acid?
Inhibits prostaglandin synthesis
| Reduces menstrual loss by 25%
184
What is the most common type 2 congenital thrombophillia?
Factor V Leiden
185
What are examples of type I thrombophillia?
Protein C + S deficiencies
186
What type of thrombophillia is antiphospholipid?
Acquired
187
What is current?
Rate of flow (amps)
188
What is voltage?
Force of flow (volts)
189
At what frequency do electrosurgery generators operate at?
200kHz - 3.3 MHz
190
At what temp does tissue death occur in electrosurgery?
45 degrees
191
At what temp does coagulation occur in electrosurgery?
70 degrees
192
At what temp does desiccation occur in electrosurgery?
90 degrees
193
At what temp does vaporisation occur in electrosurgery?
100 degrees
194
At what temp does carbonisation occur in electrosurgery?
200 degrees
195
What is cut mode in electrosurgery?
Continuous wave form at low voltage
196
What is coagulation mode in electrosurgery?
Current produced in spikes at higher voltage
197
What should the surgical site infection rate be below?
<2%
198
SSI causes an average increase in hospital stay of how many days?
6.5 days
199
What are Littlewoods forceps usually used for?
Grasping rectus sheath
200
What are Rampley forceps usually used for?
Swab on a stick
201
What are Babcocks used for?
Delicate structures e.g. ovaries/fallopian tubes
202
What are vullselum forceps used for?
Cervical lip grabbing
203
What are the commonly used types of retractors?
Doyens and Langenbecks
204
What are Green-Armytage's used for?
Haemostatic forceps - usually 4, one on each side of uterine incision angle
205
What are the different surgical positions?
1) Lithotomy
2) Trendelenberg - 45 degrees head down tilt
3) Lloyd Daavis - 30 degrees head down tilt, hips flexed at 15 degrees
206
What is the risk of Trendelenberg position?
Can increase V/Q perfusion mismatch and increase ICP
207
What size suture is used in uterine culture?
Size 1
208
What is the symbol representing a cutting needle?
Downwards triangle
209
What is the symbol representing a tapered point needle?
Circle with a dot in the middle
210
What is the healing time of skin?
1-2 weeks
211
What is the healing time of peritoneum?
4-10 days
212
What is the healing time of uterus?
8 days
213
What is the healing time of vagina and perinum?
8-10 days
214
What is the healing time of bladder?
5 days
215
What are the rates of instrumental delivery in the UK?
10-13%
216
What is an OUTLET instrumental delivery?
Fetal scalp visible w/out parting the labia
217
What is a LOW cavity instrumental delivery?
Leading point of skull is at station +2
218
What is a MID cavity instrumental delivery?
Fetal head no more 1/5th palpable per abdomen, leading point of skull above station +2
219
What are the indications for instrumental delivery?
1) Inadequate progress, inc. maternal fatigue
| 2) Maternal factors - e.g. to reduce effects of 2nd stage labour on medical conditions
220
What is inadequate progress in nullips?
Lack of progress for 2 hours w/out regional anaesthesia (suspect after 1 hours)
221
What is inadequate progress in multips?
Lack of progress for 1 hour w/out regional anaesthesia (suspect after 30 mins)
222
What are the pre-requisites for instrumental delivery?
1) Head <1/5th palpable in the abdomen
2) Cervix fully-dilated
3) Membranes ruptured
4) Vertex presentation
5) Assessment of caput and moulding
6) Pelvis deemed inadequate
7) Consent
8) Asepsis
9) Analgesia
10) Maternal bladder emptied
223
What conditions favour ventouse to forceps?
1) Urgent low lift out with no analgesia on-board
2) Rotational delivery
3) Operator/maternal preference when either instrument can be used
224
What conditions favour forceps to ventouse?
1) Poor maternal effort
2) Operator/maternal preference when either instrument can be used
3) Large amount of caput
4) Gestation <34/40
5) Marked active bleeding from FBS site
6) Face presentation
225
What are the neonatal risks of ventouse?
Cephalohaematoma
| Retinal haemorrhage
226
What are the indications for FBS?
1) Pathological CTG in labour (cervix >3cm)
| 2) Suspected acidosis in labour (cervix >3cm)
227
What are the contraindications for FBS?
1) Maternal infection; 2) Fetal blood disorders; 3) Prematurity; 4) Acute fetal compromise (e.g. prolonged bradycardia)
228
What does a fetal pH of >/= 7.25 mean?
Normal, repeat after an hour in CTG remains same
229
What does fetal pH of 7.21-7.24 mean?
Borderline, repeat after 30 mins
230
What does fetal pH of = 7.2 mean?
Abnormal, consider delivery
231
What are the limitations of continuous electronic fetal monitoring?
1) Decreased mobility; 2) Increased intervention; 3) Variation in CTG interpretation; 4) Chorioamnionitis can make interpretation unreliable
232
What is the recording rate of CTG?
1cm/min
233
What is the rule of 3 for fetal bradycardia?
3 mins - call for help
6 mins - move to theatre
9 mins - prepare for assisted delivery
12 mins - aim to deliver the baby
234
From what gestation can CTG replace handheld doppler to assess fetal movements?
24/40
235
What is the earliest gestation that fetal heart can be detected on a transvaginal USS?
5-6 weeks
236
What enzyme level may be raised in sarcoidosis?
ACE
237
What is normal CTG variability?
5-25
238
At what hCG level would a single intrauterine pregnancy be visible on scan?
1000-2400
239
Which bacterial cell component is detected by gram staining?
Peptidoglycan
240
What is a risk factor for ectopic pregnancy?
Smoking
241
What is the medical treatment for ectopic pregnancy?
Methotrexate 75mg IM STAT
242
What proportion of teratomas are bilateral?
10%
243
What is the radiation dose of a CXR? Chest CT?
| Abdo/pelvis CT/background?
CXR - 0.1 mSv
CT chest - 7 mSv
CT abdo/pelvis - 10 mSv
Background - 3mSv
244
What is the causative agent of Kapsoi sarcoma?
Human herpes virus 8
245
When in cutaneous wound healing do macrophages replace neutrophils?
48-92 hours
246
What is stage 1 of labour?
Effacement and dilatation of the cervix up to 10cm
- --> Latent phase = <4cm
- --> Active phase =>4cm
247
What is stage 2 of labour?
From full dilatation to delivery of the fetus
- --> Propulsive phase
- --> Expulsive phase
248
What is the process of delivery?
Engagement ---> descent and flexion ---> Fetal head rotation to OA ---> Extension and delivery of head ---> Restitution ---> Delivery of shoulders/body
249
What are the different types of breech?
Extended (or frank)
Flexed (or complete)
Footling
250
What are the fetal risks of vaginal breech delivery?
1. Intracranial haemorrhage
2. Brachial plexus injury
3. Limb fractures
4. Spinal cord injury
251
Why is the presentation USUALLY cephalic?
1. Piriform shaped uterus
| 2. Calcification of the fetal skull, and therefore increased density
252
What is the incidence of shoulder dystocia?
0.6%
253
Which shoulder is most commonly involved in shoulder dystocia?
Anterior shoulder
254
What is hypoxaemia? And how does the fetus respond to it?
Decreased O2 content in arterial blood with normal cell and organ function
Reduced activity of fetus ---> decreased fetal growth rate
255
What is hypoxia? And how does the fetus respond to it?
O2 deficiency which affects peripheral tissues
Surge of stress hormones ---> reduced peripheral blood flow ---> redistribution of blood flow to central organs ---> peripheral tissues enter anaerobic metabolism
256
What is spalding sign?
Spalding sign on XR represents overlapping fetal skull bones in advanced maceration of fetal tissues
257
What is the speed of CTG recording?
1cm/min
258
What is the false +ve rate of CTG?
50%
259
What are the causes of reduced variability?
Sleep cycle
| Pre-terminal pattern
260
When is a sinusoidal pattern seen on CTG?
Seen in fetal anaemia or feto-maternal haemorrhage
Frequency of 3-5 cycles/min
Seen as a smooth undulating sine wave pattern
261
What are the 4 patterns of hypoxic change?
Acute - sudden drop in baseline rate
Subacute - HR below the baseline the majority of the time
Evolving - decelerations --> loss of accelerations --> tachycardia ---> loss of variability
Chronic
262
What are the causes of acute hypoxia?
1. Unknown - approx. 50%
2. Placental abruption
3. Uterine rupture
4. Cord prolapse
5. Epidural top-up
263
What are the stages of evolving hypoxia?
1. Stress stage - decelerations
2. Distress stage - max. tachycardia, marked reduction in variability
3. Collapse stage
264
What is evolving hypoxia also known as?
Hon's stepladder pattern to death
265
Which of the androgens in females is the most potent?
Dihydrotestosterone
266
What is the distance between two z lines in a muscle fibre?
Sarcomeres
