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Revision Week > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

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1
Q

what is fibroid degeneration?

A

when a fibroid cuts off its own blood supply

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2
Q

what ways can a cyst cause acute abdomen?

A

torsion, rupture and haemorrhage

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3
Q

what is adenomyosis?

A

endometrial glands grow in the myometrium

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4
Q

what is a myomectomy?

A

surgical removal of fibroids from the uterus

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5
Q

what nodes does ovarian cancer spread to?

A

directly to the para-aortic nodes

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6
Q

what is the embryological origin of the round ligament?

A

the gubernaculum

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7
Q

what is a granulose cell tumour?

A

stromal tumour of ovary

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8
Q

how does a granulose cell tumour present?

A 
Heavy periods
intermenstrual bleeding 
acute abdomen 
precocious puberty 
pelvic mass
endometrial cancer
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9
Q

what is a sub-total hysterectomy?

A

just removing the body of the uterus

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10
Q

what is a total hysterectomy?

A

removing the body of the uterus and the cervix

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11
Q

what is the lifetime risk of a sexually active women acquiring genital HPV infection?

A

8 in 10

  • extremely common
  • extremely transmittable (mucosa to mucosa so can even be by touch)
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12
Q

the COCP is a risk factor for endometrial cancer?

A

false, it is protective

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13
Q

true or false: heart failure can raise Ca125

A

true

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14
Q

why is adipose tissue considered an endocrine organ?

A

it converts androgens to oestrogens

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15
Q

what does a snowstorm appearance on US suggest

A

a molar pregnancy

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16
Q

name some features associated with ectopic pregnancy:

A 
shock (in ruptured ectopic pregnancy)
peritonism
vaginal bleeding 
positive pregnancy test 
cervical excitation tenderness
shoulder tip pain
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17
Q

what is the nerve supply to the diaphragm?

A

C3,4,5 (keeps your diaphragm alive)

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18
Q

what is a threatened miscarriage?

A

Bleeding in early pregnancy but no evidence yet that pregnancy is not viable. usually a foetal pole and heart beat seen.

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19
Q

how would you diagnose an inevitable miscarriage?

A

Clinical diagnosis

Internal cervical os is opened

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20
Q

Caffeine limit during pregnancy?

A

<200 micrograms
1 cup of coffee a day

> 200 = risk of miscarriage and IUGR

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21
Q

Name some routine blood tests taken in every pregnancy at booking:

A

Serum antibodies
Syphillis, HIV, hepatitis B
Sickle and thalassaemia
Blood type

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22
Q

When would be screen for gestational diabetes?

A 
Previous large babies or carrying large baby
Family history of diabetes
Previous gestational diabetes
BMI >30
Higher risk ethnicity 
Signs or symptoms
Polyhydramnios
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23
Q

What trisomies are screened for?

A

Trisomy 21
Trisomy 13
Trisomy 18

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24
Q

What is the largest risk factor for Down syndrome?

A

Increased maternal age

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25
What is Trisomy 18?
Edwards Syndrome
26
What is Trisomy 13?
Patau's Syndrome
27
Purposes of booking scan?
Measure crown rump length to estimate time of delivery Determine chorionicity Determine viability of pregnancy Look for significant obvious abnormality?
28
What is observed at anomaly scan?
``` Cleft lip Brain development Size of head Skull formed in tact (no form of neural tube defects) Check spine for neural tube defects Ensure limbs work and a good length Look at feet to check for talipes Bladder Cord insertion Measure tummy Check kidneys are developing See where placenta is ```
29
What medication may prevent spina bifida and anencephaly?
5mg Folic acid
30
Who would be recommended high dose 5mg folic acid?
``` Previous baby with neural tube defect High risk (obese, on enzyme inducer, diabetic) ```
31
When should folic acid be started?
3 months before contraception
32
How many women are rhesus negative?
15% of women
33
What ethnicity is associated with sickle cell disease?
Afro-carribean and African
34
what ethnicity is associated with Thalassaemia?
Cypriot, eastern mediterranean, asian, indian and middle eastern
35
Define presentation
What is the presenting part? usually head - cephalic
36
Define postion
what what is the baby lying ? Normal = occipito-anterior. Can be occipito-posterior or orccipito-transverse
37
Define malpresentation
anything presenting that is not the head. Higher risk of cord prolapse and foetal distress. <36 weeks it is entirely normal - baby moves about a lot.
38
Define station
Where presenting part of baby is within the pelvis. Felt vaginally
39
Define engagement
How much of the of the foetal head is palpable abdominally
40
When assessing the cervix in pregnancy , what are you looking for?
``` Dilatation Length of cervix Station of presenting part Consistency Position ```
41
What are the signs on vaginal examination of obstruction?
Oedema of the foetal head (caput) | Moulding
42
What are the signs on vaginal examination of obstruction?
Oedema of the foetal head (caput) Moulding Haematuria in mother Foetal distress
43
what is entonox
Nitrous oxide and oxygen Safe and short acting Can give you nausea and vomitting
44
side effects of opioids:
``` Constipation Nausea Respiratory depression Itch Sedation Urinary retention ```
45
how to reverse respiratory depression from opioid?
naloxone
46
ductus arteriosus shunts pulmonary artery to descending....
Aorta to bypass the lungs
47
ductus venous shunts umbilical vein to ...
IVC to bypass the liver
48
Category 1 C section
Immediate threat to life of baby or mum. Baby must be delivered in 30 minutes.
49
Category 2 C section
Needs emergency delivery but not immediate threat to life
50
Category 3 C section
Scheduled c section that is needed but no foetal maternal compromise
51
Category 4 C section
Elective, planned, time suits woman
52
Can women choose an elective C section as a birth option?
Yes but need to be counselled as risks
53
How many women have C sections?
1/4
54
Methods of inducing:
Membrane sweep Give vaginal propess (prostoglandin) Give balloon that mechanically dilate cervix Syntocinon if no uterine contractions started using above
55
How common is induction?
1/5 labours are induced
56
What are the names of the 3 foetal cardiac shunts?
Foramen ovale, ductus venosus, ductus arteriosus
57
What prep happens in 3rd trimester?
Surfactant production Accumulation of glycogen- liver, muscle and heart Accumulation of brown fat – between scapulae and around internal organs Swallowing amniotic fluid
58
causes of respiratory distress in infants?
``` Surfactant deficiency Infection Pthorax Cardiac condition Metabolic acidosis TTN ```
59
Causes of respiratory distress in infants?
``` Surfactant deficiency Infection Pthorax Cardiac condition Metabolic acidosis TTN ```
60
Give some examples of autosomal dominant conditions?
Huntingtons, Marfans, Neurofibromatosis
61
Give some examples of x linked recessive conditions?
Duchenne muscular dystrophy | Haemophilia A
62
Give some examples of autosomal recessive conditions?
Cystic Fibrosis Sickle cell sydnrome Taysachs
63
what is toxoplasmosis?
a parasite causing congenital infections (miscarriage, still birth, seizures, learning disability)
64
What is toxoplasmosis carried in?
raw meat, cat faeces, soil, unpasteurised milk
65
Why would we advise pregnant women to avoid liver?
it contains vitamin A which is teratogenic
66
Why would we advise pregnant women to avoid unpasteurised milk?
risk of TB and toxoplasmosis
67
Why do we advise pregnant women to avoid soft cheese?
risk of listeria
68
Why would we advise women to stay away from shark/tuna/swordfish?
contains mercury which is teratogenic and potentially causes mental disability in offspring
69
Why would we tell pregnant women to avoid Pate?
potentially undercooked meat and risk of listeria
70
What vitamins are recommended in pregnancy?
Folic acid | Vitamin D
71
Alcohol in pregnancy is associated with:
Deformed facial features Attention deficit disorder Reduced IQ Kidney defects
72
What are PAPPA, HCG and nuchal translucency?
1st trimester screening. OFFERED but not routine
73
What are oestradiol, AFP and inhibin?
2nd trimester screening
74
Risks of rubella in pregnancy?
Neonatal cataracts, deafness, learning disability, heart defects and miscarriage i contracted <20 weeks
75
Any bleeding after 12 weeks, in someone who is Rh-ve, what do we do?
Give Anti D to try mop up any foetal maternal haemorrhage. This is because if not the mum will produce an immune response to the foreign antigen.
76
What is a 'sensitising even't for rhesus -ve women?
``` TOP Abdominal trauma CVS or amnio Miscarriage APH ```
77
What does a Kleihauer test do?
Measures number of foetal maternal haemorrhages and ensures we dose Anti D appropriately
78
Methods for operative vaginal delivery?
Forceps | Ventouse
79
Requirement for vaginal deliver?
Fully dilated | Head below spines
80
Describe the difference between the anterior fontanelle and the posterior fontanelle
Anterior fontanelle = 4 sutures run from it therefore it is a DIAMOND shape Posterior fontanelle = 3 sutures run from it therefore is a TRIANGLE shape
81
what function does feeling the fontanelles have?
determining foetal position during a vaginal examination
82
Why is general anaesthetic higher risk in a pregnant women?
progesterone effects during pregnancy relaxes ligaments. There is a higher risk of aspiration due to relaxed GOS, increased weight and breast tissue means high risk of failed intubation.
83
When may general anaesthetic be chosen above spinal?
QUICKER! used in emergencies when you don't have the 15 minutes to wait for spinal anaesthetic to take
84
What does 'two big blue eyes, one big red mouth' help you remember?
There are 2 umbilical arteries carrying deoxygenated blood from foetus to placenta. There is 1 umbilical vein carrying oxygenated blood from placenta to foetus
85
Foramen ovale shunts left to right....
atrium
86
what is the function of the placenta
Gas exchange Transfer of nutrients to foetus Waste product transport from foetus Transfer of IgG
87
What is the transition of circulation at delivery?
``` Pulmonary vascular resistance drops. Systemic vascular resistance rises. Oxygen tension rises. Circulating prostaglandins drop. Duct constricts. Foramen ovale closes. ```
88
What is hypoxic ischaemic encephalopathy?
Lack of oxygen, causing cell death and resulting neurological deficit
89
3 most important factors in the first three hours of life?
Thermoregulation | Glucose homeostasis
90
Glucose homeostasis in babies?
Separation from placental glucose supply, Use of glycogen stores. Ability to use ketones as brain fuel
91
Hypoglycaemia in babies risk factors:
``` Prematurity <37 weeks Maternal diabetes Maternal B blockers Hypothermia Hyperinsulinism ```
92
Why is jaundice r common in babies?
physiological breakdown breakdown of foetal haemoglobin
93
what is kernicterus
rare neurological disorder characterised by excessive levels of unconjugated bilirubin in the blood
94
What are the benefits of breast milk?
``` Bonding/positive mental health Transfer of immunoglobulins Decreased risk of adult co-morbidities Decreased risk of SIDS Protective against breast, ovarian cancer and heart disease for mum ```
95
What is variability on a CTG?
Upper and lower aspect of the base rate
96
What are accelerations on a CTG?
>15 bpm above base rate. | A sign of health
97
What are decelerations of a CTG?
>15 bpm below the base rate.
98
What do contractions on a CTG show?
How many - not how strong!
99
What are early decelerations?
Normal - physiological. | Sign that the head is getting compressed in contractions
100
What are variable decelerations?
All appear different. Can be physiological (cord being compressed) but if they persist can be a sign of foetal distress
101
What are late decelerations?
Always PATHOLOGICAL and a sign of foetal distress. DELIVER
102
What is the risk in pre-eclampsia?
Eclampsia - a fit
103
Initial assessment of pre-eclampsia?
ABCDE - don't forget glucose
104
Treatment of pre-eclampsia?
Labetalol and nifedipine orally
105
What counts as severe pre-eclampisa?
>160/110
106
How do we treat severe pre-eclampsia?
IV labetolol or hydralazine. MGSO4 for seizure protection. Fluid restriction.
107
With treatment of pre-eclampsia, what BP are we aiming for>
130/85
108
What is the ultimate treatment for pre-eclamapsia?
Delivery
109
Why don't we give ergometrine in pre-eclampsia?
Increases BP
110
If someone has suffered from pre-eclampsia, what would we do in their next delivery plan?
Make them take aspirin from 12 weeks.
111
What are the signs of cerebral irritation in pre-eclampsia?
Conus, confusion, hyper reflexia, agitation
112
Causes of bleeding >24 weeks gestation?
``` Placenta praevia Placental abruption Vasa praevia Ectropion Infection Trauma Uterine rupture ```
113
How does placenta praevia present?
Painless PV bleed
114
How does placental abrution present?
Painful bleed but can be painful and concealed
115
How does vasa praevia present?
Small PV bleed at time of ruptured membraned with acute and severe foetal distress
116
How do we try avoid blood transfusions in obstetrics?
Optimise Hb in pregnancy - treat anaemia and active 3rd stage to reduce chance of PPH
117
In an emergency, what type of blood can be used universally
O -ve
118
What type of blood products are used?
``` RBC's Platelet Cryoprecipitate FFP Cell salvage ```
119
What causes a pregnancy to be small for dates?
``` Wrong dating Idiopathic Multiple pregnancy TORCH infections Placental dysfunction Foetal anaemia Genetic syndromes ```
120
What causes a pregnancy to be large for dates?
Wrong dating
121
What are the risks of a small for dates baby?
Still birth Foetal distress Risk of pre-term delivery
122
What are large for dates babies at an increased risk of?
``` Obstruction in labour Shoulder dystocia Maternal trauma from tears Sphincter injury PPH ```
123
What are twins at higher risk of?
``` Anaemia Stillbirth Foetal abnormalities PPH Operational delivery Gestational diabetes Pre-eclampisa IUGR ```
124
What is the highest risk type of twins?
Monochorionic as they share a placenta. Can develop twin to twin transfusion
125
Causes of PPH:
1. Tone 2. Tissue (some placenta left behind) 3. Trauma (perineal or cervix tears) 4. Thrombin (coagulopathy occurs or clotting disorder)
126
How do we treat tone caused PPH?
Uterotonics (oxytocin, ergometrine, carboprost, misoprostal) and empty bladder.
127
How do we treat tissue caused PPH?
Empty uterus
128
How do we treat trauma caused PPH?
Identify bleed and stop it surgically
129
How do we treat thrombin caused PPH?
Treat cause of coagulopathy and replace factors

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