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Medicine > Obs & Gynae > Flashcards

Obs & Gynae Flashcards

0
Q

What is miscarriage?

A

Spontaneous expulsion of products of conception before week 24 of pregnancy

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1
Q

Define menorrhagia?

A

Excessive blood loss >80ml with regular menstruation

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2
Q

What are the maternal cause of miscarriage? General and Local causes. 5 things

A 
GENERAL
Age
Obesity
Septicaemia
Severe hypertension/Renal disease
Diabetes
Hypothyroidism
Trauma
LOCAL
Fibroids
Congenital uterine malformations
Adenomysis
Incompetent internal os
Hormone deficiency
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3
Q

Give 3 fetal causes of miscarriage?

A

Genetic abnormalities
Congenital malformations
Faulty implantation

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4
Q

What are the symptoms of a threatened miscarriage?

A

Scanty uterine bleeding

Pain usually absent; may be slight uterine contractions and backache

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5
Q

On examination, give 2 things that might be seen in a threatened miscarriage?

A

Active breasts (enlarged and tender)
Enlarged uterus
Closed cervix
No pelvic tenderness

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6
Q

What is the management for a threatened miscarriage?

A

Rest until bleeding has ceased. After bleeding, woman to resume normal life

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7
Q

What are symptoms of an inevitable miscarriage?

A

Bleeding

Pain-Crampy low abdominal pains

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8
Q

Give 2 examination findings in an inevitable miscarriage?

A

Uterus enlarged
Internal os of cervix open (products of conception may be felt)
Low BP/Pulse

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9
Q

What is the management of an inevitable miscarriage?

A

Remove any products from the open os

Evacuation of retained products of conception

Excessive bleeding-give Ergometrine

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10
Q

What is an incomplete miscarriage?

A

When some of the products of conception are retained in the uterus

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11
Q

What is the management of an incomplete miscarriage?

A

Prostaglandins to evacuate products

Evacuation of the uterus in the theatre

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12
Q

What is the definition for recurrent miscarriage?

A

3 consecutive spontaneous miscarriages

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13
Q

What are the risk factors for ectopic pregnancy? 4 things

A 
PID
Previous pelvic surgery
Previous ectopic surgery
Intrauterine device
POP
Sterilisation
Emergency contraception
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14
Q

What are the 4 common associations to recurrent miscarriages?

A

Anti phospholipid syndrome
Polycystic ovaries
Incompetent cervix
Fibroids

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15
Q

How do you investigate a couple with recurrent miscarriages?

A

Anti Phospholipid Syndrome: Lupus anticoagulant and anticardiolipin antibodies. 2 positive results

PCOS: LH, FSH and Testerone levels + U/S

Cervical incompetence: Hysterosalpingography and Transvaginal U/S

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16
Q

Give 3 ways a tubal pregnancy can terminate?

A

Absorption

Tubal abortion-products expelled into peritoneal cavity

Tubal rupture

Secondary abdominal pregnancy

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17
Q

What are the causes of infertility in both partners?

A

Mechanical difficulty

Periods of separation

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18
Q

Give 3 causes for infertility in males?

A 
Impotence
Premature ejaculation
Azoospermia/oligospermia (<20)
Poor sperm motility
Abnormal morphology
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19
Q

Give 4 areas where infertility could arise from in females?

A

Fallopian tubes-obstructed by infection

Ovaries-anovulation, PCOS, Peri menopausal

Intact hymen

Vagina-congenital malformation

Uterus-malformation or tuberculous endometritis

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20
Q

What is the action of the COCP?

A

Inhibits ovulation
Modifies endometrium preventing implantation
Thickens cervical mucus

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21
Q

Give 3 advantages of the COCP?

A

Most effective reversible birth control

Method doesn’t affect intercourse

Dysmenorrhea and menorrhagia are eased

Menstruation becomes regular

Hb levels maintained so anaemia less common

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22
Q

What are the risk factors for cervical malignancy? 4 things

A 
High parity
Multiple sexual partners
Early first coitus
Smoking
Long term use of oral contraceptives
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23
Q

Give 2 indications for a colposcopy referral?

A

Two consecutive borderline smears
Dyskaryosis
3 abnormal smears in 5 years
2 consecutive smears inadequate for assessment

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24
Q

Give 3 side effects of the COCP?

A

Fluid retention and weight gain
Thromboembolism
Skin pigmentation
Migraine aggravation

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25
Q

When should emergency contraception be administered?

A

Within 72 hours

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26
Q

Give 4 contraindications to COCP use?

A

History or FHx. of thrombophlebitis, severe heart disease or cerebrovascular accidents

40y/o+, obese and heavy smoker

Liver damage

Hx. of breast cancer

> 30 BMI

Moderate hypertension (>160 systolic)

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27
Q

Give 3 types of barrier contraception?

A

Condoms
Cervical diaphragm
Female condom
Spermicide

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28
Q

Give 3 problems attached with using a copper intrauterine device?

A

Expulsion from uterus
Pelvic infection
Dysmenorrhea/Menorrhagia

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29
Q

State 3 contraindications to using an intrauterine device?

A

Pregnancy
Current pelvic/ST infection
Gynaecological cancer

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30
Q

Give 4 symptoms of endometriosis?

A

Dysmennorrhea
Deep dyspareunia
Ovulation pain
Infertility

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31
Q

State 3 investigations in endometriosis?

A

Laparoscopy (gold standard)
USS
MRI

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32
Q

Give 3 ways to manage endometriosis?

A

Medical: simple analgesia, hormones (COCP, POP, GnRH)
Surgical: excision, laparoscopic ablation

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33
Q

Give the antibiotic of choice for chlamydia infection?

A

Doxycycline

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34
Q

Define primary and secondary amenorrhea?

A

Primary: Absence of menses at 14 (without secondary sexual characteristics)
OR Absence of menses at 16

Secondary: Absence of menses for 6 months after period of regular menses

35
Q

Name 5 causes of amenorrhea?

A 
Pregnancy
Menopause
Head injury, Tumour
Weightloss
Hypopituitarism
PCOS
36
Q

State 5 clinical features of PCOS?

A 
Oligo/Amenorrhea
Infertility
Hirtuism
Obesity
Acanthosis nigricans on flexural surfaces
37
Q

Give 5 ways you can manage PCOS?

A 
Lifestlye changes (lose weight, stop smoking, exercise etc.)
Supportive

Metformin - increase insulin sensitivity
Clomifene - induce ovulation for infertility
COCP - increase sex hormone binding globulin
Cosmetic - hair removal

38
Q

State 4 ways fibroids can be managed?

A

Medical:
IUCD
GnRH analogues

Surgery:
Hysterectomy (definitive)
Myomectomy

39
Q

Give 4 risk factors for developing endometrial cancer?

A 
Unopposed oestrogen therapy
Obesity
Nulliparity
Late menopause
FHx
Tamoxifen
40
Q

If a patient is experiencing post menopausal bleeding, what differentials come to mind?

A 
Endometrial/cervical carcinoma
Vaginitis
Polyps
Oestrogen withdrawal (stopping HRT)
Foreign body
41
Q

State 6 immediate complications of menopause?

A

Vasomotor: Hot flushes, Night sweats
End organ atrophy: Vaginal dryness, dyspareunia, dysuria
Psychological: Depression, loss of libido

42
Q

Give 2 long term complications of menopause?

A

Osteoporosis

Cardiovascular disease

43
Q

State 4 possible complications of HRT?

A

Unopposed oestrogens: increased risk of endometrial/ovarian cancer
Increased risk of breast cancer
Increased risk of IHD and CVA
Increased risk of venous thromboembolism

44
Q

How can you estimate the date of delivery?

A

EDD=LMP+1year-3months+7days

45
Q

What are the 3 stages of labour?

A

Creation of birthing canal
Expulsion of foetus
Expulsion of placenta

46
Q

What drug is given in the 3rd stage of labour and whats its action?

A

Syntometrine (oxytocin and ergometrine)
Stimulation of uterine contraction and smooth muscles in blood vessels to contract

Expulsion of placenta and reduces risk of PPH

47
Q

How is Premature rupture of membranes managed?

A

Administration of: Prostaglandinds and oxytocin to induce labour

48
Q

If there is meconium in the liquor, what 2 steps must be taken?

A

Fetal blood sampling
Scalp electronic monitoring (CTG)
?C-section (thick meconium or low foetal pH)

49
Q

Name 4 ways pain relief can be achieved during labour?

A

Simple: breathing exercises, relaxation techniques, water immersion
Narcotic injections (pethidine) IM
Nitrous oxide (entonox)
Spinal block
Epidural anesthesia
Transcutaneous electrical nerve stimulation (TENS)

50
Q

How can a breech presentation be managed?

A

External cephalic version (ECV)

C-Section

51
Q

Give 3 indications for induction of labour?

A 
Prolonged pregancy
Hypertension
Pre-eclampsia
Rhesus disease
PROM
52
Q

Give 6 causes of dystocia?

A

Difficulty in labour

Passage: Abnormal bony pelvis, Cervical dystocia (fail to dilate)

Passenger: Large (macrosomia, hydrocephalus), Malpresentation

Powers: Insufficient activity, hypotonic contractions, Uncoordinated contractions

53
Q

How might a problem with contractions be managed during labour?

A

Hydration
Analgesia (pain & fear produces catecholamines which can inhibit uterine activity)
Amniotomy
Oxytocin infusion

54
Q

What are 4 indications for forceps delivery?

A

Delay in the second stage of labour (failure of maternal effort e.g. exhaustion, epidural analgesia or malposition of fetal head)

Complications in the second stage (fetal distress, prolapsed cord, ecalmpsia)

Prevent undue maternal effort (cardiac disease, respiratory disease, pre-eclampsia)

Breech delivery

55
Q

What are 3 possible complications of forceps deliever?

A

Maternal trauma
Foetal bruising
Foetal facial nerve paralysis (usually resolves)
Foetal brachial plexus injury

56
Q

Give 6 indications for emergency C-Section?

A 
Severe pre-eclampsia
Placental abruption 
Foetal distress
Failure to progress
Prolapsed cord
Failed induction of labour
57
Q

What are the TORCH infections?

A

Infections passed from mother to foetus which can have severe consequences?

Toxoplasmosis
Others: syphillis, VZV, HIV, Parvovirus
Rubella
Cytomegalovirus
Herpes simplex
58
Q

How are the TORCH infections managed?

A

High dose aciclovir

59
Q

What 4 pieces of advice will you give to a woman at her first antenatal clinic appointment?

A

Folic acid supplements
Lifestyle advice (smoking and alcohol cesation)
Food hygiene
Antenatal screening tests available (anomalies, downs syndrome, haemoglobinopathies)

60
Q

What 2 tests can be done to screen for downs syndrome and when?

A

1st trimester: Combined test (nuchal translucency, bHCG, pregnancy assosciated plasma protein, womans age)

2nd trimester: Quadruple test (bHCG, Alpha fetoprotein, Inhibin A, unconjugated estriol)

61
Q

How is gestational diabetes and pre-eclampsia screened?

A

Oral glucose tolerance test
&
Blood pressure and protein in urine

62
Q

State 4 causes of a large for gestational age foetus?

A

Constitutionally large
Maternal diabetes
Intrauterine infections
Hyperinsulinaemia

63
Q

State 4 possible complications of intrauterine growth restriction?

A 
Hypoxia
Hypothermia
Jaundice
Hypoglycaemia
Infection
64
Q

Give 4 possible causes of intra uterine growth restriction?

A

Maternal: poor nutrition, smoking/alcohol
Foetal: abnormality, infection
Placental: failure of trophoblast invasion

65
Q

Give 5 possible complications of pre-eclampsia?

A 
Eclampsia
Cardiac/pulmonary oedema
Acute renal failure
HELP syndrome (haemolytic anaemia, elevated liver enzymes, low platelet count)
Placental abruption
Foetal death
66
Q

How can pre-eclampsia be managed?

A

Primary prevention: calcium supplements/aspirin

Medical: magnesium sulphate prevents seizures, antihypertensives (labetalol), steroids for foetal lungs, induction of labour

Surgery: C-Section

Delivery is the only cure!

67
Q

Give 4 risk factors for developing pre-eclampsia?

A 
FHx of pre-eclampsia
Primigravida
Past Hx of pre-eclampsia
Multiple pregnancy
Extremes of maternal age
68
Q

Give 4 problems associated with twin pregnancies?

A 
Malpresentation
Polyhydramnios
Conjoined twins
IUGR
Low birth weights
69
Q

Give 5 possible complications to the foetus from gestational diabetes?

A 
Macrosomia
Shoulder dystocia
Hypoglycaemia
Hypoxia
Intrauterine death/Miscarriage
70
Q

State 4 conditions which are suggested by presence of hyperemesis gravidarum?

A

Multiple pregnancy
Thyrotoxicosis in pregnancy
Molar pregnancy
UTI in pregnancy

71
Q

Give 4 things you look for on vaginal examination during labour?

A 
Cervix (consistency, effacement and dilatation)
Intact membranes
Colour of amniotic fluid
Presenting part
Size of pelvic outlet
72
Q

Give 4 signs on a CTG that might indicate foetal distress?

A

Absence accelerations
Presence decelerations
Decreased baseline activity
Baseline tachycardia/bradycardia

73
Q

What is the difference between an epidural and a spinal anaesthetic?

A

Epidural anaesthetic is inserted in the potential space between dura mater and periosteum inside the vertebral column

Spinal anaesthetic is inserted into CSF fluid after piercing the dura mater

74
Q

State 4 risk factors for prematurity?

A 
Extremes of maternal age
Smoking
PROM
Prev. preterm labour
Drug abuse
75
Q

How can you prolong labour?

A 
Tocolytics:
Beta agonists (Terbutaline)
Calcium channel blockers (Nifedipine)
76
Q

State 3 risk factors of developing cervical cancer?

A

Multiple sexual partners
Smoking
Early onset of sexual activity

77
Q

Give 4 ways you can manage prolapse in women?

A 
Lifestyle: Lose weight, stop smoking
Topical oestrogens
Pessary
Pelvic floor physiotherapy
Surgery
78
Q

What are the advantages and disadvantages of breast feeding? Give 3 each

A 
Advantages for the baby:
Reduced diarrhoea
Reduced risk of infections
Advantages for the mother:
Reduced risk of breast CA+ ovarian CA
Bonding with the baby

Disadvantages:
Volume of intake is uncertain
Transmission of drugs
Insufficient vit K/vit D

79
Q

Give 3 differences of amniocentesis and chorionic villius sampling?

A

Time to test
Chorionic villus sampling = 10wks-20wks
Amniocentesis = 16wks+

Foetal death
Chorionic villus sampling = 4%
Amniocentesis = 1%

Neural tube defects
Chorionic villus sampling = Not detected
Amniocentesis = Detected

80
Q

State 3 ways you can manage menorrhagia?

A

Progesterone containing IUCDs (Mirena)

Antifibrinolytics (Tranexamic acid)

Antiprostaglandins (Mefenamic acid)

Endometrial resection

81
Q

Give 4 clinical features of fibroids?

A

Menorrhagia
Fertility problems
Pain
Palpable mass

82
Q

How might vaginal thrush present?

A

Red and sore
Non offensive with white curds
Around vagina and vulva

83
Q

How can you treat vaginal thrush?

A

Topical Tx. Cotrimazole and cream

Oral fluconazole

84
Q

How can you differentiate Trichomoniasis and Bacterial vaginosis?

A

Trichomoniasis produces vaginitis and sexually transmitted

BV mostly asymptomatic

BOTH produce fishy odour
BOTH treated by Metronidazole

Medicine (17 decks)

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