O&G (19/06) Flashcards
(194 cards)
1
Q
Treatment for stage 1 cervical cancer?
A
Cone biopsy
2
Q
Treatment for stage 2 cervical cancer?
A
Radical hysterectomy (radical trachelecomy to preserve fertility)
3
Q
Treatment for stage 3+ cervical cancer?
A
Chemo-radiotherapy
4
Q
A 22 year old girl presents to rapid access clinic with persistent bloating, 5kg weight loss and lower abdominal pain. Abdominal examination demonstrates tense ascites. VE reveals a mobile AV uterus with a firm right-sided adnexal mass. What would be the most appropriate next step in her management?
A
Urgent ultrasound abdomen/pelvis
5
Q
Epithelial cancers of the ovary?
A
Serous and mucinous cystadenoma (serous is more common)
6
Q
Stages of ovarian cancer?
A
Stage 1 - limited to ovaries
Stage 2 - limited to pelvis
Stage 3 - limited to abdomen
Stage 4 - distant mets
7
Q
Treatment for vulval cancer?
A
Can perform wide local excision (1a), groin lymphadenectomy or radical vulvectomy
8
Q
Cause of urge incontinence?
A
Overactive destrusor activity
9
Q
Invasive options if incontinence caused by destrusor activity?
A
Botox injection
* Percutaneous sacral nerve stimulation
* Augmentation cystoplasty
* Urinary diversion
10
Q
Surgical management of stress incontinence?
A
Colposuspension or
Autologus rectal fascia sling
Can also offer mid-urethral mesh sling but should not be offered first line as per NICE guidance
11
Q
Staging of pelvic organ prolapse?
A
POPQ score - 1 to 4
12
Q
Treatment options for uterine prolapse?
A
- Vaginal hysterectomy +/- sacrospinous fixation
- Sacrospinous hysteropexy
- Manchester repair (a.k.a Fothergill operation)
- Sacro-hysteropexy with mesh
13
Q
Treatment for rectocele?
A
Posterior repair
14
Q
Treatment for cystocele?
A
Anterior repair
15
Q
Primary amenorhoea
A
Girls who have not established menstruation by the age of 13 years and have no secondary sexual characteristics (such as breast development).
* Girls who have not established menstruation by the age of 15 years and have normal secondary sexual characteristics.
16
Q
Submucosal fibroids can lead to what?
A
Menorrhagia or IMB
17
Q
Gold standard Ix for endometriosis?
A
Diagnostic laproscopy
18
Q
Mood disturbance associated with which phase of menstrual cycle?
A
Luteal
19
Q
Rotterdam criteria for PCOS:
A
Oligo/anovulation (> 2 years)
* Clinical or biochemical features of hyperandrogenism
* Polycystic ovaries on ultrasound (> 12 in one ovary measuring 2-9 mm in diameter)
Associated with insulin resistance
20
Q
How long can clomiphene be used for?
A
6 months
21
Q
MOA of clomiphene in pcos?
A
selective estrogen receptor modulator (SERM)
22
Q
Surgical treatment to enhance fertility in PCOS?
A
Laparoscopic ovarian drilling
23
Q
AMH demonstrates what?
A
Ovarian reserve
24
Q
When is laproscopy and dye performed?
A
Subfertility with history of tubal disease
25
Investigating subfertiltiy
Blood hormones: day 2-3 FSH, LH and oestradiol. AMH demonstrates ovarian reserve
* STI screening
* TVUS and antral follicle count
* Tubal assessment (HYSTEROSALPINGOGRAM or LAP+DYE)
* Semen analysis
26
Treatment for Failed IUI/ovulation induction?
ICSI
27
Ovarian causes of amenorrhoea?
POI, menopause, Turner's syndrome (46XO), gonadal dysgenesis, androgen insensitivity
28
Causes of POI?
Chemo/radiotherapy exposure.
Addisions, thyroid disease
Genetic
Idiopathic
29
When to give continuous combined HRT?
Tend to give continuous to women who are definitely post-menopausal otherwise can cause erratic bleeding in perimenopausal women
30
history of poor memory, difficulty in word finding and difficulty in planning.
Alzheimer's disease
31
uterine rupture
This may be preceded by hypercontractility of the uterus. The rupture results in fetal compromise with reduced fetal movements and bradycardia. Rupture into the bladder may result in haematuria. Suprapubic pain is a classic symptom.
32
Antibiotics for endometritis?
Clindamycin and gentamicin
33
Definition of pre-eclampsia?
BP >140/90 and proteinuria with any of the following
Severe headache
Visual disturbance
Severe RUQ pain / vomiting / liver tenderness
Papillodema
>3 beats of clonus
HELLP
Platelets <150, ALT >70
BP >160/110 and proteinuria (PCR >30*)
34
Contraindication to ergometrine?
Blood pressure issues.
35
Contraindication to carboprost?
Asthma
36
Treatment for pyloric stenosis?
Pyloromyotomy
37
Sign of duodenal atresia?
Abdominal X-ray – ‘double bubble’
38
Ix for hirschsprung's disease?
Full length rectal biopsy
39
Intussception management?
Reduction with air insufflation
Operative reduction
40
Treatment of pyelonephritis?
IV Ceftriaxone and Gentamicin
41
When to do DMSA?
DMSA (dimercaptosuccinic acid scintigraphy) 4-6 months after infection
Used to detect renal parenchymal defects i.e. scarring
In all children under 3 with atypical/recurrent UTI
In all children over 3 with recurrent UTI
42
Microbe cause of epiglottitis?
Haemophilus influenzae B
43
Treatment for eppiglottitis?
IV Ceftriaxone
44
Which scan increases risk of maternal breast cancer?
CTPA
45
Which scan increases the risk of childhood malignancy?
V/Q scan
46
Antihypertensive in labour?
PO labetalol
47
Which malignant breast cancer affects young women?
Dysgerminoma
48
What is not a common cause for oligomenorrhoea?
Copper IUD
49
Can obesity cause oligomenorrhoea?
Yes!
50
During the evaluation of secondary amenorrhea in a 24-year-old woman, hyperprolactinaemia is diagnosed. Which of the following conditions could cause increased circulating prolactin concentration and amenorrhea in this patient?
Stress
51
A 4 year old boy is brought to the emergency department due to non blanching rash on both his legs. He also has swelling to his face and abdominal distension. He has been unwell for 4 days leading up to this with abdominal pain and bloody diarrhoea. Blood tests show an acute renal injury, anaemia, and thrombocytopenia. His urine dip shows 3+ proteinurea and haematuria. What is the most likely diagnosis?
Haemolytic uraemic syndrome
52
Rash behind the ears?
Measles
53
Definitive management of septic arthritis?
Joint aspiration and washout with IV antibiotics
54
Lumacaftor is a novel drug used to treat Cystic Fibrosis. What is it's mechanism of action?
prevents misfolding and increases protein trafficking
55
A 7 year old child with Down Syndrome presents to A&E with bilious vomiting and some abdominal distension.
What is the most likely diagnosis?
Volvulus
56
A neonate born at 34 weeks is found in NICU to be passing bloody stools and have profound abdominal distension. Given the likely diagnosis, the consultant asks the keen medical student what would be an X-ray sign for an urgent laparotomy?
Rigler's sign
The situation is describing NEC
57
An atypical UTI in children usually requires further investigations. Which of these options are listed in the NICE guidelines as a feature?
Increased UTI
58
When to do an USS during an acute UTI?
During acute infection if atypical UTI or child less than 6 months with recurrent UTI
59
Signs of atypical UTI
Poor urine flow.
Abdominal or bladder mass.
Raised creatinine.
Sepsis.
Failure to respond to treatment with suitable antibiotics within 48 hours.
Infection with non-E. coli organisms.
60
When to do an USS 6 weeks following UTI?
Within 6 weeks for children aged 6 months and over with recurrent UTI.
Within 6 weeks, for all children younger than 6 months of age with first-time UTI that responds to treatment.
61
When to do a DMSA scan at 4-6 months following UTI?
All children aged under 3 years with atypical or recurrent UTI.
All children aged 3 years or over with recurrent UTI.
62
When to offer IV syntocinon?
2 hours after ARM if labour has not ensued
63
Major PPH
>1000ml
64
Treatment for toxoplasmosis?
Spiromycin
65
First line for agitated patients medication?
PO, is it haloperidol?
66
HSV in third trimester?
Offer C-section delivery
If vaginal delivery, give IV aciclovir intrapartum and to the neonate
67
Neonate with HIV positive mother with >50 copies/mL treatment
Triple ART within 4 hours of birth for 4 weeks if high risk
Do PCR test at 6 weeks, 12 weeks and 18 months
68
Why stop methyldopa post-partum?
Can cause depression
69
Mode of delivery for MCMA twins?
Elective C section at 32 weeks
70
When to deliver MCDA twins?
36 weeks
71
When to do deliver DCDA twins?
37 weeks
72
Lamda sign indicates which twins?
DCDA
73
How long to avoid conceiving after methotrexate?
3 months
74
Management for mole pregnancy?
Suction cutterage
75
MOA of ullipristal?
Progesterone receptor modulator - inhibits ovulation
76
MOA of mirena?
Thins the womb lining
77
MOA of POP?
Thickens cervical mucus
78
Effect of clomphiene?
Increases chance of multiple pregnancy
79
BV treatment?
Metronidazole (fishy smell)
80
What is colpocleisis?
Involves closure of the vagina to treat prolapse
81
Does uterine artery embolism affect fertility?
Yes
82
Cysts in young women?
<50mm = doesn't require follow up
50-70mm = require yearly USS f/u
>70mm = Requires further imaging and maybe surgical intervention
83
Constituents of RMI?
USS features, menopausal cysts + CA 125 (concerning if over 35)
84
How frequently does puerperal psychosis reccur?
50%
85
PMS Ix?
Must do a menstrual diary
Treat with COCP and referral for CBT
Can give SSRI for severe PMS
86
Cause of cerebral palsy?
Hypoxic ischaemic encephalopathy
87
Treatment for ASD?
Transcatheter closure
88
Treatment of PDA?
Indomethacin is first line. Otherwise may need surgical ligation or percutaneous catheter device closure
89
Treatment for pulmonary stenosis?
Transcatheter balloon dilatation
90
TOF treatment?
Prostaglandin E1 infusion, blalock-Taussig shunt
Definitive surgery from 4 months
91
First line treatment for CF?
rhDNAse
92
Chronic otitis media treatment?
Clotrimazole
93
Treatment for scarlet fever?
Pencillin V for 10 days. Avoid school for 24 hours after starting antibiotics
94
What kind of laxative is movicol?
Osmotic
95
Senna is what kind of laxative?
Stimulant
96
Definitive management of Hirschsprung's disease?
Anorectal pull-through
97
Treatment for sebhorreic dermatitis in children?
Ketoconazole shampoo/creams
98
What causes molluscum?
Pox virus
99
When can you give tetracyclines?
Over 12 years old
100
Treatment for headlice?
Dimeticone 4% lotion
101
Describe HSP?
IgA vasculitis
102
At what age is an MCUG recommended?
Before 6 months of age
103
X-ray sign of SUFE?
Trethowan's sign
104
Duchenne muscular dystrophy?
Cretinine kinase raised. Do muscle biopsy
105
First line treatment for absence seizure?
Ethosuximide or valproate
106
First line treatment for focal seizure?
Levetiracetam or lamotrigine
107
SE of valproate?
Weight gain, hair loss
108
SE of lamotrigine?
Rash
109
Treatment for hydrocephalus?
Ventriculoperitoneal shunt
110
Management of migraine?
1: paracetamol
2: Nasal sumatriptan
3: Combination therapy
Prophylactic treatment:
Topiramate or propanaolol
111
Risk of topiramate?
Foetal malformations
112
When to correct congenital hydrocele?
2 years, observe before this
113
What is hypospaias?
Urethral opening is not on the head of the penis.
don't allow circumcision before it is repaired.
114
What is paraphimosis?
Paraphimosis is a common urologic emergency that occurs in uncircumcised males when the foreskin becomes trapped behind the corona of the glans penis. This can lead to strangulation of the glans and painful vascular compromise, distal venous engorgement, edema, and even necrosis.
115
Treatment of paraphimosis?
Manipulation with topical analgesia
Puncture technique
Surgical reduction - circumcision
116
Management of phimosis?
<2yo - reassure and review in 6 months (personal hygiene promotion)
>2yo - circumcision or topical steroid creams (depends on severity)
117
Balanitis Xerotica Obliterans (BXO)
= pathological phimosis = scarring of foreskin; rare before 5y
§ S/S: haematuria, painful erections, recurrent UTI, weak stream, swelling, redness, tenderness
118
Balanoposthitis
inflamed/purulent discharge from foreskin
Single attacks common
Management:
Warm baths
Broad spectrum ABX
Recurrent (rare) - circumcision
119
Complications of nephrotic syndrome:
Risk of thrombosis loss of AT-III in the urine - hypercoagulable state
Risk of infection loss of immunoglobulin in urine - infection risk (esp. NHS bacteria)
Hypercholesterolaemia urinary albumin loss - less oncotic pressure - hepatic cholesterol synthesis
120
Cyanotic heart disease
Hyperoxia (nitrogen washout test): To determine the presence of HD in a cyanosed neonate
1) 100% O2 for 10mins
2) If right radial artery PaO2 from blood gas stays low (<15kPa, 113mmHg) à diagnose of cyanotic CHD
o Only if lung disease and persistent pulmonary HTN of the newborn have been excluded
o If PaO2 >20kPa then it is not cyanotic HD
121
Steroid ladder?
– Help (hydrocortisone) Every (Eumovate) Busy (Betnovate) Dermatologist (Dermovate)
122
Hypogonadotrophic (low LH and FSH) hypogonadism:
Hypothalamo-pituitary disorders – panhypopituitarism, intercranial tumours
Kallmann’s syndrome (LHRH deficiency and anosmia), Prader-Willi syndrome
Hypothyroidism (acquired)
123
Hypergonadotrophic (high LH and FSH) hypogonadism:
Congenital – cryptorchidism, Klienfelter’s syndrome (47 XXY), Turner’s syndrome (45 XO)
§ Acquired – testicular torsion, chemotherapy, infection, trauma, autoimmune
124
Small testes in precocious puberty
Tumour or CAH (adrenal cause)
125
GOLD-STANDARD ix in precocious puberry?
GnRH simulation test
126
Isolated short stature in a young girl
Must exclude Turner's syndrome
127
Chondromalacia patellae?
Grating sensation
128
Reactive arthritis also known as?
Reiter's syndrome (can't see/pee/climb a tree)
129
“Loss of internal rotation of a flexed hip” describes?
SUFE
130
"Ash leaf patch"
Tuberous sclerosis
131
Gower's sign?
Ducehnne muscular dystrophy. Walking up legs
o Pseudohypertrophy of calves (due to replacement of muscle fibres by fat and fibrous tissue)
o Primary dilated cardiomyopathy
132
Types of migraine?
Episodic = <15 days/month
Chronic = ≥15 days/month
133
West syndrome
à EEG (hypsarrhythmia – disordered activity in the brain)
134
Benign Rolandic Epilepsy (BRE) (most common childhood epilepsy)
S/S: seizures of face / upper limbs during sleep with hypersalivation & speech arrest
o AKA: Sylvian seizures
o Childhood (age 3-12yo) seizures – outgrown at end of puberty
DON'T TREAT
135
Treatment for focal seizure?
Carbamezapine, lamotrigine
136
Beta chains on what chromsome?
11
137
Omphalocele (SAC)
Omphalocele / Exomphalos = bowel protruding out the body with a peritoneal covering / umbilical attached
o Manage with staged closure starting immediately, finishing at 6-12 months
o Chromosomal abnormalities in 15% of cases (Trisomy 13 (Patau’s), 18 (Edward’s), 21 (Down’s); Turner’s)
138
Gastroschis (NO SAC)
Gastroschisis = paraumbilical abdominal wall defect à abdominal contents outside body, without peritoneal covering
o Manage with immediate surgery (cover with cling-film) “Gastro-ski-sis”
139
Umbilical hernia repair
<1yo à watch and wait
o >1yo à large or symptomatic = surgical repair 2-3yo; small or asymptomatic = surgical repair 4-5yo
140
Target sign in what condition?
Intussception
141
William's syndrome
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
142
Which antipsychotic is good for negative symptoms?
Clozapine
143
Benign rolandic epilepsy EEG?
EEG characteristically shows centrotemporal spikes
144
Terbutaline is what?
tocolytics
145
The key investigation in pyloric stenosis is what?
Ultrasound
146
Postpartum thyroiditis treatment?
Give propanalol
147
A baby is born by elective Caesarean section at 38 weeks performed due to pregnancy-induced hypertension. At one hour the female baby is noted to be grunting with mild intercostal recession. Oxygen saturations are 95-96% on air. What is the most likely cause of her respiratory distress?
Transient tachnopnea of the newborn
148
Pain after exercise
Intermittent swelling and locking
Osteochondritis dissecans
149
Chondromalacia patellae
Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy
150
The diagnostic investigation for necrotising enterocolitis?
Abdo X-ray
151
Turner's syndrome is associated with aortic coarctation
YES
152
Ovarian torsion may be associated with what on USS?
with a whirlpool sign on ultrasound imaging
153
SSRI with worst discontinuation symptoms?
Paroextine
154
First line treatment for delirium tremens?
Oral lorazepam
Also give IV thiamine
155
What is buprenorphine?
Sublingual medication for opioid withdrawal
156
Lofexidine?
2nd line medication for opioid withdrawal
157
Follow up after opioid detox?
At least 6 months with drugs and alcohol service
CBT offered
158
Withdrawing benzos?
1/8th of the daily dose every fortnight
Switch to diazepam
159
Drugs for AD?
Acetylcholinesterase inhibitors, memantine (NMDA antagonist)
160
10-20 MMSE?
Moderate AD
161
What can be given for lewy body dementia?
Donepezil, rivastigmine, clonazepam
162
GAD disorder treatment ladder?
Step 1 - CBT
Step 2 - Sertraline
Step 3 - specialist assessment
163
First line for OCD
CBT with ERP
164
Second line for OCD
SSRI - sertraline for at least 12 months following remission of symptoms
165
third line OCD?
Clomipramine or alternative SSRI
166
First line PTSD?
Trauma-focused CBT or EMDR therapy
167
Second line PTSD?
SSRI (paroxetine/mirtazapine) or venlaxafine
Consider antipsychotics if not responsive
168
What is different about PTSD management?
Sertraline not first line, give paroxetine or mirtazapine
169
Routine referral to community eating disorder service?
BMI 15-17
170
Urgent referral to community eating disorder service?
BMI <15
171
Admit in anorexia nervosa?
BMI <15
172
Bulimia nervosa treatment?
Family therapy/BN-focused guided self-help/CBT
SSRI such as fluoxetine
173
When to urgently refer bulimia?
Daily purging with significant electrolyte imbalance, comorbidity
174
Treatment for hypersexuality?
CBT based treatments
175
First line treatment for PND?
SSRI
176
First line treatment for depression in children?
CBT!!!
Only give fluoxetine in severe cases
177
Conduct disorder?
Family education
Parent management training and family therapy
178
MOA of clozapine?
Blocks D1 and D4 receptors
179
SSRIs in third trimester?
Risk of persistent pulmonary hypertension of the newborn
180
Worst SSRI in pregnancy?
Paroextine
181
MMSE normal cut off?
<24
182
Normal MoCA cut off?
<26
183
AMTS dementia score?
A score of <6 is significant for dementia or delirium
184
Antipsychotic MOA?
is antagonism of dopamine D2 receptors in the mesolimbic dopamine pathway.
185
Atypical antipsychotic available as depot?
Risperidone
186
Treatment for akathisia?
Review medication, consider propranolol
187
Memantine MOA?
NMDA receptor blocker
188
Acamprosate CI?
Hepatic or renal impairment
189
Disulfiram CI?
Cardiac disease, hypertension, previous CVA, psychosis
190
Pre-cursor to PTSD?
Acute stress reaction
191
3 main symptoms of PTSD?
* Hyperarousal: Persistent anxiety, hypervigilance, poor concentration, insomnia, irritability, exaggerated startle response
* Intrusions: Flashbacks, nightmares, vivid memories, frequent thoughts of incident
* Avoidance: Avoid reminders, inability to recall some of the events, poor interest in everyday life,
emotional detachment, avoids discussing incident
192
Categories of depression?
Mild Depression- 2 core symptoms and 2 additional symptoms
Moderate Depression- 2 core symptoms and 3 additional symptoms
Severe depression- 3 core symptoms and 4 additional symptoms
193
Naltrexone
opioid antagonist. Reduces reinforcing actions of alcohol (e.g the pleasure)
194
Which part of the brain is affected first in AD?
Hippocampus
