general Flashcards
(203 cards)
1
Q
how many no. of pregnancies are induced
A
1/5
2
Q
indications for induction of pregnancy
A
diabetes post dates DVT/Preeclampsia oligohydramnios growth concerns
3
Q
post dates time frame for induction of pregnancy
A
+7 days
4
Q
Bishop’s score is for
A
clinically assessing the cervix and the success of induction
5
Q
first stage suboptimal progress for primigravid women are
A
less than 0.5cm per hour
6
Q
first stage suboptimal progress for parous women are
A
less than 1cm per hour
7
Q
average rate of C section percentage is
A
25%
8
Q
post partum we see midwife for how many days?
A
9-10 days
9
Q
postnatal checkup at GP is at what week?
A
6
10
Q
primary postpartum haemorrhage classification
A
> 500mls within 24hrs of delivery
11
Q
secondary postpartum haemorrhage classification
A
blood loss > 500ml from 24 hrs post partum 6 weeks
12
Q
how many times is a pregnant women likely to develop a DVT
A
6-10 times
13
Q
a quarter of women who died six weeks and one year after pregnancy due to
A
mental health related causes
14
Q
morning sickness affects what percentage of women
A
80-85%
15
Q
morning sickness is related too
A
increased human chorionic gonadotrophin
16
Q
HR in pregnancy increases too
A
70-90bpm
17
Q
CO increases in pregnancy by
A
30-50%
18
Q
why does blood pressure drop in second semester
A
expansion of uteroplacental circulation
fall in systemic vascular resistance
reduction in blood viscosity
reduction in sensitivity to angiotensin
19
Q
renal plasma flow increases by
A
25-50%
20
Q
GFR increases by
A
50%
21
Q
serum urea and creatinine increases or decreases?
A
decreases
22
Q
RBC mass increases by
A
25%
23
Q
plasma volume increases by
A
50%
24
Q
iron req. for pregnancy increases or decreases by
A
increases by 1g
25
platelets increases or decreases preg.
falls
26
WBC increases or decreases preg.
increases slightly
27
why does Gi motility decrease preg
increased progesterone, reduced motilin
28
oxygen consumption increases in pregnancy by
20%
29
effects of progesterone centrally
increased tidal volume, RR and plasma pH
30
is plasma PO2 effected by pregnancy
unchanged
31
what happens to respiratory mucous membranes in pregnancy
hyperaemia
32
what number of pregnancies are unplanned
1/3
33
hepatitis B solutions in pregnancy if tested positive
passive and active immunity for the baby
34
syphilis for pregnancy if positive
penicillin
35
isoimmunisation screening is for
rhesus disease, anti-c, anti-kell
36
overall risk for Down syndrome is
1/700
37
further testing for down syndrome is risk is greater than
>1 in 150
38
CVS is performed between the weeks of
10-14 weeks
39
amniocentesis is conducted between
15 weeks onward
40
bladder injury risk in C section
1/1000
41
risk of ureteric injury in C section
1/10000
42
physiological hydro nephrosis can occur how long post partum
6 weeks
43
what side is dilatation more pronounced for ureters
right
44
differentials for severe right iliac fossa pain, tender in RIF, guarding, tachycardia
```
ovarian torsion
appendicitis
renal calculi
constipation
ectopic pregnancy
```
45
oestradiol arises from
granulosa cells
46
bulbourethral gland produces what percentage of seminal fluid
5%
47
prostate gland produces what percentage of seminal fluid
30%
48
seminal vesicle produces what percentage of seminal fluid
60%
49
mammography is normally for people over the age of
40
50
mammography for under the age of 40 if
suspicion of cancer
| FH >40%
51
US is first line for
under 40 age group
52
sensitivity or specificity for MRI of breast disease
specificity is poor
53
breast screening is for women
50-70
54
how many years between breast screens
3 years
55
how mammograms detect cancer per 1000
5
56
5 year survival all stages of ovarian cancer is
30%
57
high risk families constitute what percentage of ovarian cancers
5-10%
58
genetic types for high risk ovarian cancer families
HNPCC, BRAC1, BRAC2
59
what percentage of women with ovarian cancer have raised CA 125
80%
60
stage 1 ovarian cancer
limited ovaries with capsule intact
61
stage 2 of ovarian cancer
one or both ovaries with pelvic extension
62
stage 3 of ovarian cancer
one or both ovaries with peritoneal implants outside pelvis or + nodes
63
stage 4 of ovarian cancer
distant metastasis
64
first line pharma treatment for ovarian cancer
platinum and taxane
65
ovarian cancer chemo should be within how many weeks of surgery
8 weeks
66
66 year old para 1 with 6 month Hx of abd discomfort, early satiety and constipation, Ca 125 2560 you consider...
ovarian cancer
67
what percentage of vulvovaginal candiosis is candida albicans
90%
68
progesterone converts endometrium into
decidua
69
what occurs as endometrium into decidua
increases vascularity, between glands and vessels enlarge and become procoagulant
70
what are the cells on the outer edge of chorion
trophoblast cells
71
what types of pregnancy is susceptible to twin to twin transfusion
monochorionic diamniotic
| monochorionic monoamniotic
72
two separate placenta, two sacs means
dichorionic diamniotic
73
one sac one placenta
monochorionic monoamniotic
74
T sign on ultrasound refers too
monochorionic
75
Lamda signs on US refers too
dichorionic
76
spontaneous miscarriage refers too before how many weeks of gestation
before 24 weeks
77
incidence of spontaneous miscarriage
15%
78
aetiology of spontaneous miscarriage
```
abnormal conceptus
uterine abnormality
cervical incompetence
maternal
idiopathic
```
79
incidence of ectopic pregnancy
1:90
80
risk factors for ectopic pregnancy
pelvic inflammatory disease
tubal surgery
previous ectopic
assisted conception
81
placenta praevia refers too
all or part of placenta implants in lower uterine segment
82
incidence of placenta praevia
1/200
83
placenta praevia more common in
multiparous women
multi pregnancy
prior C section
84
placenta praevia grade 1
encroaching on lower segment but not internal cervical os
85
placenta praevia grade 2
reaches internal os
86
placenta praevia grade 3
placenta eccentrically covers os
87
placenta praevia grade 4
central
88
key feature of placenta praevia
PAINLESS PV BLEEDING
89
what examination should never be done with placenta praevia
vaginal examination
90
placental abruption refers too
haemorrhage from premature separation of placenta before birth of baby
91
incidence of placental abruption
0.6%
92
key feature of placental abruption
pain
93
spot urinary protein: creatinine ratio is (in pregnancy for hypertension)
>30 mg/mmol
94
24 hour urine protein collection is (in pregnancy for hypertension)
>300mg/day
95
physiology of pre-eclampsia
immunity
genetic
failure of maternal spiral arterioles
imbalance between prostacyclin/thromboxane
96
the pearl index refers too
no. of contraceptive failures per 100 women-years of exposure
97
most sperm survive less than how many days?
4
98
highest chance of pregnancy is from sex on day
8-19
99
standard regime for combined hormonal contraception
21 days with a hormone free week
100
EVRA patch has to be changed every
week
101
Nuvaring has to be changed every
3 weeks
102
how long can a nuvaring be removed for and still be effective
3 hrs in 24hr
103
what is the reduction in ovarian and endometrial cancer for combined method of hormonal contraception
50%
104
benefits of combined hormonal contraception
reduced/ regulate bleeding
stop ovulation
reduction in functional cysts
reduction in ovarian and endometrial cancer
improve acne
reduction in benign breast disease, RA, colon cancer and osteoporosis
105
avoid CHC in
smokers >35m PH of arterial thrombosis, focal migraine, age >50, hypertension, BMI >34, previous VTE, relative under 45 with VTE, thrombophilia, active gall bladder disease, previous tumour
106
delay in return to fertility with injectable progestogen
9 months
107
what percentage of progestogen implants have prolonged frequent bleeding
30%
108
intrauterine contraception risk of perforation
1:1000
109
risk of intrauterine contraception of expulsion
5:100
110
how many years can a copper IUD last
5-10 years
111
emergency contraception Copper IUD time frame
within 120 hours or by day 19 of a 28 day cycles
112
if 100 women use an emergency IUD there will be how many pregnancies?
<1
113
levonorgestrel pill timeframe for emergency use
72 hrs
114
levonorgestrel 100 women emergency use how many pregnancies?
2-3
115
ulipristal pill emergency take within what timeframe?
120hours
116
ulipristal pill how many women use emergency will result out of pregnancy 100
1-2
117
can get pregnant how many days after delivery?
21
118
how many days can one get pregnant post miscarriage or abortion?
5 days
119
termination of pregnancy what number of women In the u.k will have an abortion
1/3
120
role of misoprostol in termination of pregnancy
initiates uterine contraction which opens cervix and expels pregnancy
121
mifepristone is an
oral antiprogestogen tablet for termination of pregnancy
122
bladder fills at the rate of
0.5-5mls/min
123
what percentage of women aged 15-60 report urinary incontinence
10-25%
124
what percentage of women over the age of 60 in the community report incontinence
15-40%
125
what percentage of women in nursing home are incontinent
50%
126
pharmacological treatment for overactive bladder syndrome
anti-muscarinic, tri-cyclic antidepressants
127
FNA needle is a
23G
128
cytology scoring for breast disease C1
unsatisfactory
129
cytology scoring for breast disease C2
benign
130
cytology scoring for breast disease C3
atypia (probably benign)
131
cytology scoring for breast disease C4
suspicious (probably malignant)
132
cytology scoring for breast disease C5
malignant
133
limitations for FNA in breast disease
grading or invasion not assessed
lesion missed
difficulty to examine
interpretation
134
complications of FNA
```
pain
haematoma
fainting
infection
pneumothorax
```
135
core biopsy needle size
14G
136
Duchenne muscular dystrophy is a
x-linked fatal disease that occurs in early adult life
137
what can Duchenne muscular dystrophy be diagnosed
prenatal diagnosis, pre-implantation diagnosis
138
screening in babies for
PKU, congenital hypothyroidism, CF, MCADD
139
what number of couples report infertility problems?
1/7
140
definition of infertility
It is defined as inability of a couple to conceive after 12 months of regular intercourse without use of contraception.
141
what percentage of couples conceive within 1 year
80% of couples in the general population will conceive within 1 year
142
Klinefelter syndrome is a chromosomal abnormality of
XXY
143
fertility issues of Klinefelter syndrome
small testes and almost always azoospermia
144
A 24-year-old presents with an 18-month history of amenorrhoea since stopping the oral contraceptive pill 18 months ago in order to try for a pregnancy. She had been on the combined pill since she was 16, during which time her periods had been regular. Her BMI currently is 31.
What is the most appropriate next step for investigation?
1) A diagnostic laparoscopy
2) A pelvic ultrasound scan
3) Hormone profile to check SHBG, free testosterone and FSH and LH and prolactin
4) MRI of pelvis to exclude pelvic mass
3) hormone profile
145
A 24-year-old presents with an 18-month history of amenorrhoea since stopping the oral contraceptive pill 18 months ago in order to try for a pregnancy. She had been on the combined pill since she was 16, during which time her periods had been regular. Her BMI currently is 31.
What is the likely diagnosis?
1) Anorexia nervosa
2) Hyperprolactinaemia
3) Hypogonadotrophic hypogonadism
4) Polycystic ovarian syndrome
5) Premature ovarian failure
4) PCOS
146
Which of the following is correct with regards to the diagnosis of PCOS?
1) A high FSH and LH level
2) Affected women are very fertile
3) Affects >50% of the infertile population
4) Metformin is contraindicated
5) Ultrasound appearance of a large number of follicles arranged peripherally in the ovarian cortex of large volume ovaries
Ultrasound appearance of a large number of follicles arranged peripherally in the ovarian cortex of large volume ovaries
147
A 28-year-old with PCOS and primary subfertility of 4 years attends the fertility clinic. Her cycles are very irregular and she is currently on metformin, which is helping with her weight control (BMI 28), but is she still is amenorrhoeaic. She is very keen to commence with fertility treatment. An hysterosalpingogram confirmed bilaterally patent tubes.
What is the most appropriate initial management of her subfertility?
1) Advice on weight loss and review in 6 months
2) Intrauterine insemination for six cycles
3) Laparoscopic diathermy to ovaries
4) Ovulation induction with clomifene 50 mg for 6 months
5) Recommend one cycle of IVF treatment
Ovulation induction with clomifene 50 mg for 6 months
148
maternal mortality timeframe
while pregnant or within 42 days of termination of pregnancy
149
1 maternal death occurs every how much minutes?
2
150
what percentage of maternal death is preventable?
>80%
151
leading cause of maternal death worldwide?
haemorrhage
152
normal frequency of menstruation
24-38 days
153
normal regularity of menstruation
<20 days variation
154
normal duration of menstruation
2-7 days
155
volume normal of menstruation
5-80 mls
156
what percentage of women aged between 30-49 see a GP in regards to heavy menstrual bleeding?
5%
157
PALM COEIN causes for heavy bleeding
```
Polyp
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy
ovulation dysfunction
endometrium
iatrogenic
not yet classified
```
158
within the second stage of labour a primigravida birth should be expected within how many hours?
2hrs
159
within the second stage of labour a multigravida birth should be expected within how many hours?
one hour
160
Gillick competence refers too
Children under 16 can consent if they have sufficient understanding and intelligence to fully understand what is involved in a proposed treatment, including its purpose, nature, likely effects and risks, chances of success and the availability of other options
161
if a child fails the Gillick competence then
the consent of a person with parental responsibility (or sometimes the courts) is needed in order to proceed with treatment.
162
what percentage of adolescents presenting with chronic pelvic pain have endometriosis
38%
163
intraduct papilloma usually effects what age group of women?
middle aged women
164
appearance of breast fat necrosis of histology
histocytes with foamy cytoplasm, lipid filled cysts, calcifications
165
what has an egg shell appearance on a mammography?
fat necrosis
166
phyllodes tumour appearance
leaf like pattern and cysts on cut surface
167
fibroadenoma is most common breast tumour in which group?
adolescent and young adult women
168
phyllodes tumour spread is
haematogenous
169
what percentage of breast cancers can be attributed to inherited factors
5-10%
170
ER/PR positive breast tumour marks strong response to
hormonal therapy
171
HEr-2 positive breast tumour predicts response to
20/30% to trastuzumab
172
prolapse percentage effecting of multiparous women
12-30%
173
biggest risk of teratogenicity is during which phase?
3-8 weeks during organogenesis
174
male Sertoli cells role
support sperm, producing cells, produce inhibin
175
Leydig cells in men produce
testosterone
176
CRP increases or decreases in pregnancy
maintains the same
177
ESR increases or decreases in pregnancy
increases
178
24hr protein increases or decreases in pregnancy
increases
179
total protein increases or decreases in pregnancy
decreases
180
albumin increases or decreases in pregnancy
decreases
181
Alk Phos increases or decreases
greatly increases
182
D dimer increases or decreases
increases
183
CI to systemic HRT
```
hormone dependent cancer endometrium/breast
active liver disease
abnormal bleeding
thrombophilia
prior breast cancer or BRCA carrier
```
184
why is breast imaging sensitivity be reduced in young women
increased presence of glandular tissue
185
T2 breast cancer
tumour size 2-5cm
186
T3 breast cancer
5>cm
187
T4a breast cancer
tumour invading skin
188
T4b breast cancer
invading chest wall
189
T4c breast cancer
tumour invading both
190
T4d breast cancer
inflammatory breast cancer
191
complications of axillary treatment
```
lymphoedema
sensory disturbance
decrease ROM of shoulder joint
nerve damage
vascular damage
radiation induced sarcoma
```
192
endometrial cancer stage 1A
inner half of myometrium
193
endometrial cancer stage 1B
outer half of myometrium
194
endometrial cancer stage 2
invades cervix
195
endometrial cancer stage 3A
serosa/adnexa
196
endometrial cancer stage 3B
vagina/parametrium
197
endometrial cancer stage 3C
pelvic or para-aortic nodes
198
endometrial cancer stage 4
bladder/bowel/intra-abdominal/inguinal nodes
199
average incubation period of Gonorrhoea
5-6 days
200
follow up for reinfection for chlamydia
3-12 months
201
follow up for reinfection for Gonorrhoea
2 weeks and test of reinfection at 3 months
202
what percentage of the U.K. population has herpes
15-20%
203
anogenital warts causes
HPV type 6 and 11
