Obs and Gynae Flashcards
(140 cards)
1
Q
When is Hutchinson’s triad seen and what does it consist of? (4)
A
Congenital syphilis infection
Interstitial keratitis, teeth abnormalities, deafness
2
Q
When is the combined test performed for trisomies? (1)
What does it involve and what results are expected if a trisomy is present? (6)
A
10-14 weeks
Nuchal translucency (Increased)
Serum PAPP-A (reduced)
Serum beta HCG (raised)
3
Q
A woman presents and is 16 weeks pregnant, what test is performed to assess risk of trisomies? (4)
A
The quadruple test - alphafetoprotein, hCG, uE3 and inhibin A
4
Q
At how many weeks is the test for structural abnormalities performed? (1)
A
18-21 weeks
5
Q
When is the early pregnancy scan performed and what is its function? (4)
A
11-14 weeks
Assess gestational age, foetal demise, multiple pregnancies
Gross heart defects, anencephaly and increased nuchal translucency
6
Q
When is the Guthrie/blood spot test performed? (1)
A
Within 5 days of birth
7
Q
When is the newborn physical exam performed? (1)
A
Within 72 hours of birth
8
Q
What malignancies are caused by exposure to unopposed oestrogen? (3)
A
Endometrial
Ovarian
Breast
9
Q
Which HPV stains are associated with increased cervical cancer risk? (2)
A
16 and 18
10
Q
What can be used to treat endometrial cancer? (3)
A
Surgery - hysterectomy +/- pelvic lymph nodes
Adjuvant radiotherapy
High dose progesterone
11
Q
What is the treatment for the different stages of cervical cancer? (3)
A
Ia - Simple hysterectomy or cone biopsy to preserve fertility
Ib - Total hysterectomy, radiotherapy, chemotherapy
II-IV - Palliative chemotherapy
12
Q
What is the treatment for CIN (cervical intraepithelial neoplasia? (1)
A
LLETZ - Large loop excision of the transformation zone
13
Q
What histological type of cancer are the following?
1) Endometrial
2) Cervical
3) Ovarian
4) Vulval
A
1) Adenocarcinoma
2) Squamous cell carcinoma
3) Epithelial carcinoma
4) Squamous cell carcinoma
14
Q
What cancer is the risk of malignancy index used for and how is it calculated? (4)
What is considered high risk? (1)
A
Ovarian cancer
CA125 x USS assessment x menopausal status
Score >200
15
Q
What genetic predispositions are associated with ovarian cancer? (3)
A
HNPCC syndrome
BRCA1/BRCA2
Peutz-Jegers syndrome
16
Q
What are ultrasound features that would differentiate between a likely benign versus malignant ovarian mass? (8)
A
Benign - Thin, uniform walls, smooth margins, anechoic, cystic
Malignant - Irregularly thickened septa, indistinct borders, variable echogenicity, variable density, central vascularisation, free fluid in pouch of Douglas
17
Q
What time period is considered to be the puerperium? (1)
A
From delivery of the placenta to 6 weeks following the birth
18
Q
What substances are in colostrum? (5)
A
Protein, vitamin A, NaCl, growth factors and antimicrobial factors
19
Q
What substance is involved in the milk ejection reflex? (1)
A
Oxytocin
20
Q
What are the four causes of postpartum haemorrhage? (4)
Which is the most common cause? (1)
A
Trauma
Tissue
Thrombin
Tone - most common
21
Q
What are risk factors for reduced uterine tone following delivery? (3)
A
Prolonged labour
Polyhydramnios
Multiple pregnancy
22
Q
When is a pregnant women at greatest risk of venous thromboembolism? (1)
A
Just after birth up to 6 weeks following the birth
23
Q
How long are women with medium risk and high risk of VTE in pregnancy? (2)
A
Medium - from 28 weeks gestation until 10 days postpartum
High - Throughout pregnancy and up to 6 weeks postpartum
24
Q
What scoring system is used to assess postpartum depression?
A
Edinburgh score
25
What is the management for postpartum haemorrhage? (4)
ABCDE assessment
Oxytocin
Bimanual compression
Blood transfusion
26
What hormone is responsible for pelvic girdle pain? (1)
Progesterone
27
What are the three phases of stage 1 of labour? Describe them (6)
Latent phase - Cervix shortens, effacement occurs and it dilates, irregular contractions.
Active labour - >4cm dilated, contractions are regular, frequent and progressive
Transition - Long, strong contractions with little gap in between, feeling of pressure. Contractions can stop.
28
What 3 things control the active stage of labour? (3)
Power of the uterus
Passage of the vaginal tract
Passenger (foetus)
29
What occurs in stage 2 of labour? (2)
Starts with full dilation with visible head and crowning
| Baby is delivered
30
What occurs in stage 3 of labour? (1)
Delivery of placenta
31
What is the main method used to monitor foetal heart rate and what does it measure? (4)
Cardiotocography (CTG)
| Baseline, variability and accelerations
32
What are risk factors for premature labour? (5)
```
Previous preterm birth
Genital infection - Bacterial vaginosis, group B strep
Cervical weakness
Multiple pregnancy
Low socioeconomic status
```
33
At how many weeks and what substance in cervicovaginal fluid can predict increased risk of preterm labour? (2)
```
Fetal fibronectin (fFN)
After 20 weeks
```
34
What is the management for preterm labour? (5)
```
IM/Pessary Progesterone
Tocolytics - Magnesium sulphate
Cerclage - for short cervix
Corticosteroids
Antibiotics - to treat GBS
```
35
When is breast screening offered to women? (1)
Every 3 years for women between 50 and 70
36
What does the breast lump triple assessment consist of? (3)
Physical examination
Mammography (If >40, otherwise use ultrasound)
Fine needle aspiration cytology
37
What plains are the breasts compressed between for mammogram? (2)
Craniocaudal and mediolateral oblique
38
What can be seen on imaging of ductal carcinoma in situ? (1)
Microcalcifications
39
What molacular marker differentiates luminal A and luminal B breast cancer? (2)
Ki67 - low in A, high in B
40
How is oestrogen receptor positive breast cancer treated? (3)
Endocrine therapy - if premenopausal - Tamoxifen
If postmenopausal - aromatase inhibitors (e.g.) Anastrozole). For 5 or more years.
Chemotherapy in luminal B
41
How is HER2 receptor positive breast cancer treated? (2)
With transtuzumab/Herceptin + chemotherapy
42
How is triple negative breast cancer treated? (3)
Chemotherapy
Bisphosphonates decrease rate of bone metastasis
Surgery - mastectomy, axillary clearance if sentinel node biopsy is positive
43
How is ductal carcinoma in situ treated? (2)
Lumpectomy and radiation therapy
44
When should early referral be considered for infertility? (2)
Maternal age >35
| Known or suspected problem
45
What preconception advice is given in couples that are struggling to conceive? (7)
```
Smoking cessation
BMI 19-30
Reduce alcohol intake
Rubella immunity (test and vaccination if needed)
Smear up to date
Folic acid supplements
Intercourse 2-3 times per week
```
46
What are the triad for signs for polycystic ovary syndrome? (3)
How many must be present for a diagnosis? (1)
Signs of hyperandrogenism
Oligo/anovulatory
Polycystic ovaries on ultrasound
2 must be present for diagnosis
47
What investigations are done in women in couples struggling to conceive? (4)
Ovulation - midluteal phase progesterone 7 days before end of cycle
Ovarian reserve - day 2 FSH, antral follicle count, antimullerian hormone levels
48
What test results are considered normal in semen analysis? (3)
Count > 15 million/ml
Motility > 40%
Morphology > 4%
49
What is the management for anovultatory infertility? (2)
Clomifene (antioestrogen) - for up to 6 months
| Ovarian drilling
50
What can be used with clomifene to increases its effectiveness? (1)
Metformin
51
What are the risks of clomifene treatment? (2)
Increased risk of multiple pregnancy
| Ovarian hyperstimulation syndrome
52
What is used to treat prolactinoma? (1)
Bromocriptine (dopamine agonist)
53
What investigations are done in suspected PCOS? (3)
Free androgen index - to measure testosterone
LH, FSH, TSH and prolactin to rule out differentials
TVUSS
54
What is the karyotype for a partial and complete hydatidiform mole? (2)
Partial - triploid
| Total - diploid (most commonly 46XX)
55
What is the origin of the DNA in complete moles? (1)
Paternal
56
What are the clinical features of a molar pregnancy? (5)
```
Large uterus for gestational age
Hyperthyroidism
Hyperemesis
Vaginal bleeding
Early pre-eclampsia
Elevated HCG
```
57
What is seen on ultrasound of a complete mole? (1)
Snowstorm appearance
58
What is the malignant progression from a hydatidiform mole? (1)
Choriocarcinoma
59
How is a molar pregnancy managed?
Removal by suction curettage
Histological diagnosis
Serial HCG levels
60
What are risk factors for gestational hypertension? (4)
```
Young
BME
Multiple pregnancy
Chronic hypertension
Renal disease
```
61
What are red flag signs for risk of eclampsia? (2)
Hyper-reflexia, ankle clonus
62
How is pre-eclampsia diagnosed? (2)
BP >140/90 6 hours apart
| +2 protein on urine dipstick or protein creatinine ration >30%
63
How are women with a history of pre-eclampsia treated in future pregnancies? (1)
Prophylactic low dose aspirin
64
What are the features of HELLP syndrome? (3)
Haemolysis
ELevated liver enzymes
LP - Low platelets
65
How is pre-eclampsia managed? (3)
>150/100 - Labetalol
>160/105 - Hydralazine and labetalol
Acute severe - Oral nifedipine
66
How is eclampsia managed? (3)
Magnesium sulphate IV
Antihypertensives
Corticosteroids
67
Name two key risk factors for stress incontinence (2)
Obesity
| Old age
68
What are the findings on urodynamics in stress incontinence? (1)
Normal
69
What is the treatment for stress incontinence? (4)
Pelvic floor exercises
Ring pessary
SNRI - Duloxetine
Surgery - Sling procedure, tension free vaginal tape (TVT), cholposuspension
70
What is the mechanism of urge incontinence? (2)
Involuntary contractions of the detrusor muscles due to detrusor instability or brain damage
71
What lifestyle measures can improve the symptoms of urge incontinence? (4)
Reduce fluid intake
Reduce caffeine intake
Avoid irritant foods
Smoking cessation
72
How is urge incontinence managed? (4)
```
If vaginitis - estriol + cyclical progesterone
Pads
Toilet regimen
Anticholinergic drugs - Oxybutynin
Botox to the bladder neck
```
73
What is the surgical management of vaginal prolapse? (1)
Sacrospinous fixation
74
What range of days is considered a normal menstrual cycle? (1)
21-35 days
75
What investigations can be done in mennorhagia? (3)
| What is required if there is inter-menstrual bleeding? (1)
FBC
TVUS
Hysteroscopy
Endometrial biopsy
76
What is the treatment for menorrhagia? (3)
1) Mirena coil
2) Tanexamic acid / Mefanamin acid. Or COCP
3) Fibroids >3cm - endometrial ablation or hysterectomy
77
When should primary amenorrhoea be investigated?
14 year old with no secondary sexual characteristics
| 16 year old with secondary sexual characteristics
78
What investigations can be done in secondary amenorrhoea?
FSH (can be elevated in early menopause)
LH
Testosterone (raised in PCOS)
79
What is the likely cause of this bleeding in pregnancy? (1)
Intermittent, painless bleeding that is increasing in frequency. On abdominal examination, the foetus is in transverse position.
What should not be done and why, what should be done for diagnosis instead? (3)
Placenta previa
Vaginal examination - risk of causing bleeding
Ultrasound scan
80
What is the management for a presentation of symptomatic placenta praevia before 34 weeks gestation? (1)
Admission
| Corticosteroids
81
What are risk factors for placental abruption? (5)
Intrauterine growth restriction, pre-eclampsia, chronic hypertension, maternal smoking, previous abruption
82
What is a typical presentation for placental abruption? (4)
Woody hard uterus
Painful vaginal bleeding
Tachycardia
Foetal distress
83
What investigations should be done in suspected placental abruption? (4)
CTG, FBC, coagulation screen and cross match
84
How does vasa previa present? (3)
| Name some risk factors (2)
Membrane rupture, painless bleeding, foetal bradycardia/death
Multiple pregnancy, IVF
85
What are the symptoms of endometriosis? (4)
Dysmennorhoea before onset of menstruation
Deep dyspareunia
Subfertility
Pain on passing stool
86
What are the signs of endometriosis? (3)
Lower abdominal tenderness
Thickening behind uterus
Retroverted, immobile uterus if advanced
87
What procedure is diagnostic for endometriosis? (1)
Laparoscopy
88
What are risk factors for fibroids? (4)
Menopausal
Afro-Caribbean
Family history
Nulliparous
89
What pregnancy risks are fibroids associated with? (4)
```
Premature labour
Malpresentation
Transverse lie
PPH
Obstructed labour
```
90
Why can haemoglobin be high or low with uterine fibroids? (2)
Low - causes menorrhagia due to increased surface area
| High - can secrete EPO
91
What is the first line medical management for fibroids? (3)
Tranexamic acid (+ Mefanamic acid) or progestogens
92
What is the secondary medical management for fibroids? (1)
GnRH agonists (e.g.) Lupron. Induce temporary menopausal state)
93
What ovarian cysts are more common in younger, perimenopausal women? What cells do they originate from? (2)
Dermoid cysts - can progress to malignant teratomas
Originate from germ cells
Commonly bilateral
94
What are complications of gestational diabetes? (4)
```
Macrosomia - shoulder dystocia - Erb's palsy
Neural tube defects
Cardiac defects
Preterm labour
Intrauterine death
```
95
What is damaged in Erb's palsy? (1)
Brachial plexus
96
What can be seen in Erb's plasy as the child develops? (4)
```
Anteriorly rotated shoulder
Atrophied muscle
Horner's syndrome
Shortened arm length
Waiter tip wrist deformity
```
97
What is the management for gestational diabetes (1st, 2nd, 3rd, 4th)?
1) Diet control and blood glucose monitoring. Refer to dietician.
2) Metformin
3) Insulin
4) Glibenclamide
98
What dose of folic acid is given to high risk groups? (1)
| Who would be considered high risk? (3)
5mg daily
| Gestational diabetes, on anti-epileptics, family history of neural tube defects, previous child with neural tube defect
99
What is the daily folic acid dose for low risk pregnant women? (1)
400 micrograms
100
Where is the most common location for an ectopic pregnancy? (1)
Where is the second most common? (1)
The ampulla of the fallopian tube
| Isthmus
101
What are the risk factors for ectopic pregnancy? (4)
PID/previous STIs, assisted contraception, previous pelvic surgery, smoking, history of ectopic
102
What are the clinical signs of a ruptured ectopic? (5)
```
Vaginal bleeding
Closed os
Uterus smaller than expected for gestational age
Shoulder tip pain
Syncope
Signs of haemodynamic instability
Hyperemesis
```
103
What investigations can be done in suspected ectopic? (4)
Urine hCG - high
TVUS - absence of intrauterine pregnancy, free fluid in abdomen if ruptured
Quantitative hCG - if >1000 would expect to visualise a uterine pregnancy
Laparoscopy
104
What type of miscarriage is this? (1)
| There is heavy bleeding and the os is open but no foetal tissue has passed
Inevitable miscarriage
105
What is the medical management for ectopic pregnancy? (2)
Single dose methotrexate and serial hCGs
106
What is the surgical management for an ectopic pregnancy if there are concerns about the health and fertility of the other ovary? (1)
Salpingostomy
107
What is the surgical management for an incomplete miscarriage? (1)
Evacuation of retained products of conception
108
What is the medical management for a missed or incomplete miscarriage? (3)
Misoprostol
Ergometrine for bleeding
Anti-D if rhesus negative
109
What drugs are used for medical termination of pregnancy? (2)
Oral Mifepristone
| Vaginal Misoprostol
110
Name some organic causes or erectile dysfunction (4)
```
Spinal cord disease
Multiple sclerosis
Endocrine disease
Vascular disease
Hypertension or hypertensive drugs
```
111
Name some psychological causes of erectile dysfunction (2)
Depression
| Relationship problems
112
What is the medical management for erectile dysfunction? (1)
PDE-5 inhibitor - Sildenfil
113
What joint condition is associated with Chlamydia?
| Which is associated with Gonorrhoea?
Reiter's syndrome
| Septic arthritis
114
What investigations are done in suspected Chlamydia? (3)
NAAT (nucleic acid amplification test)
First void urine - male
Swab - female
115
What is the management for Chlamydia? (1)
| What is the management in pregnancy? (1)
Doxycycline
| Azithromycin
116
What is seen under a microscope in Gonorrhoea? (1)
Gram negative intracellular diplococci
117
What is the management for Gonorrhoea? (2)
IM Ceftriaxone 1g
118
What are the signs and symptoms of trichomoniasis? (4)
Green frothy discharge
Strawberry cervix
pH <4.5
Postcoital bleeding
119
What is the management for trichomoniasis? (1)
Metronidazole
120
What is a chancre? (2)
A painless solitary ulcer seen in primary syphilis
121
What is the characteristic rash seen in secondary syphilis? (2)
Rough red spots seen on the soles of the feet and palms of the hand
122
What investigation is done in suspected syphilis? (1)
Serology for cardiolipin antibody
123
What is the management for syphilis? (1)
IM Benzypenicillin
124
What is the treatment for thrush? (2)
Oral - Fluconazole
| Topical - Clotrimazole
125
What investigations are done for bacterial vaginosis? (3)
Whiff test with potassium hydroxide
pH > 4.5
Triple swab
126
What is seen in microscopy in bacterial vaginosis? (1)
Clue cells
127
What criteria is used to determine the safety of contraceptives in certain conditions? (1)
UKMEC guidelines
128
What are contraindications for the combined oral contraceptive pill? (6)
```
Smoking >15 cigarettes per day
BP > 160/100
Postpartum 0-6 weeks
Peripheral vascular disease
Ischaemic heart disease
Atrial fibrillation
Antiphospholipid antibody positive
Migraine with aura
Current breast cancer
Major surgery with prolonged immobilisation
```
129
What can be used to stimulate expulsion of the placenta? (2)
IM Syntocin
| Breastfeeding
130
When should insulin be commenced immediately in gestational diabetes? (1)
When fasting glucose in >7 mmol/l
131
What is Mittelschmerz? (2)
Mid-cycle pelvic pain
| There is often free fluid seen in the pouch of douglas
132
Which method of HRT is associated with increased risk of VTE? (1)
Oral combined
133
What test can be done to determine if there has been foeto-maternal haemorrhage? (1)
Kleihauer test
134
At what point in pregnancy should the fundal height be at the umbilicus? (1)
20 weeks
135
Which COCP is best for treating hirsutism in PCOS? (1)
Dianette (Co-cyprindiol)
136
What genetic syndrome causes hypogonadotrophic hypogonadism? (1)
What sense is impaired in this syndrome? (1)
Kallmann syndrome
| Smell
137
What is the first line management for mild, moderate and severe PMS? (3)
Mild - lifestyle advice
Moderate - COCP
Severe - SSRIs (Fluoxetine)
138
What alternative medication could be used for an epileptic woman treated on sodium valproate that wants to plan a pregnancy? (1)
Lamotrigine
| Carbamazepine
139
What is Sheehan's syndrome and what are the symptoms? (4)
The pituitary gland is damaged by hypoxia due to excess blood loss in childbirth.
Symptoms vary depending on extent of damage and which hormone levels are reduced.
Commonly agalactorrhea, amenorrhoea, symptoms of secondary hypothyroidism, adrenal insufficiency
140
How long into pregnancy should folic acid supplements be taken? (1)
12 weeks
