Obs and Gynae anki 1 Flashcards

Question

How are persistent or enlarging ovarian cysts treated?

Answer 1

Surgical intervention-laparoscopy->ovarian cystectomy, sometimes with affected oophorectomy

Answer 2

Physiological/functional cysts Benign germ cell tumours Benign epithelial tumours Benign sex cord stromal tumours

Answer 3

Represent the developing follicle When these fail to rupture and release the egg the cyst can persist. Typically on US they have thin walls and no internal structures

Answer 4

Occur when the corpus luteum fails to break down and instead fills with fluid They may cause symptoms such as pelvic discomfort, pain or delayed menstruation. They are often seen in early pregnancy.

Answer 5

Lump of endometrial tissue within the ovary, occurring in patients with endometriosis. They can cause pain and disrupt ovulation

Answer 6

Benign ovarian teratomas- Come from germ cells Can contain tissue types like skin, teeth hair and bone. Torsion is more likely than with other ovarian tumours

Answer 7

Twisting of the adnexa and blood supply to the ovary leads to ischaemia. If the torsion persists, necrosis will occur, and the function of that ovary will be lost.

Answer 8

Sudden onset severe unilateral pelvic pain Pain is constant and gets progressively worse Associated with nausea and vomiting Pain can also come and go if ovary twists and untwists intermittently

Answer 9

1st line: Pelvic US(transvaginal ideally, transabdominal as backup)->;'whirlpool sign' free fluid in pelvis and oedema or ovary Doppler-> reduced blood flow Definitive->laparoscopic surgery

Answer 10

Urgent admission and gynae involvement Laparoscopic surgery to:Untwist the ovary and fix it in place(de-torsion) Remove the affected ovary (oophorectomy) Laparotomy may be needed if large ovarian mass or malignancy is suspected

Answer 11

Thought to be autoimmune reaction-associated with T1DM Also genetics and hormonal factors

Answer 12

45-60yr old woman Vulval itching Soreness/pain Skin tightness Painful sex (superficial dyspareunia) Erosions Fissures Koebner phenomenon

Answer 13

“Porcelain-white” in colour Shiny Tight Thin Slightly raised There may be papules or plaques

Answer 14

Mostly clinical Skin biopsy can be used to confirm the diagnosis-usually done if atypical features are present(e.g. doesn't respond to treatment, clinical suspicion of cancer etc) Blood tests to check for potential autoimmune conditions

Answer 15

Topical corticosteroids(dermovate) to reduce inflammation and itching Avoidance of soap in affected areas to prevent further irritation Emollients to relieve dryness and soothe itching

Answer 16

2 main tumour suppressor genes: P53 and pRb HPV produces 2 main proteins: E6 and E7 E6 protein inhibits p53 E7 inhibits pRb Therefore, HPV promotes the development of cancer by inhibiting tumour suppressor genes.

Answer 17

age 12-13 yrs

Answer 18

Most commonly picked up on screening incidentally Abnormal vaginal bleeding (intermenstrual, postcoital or post-menopausal bleeding) Vaginal discharge Pelvic pain Dyspareunia (pain or discomfort with sex) Urinary/bowel habit change Abnormal white/red patches on cervix Mass on PR exam

Answer 19

-If symptoms-speculum exam and smear test If abnormal appearance of cervix-urgent cancer referral for colposcopy

Answer 20

Colposcopy NOT screening

Answer 21

CIN I::mild dysplasia, affecting 1/3 the thickness of the epithelial layer likely to return to normal without treatment CIN II: moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated CIN III: severe dysplasia, very likely to progress to cancer if untreated

Answer 22

All women between ages 24-64 25-49 yrs: 3 yearly 50-64 yrs: 5 yearly

Answer 23

Inadequate Normal Borderline changes Low-grade dyskaryosis High-grade dyskaryosis (moderate) High-grade dyskaryosis (severe) Possible invasive squamous cell carcinoma Possible glandular neoplasia

Answer 24

Treatment for cervical intraepithelial neoplasia(CIN) and very early-stage cervical cancer. It involves a general anesthetic. The surgeon removes a cone-shaped piece of the cervix using a scalpel This sample is sent for histology to assess for& malignancy

Answer 25

Targets vascular endothelial growth factor A: which is responsible for the development of new blood vessels. Reduces the development of new blood vessels

Answer 26

Endometrium of the uterus

Answer 27

>55yrs with post menopausal bleeding-suspected cancer pathway 2ww

Answer 28

1)Trans-vaginal ultrasound: endometrial thickness >4mm 2)Hysteroscopy with endometrial biopsy

Answer 29

Surgery: hysterectomy with bilateral salpingo-oophorectomy-can be curative if limited Radio/chemotherapy Progesterone therapy sometimes used in frail elderly women not suitable for surgery

Answer 30

1. Most return to normal 2. 5% become cancer

Answer 31

Intrauterine system(mirena coil) Continuous oral progesterones(levonorgestrel)

Answer 32

Contains aromatase->converts androgens. More adipose tissue->more androgens converted to oestrogen

Answer 33

5th most common malignancy in femals

Answer 34

Partially cystic so can contain fluid

Answer 35

Via lymphatics

Answer 36

Typically present late-non-specific symptoms Abdominal pain Bloating Early satiety Urinary frequency or change in bowel habits Later stages:Ascites(vascular growth factors increasing vessel permeability) Pelvic, back and abdominal pain Palpable pelvic or abdominal mass

Answer 37

Raised CA125(>=35IU/mL)-> urgent US of abdomen and pelvis

Answer 38

Surgery:If early disease-remove uterus, fallopian tubes, ovaries and infracolic omentectomy Advanced-debulking surgery Pelvic exenteration if severe Adjuvant/intraperitoneal chemotherapy Biologics

Answer 39

80% have advanced disease at presentation All stage 5 year survival is 46%

Answer 40

Presses on the obturator nerve-> referred hip or groin pain

Answer 41

Rare-4% of gynae cancers

Answer 42

Lump on labia majora Inguinal lymphadenopathy Itching/discomfort in vulval area Non healing ulcer Changes in skin colour/thickening of vulva Bleeding/discharge not related to the menstrual cycle

Answer 43

Surgery Radical/wide local excision Radical vulvectomy for multi-focal disease Reconstructive surgery Radiotherapy.chemo

Answer 44

AKA hydatidiform mole Spectrum of disorders known as gestational trophoblastic disease Imbalance in no of chromosomes originating from the mother and father during conception

Answer 45

Complete Partial

Answer 46

Vaginal bleeding Enlargement of uterus beyond the expected size for gestational age Nausea and hyperemesis gravidarum Thyrotoxicosis

Answer 47

Excessive growth of trophoblasts and retained blood

Answer 48

HCG closely related to TSH so able to activate receptors

Answer 49

B-HCG-> higher than normal Trans-vaginal US->'snowstorm' appearance, low resistance of blood vessel flow and absence of a foetus

Answer 50

Specialist centre-> choriocarcinoma Suction curettage Hysterectomy if not fertility performed Surveillance: Partial mole, repeat hCG test is done 4 weeks later - if normal, discharge Complete mole, monthly repeat hCG samples are sent for at least 6 months.

Answer 51

Common-10% of women in reproductive years

Answer 52

Chronic pelvic pain Dysmenorrhoea Dyspareunia Subfertility Non-gynaecological-> dysuria, urgency, haematuria Cyclical rectal bleeding, if endometrium-like tissue grows outside the female reproductive system

Answer 53

Analgesia-paracetemol/NSAIDs Hormonal therapies-mirena coil, COCP, medroxyprogesterone acetate, Gonadotrophin releasing hormone agonists

Answer 54

Laparoscopic excision or ablation plus adhesiolysis-> especially for fertility Ovarian cystectomy(for endometriomas) Bilateral oophorectomy(sometimes hysterectomy)

Answer 55

Asymptomatic Dysmenorrhoea Menorrhagia Dyspareunia Infertility or pregnancy-related complications (Older then endo, often post-menopausal women-enlarged boggy uterus')

Answer 56

Symptomatic: TXA/mefenamic acid Mirena coil(first line) COCP Cyclical oral progesterones GnRH agonists Uterine artery embolisation Hysterecomy-definitive treatment

Answer 57

Buccal smear or chromosomal analysis to reveal 46XY genotype After puberty: hormonal tests

Answer 58

Vaginal dryness and discharge Dyspareunia Occasional spotting Loss of pubic hair Urinary symptoms like dysuria and recurrent UTI

Answer 59

Lubricants and moisturisers Topical HRT Systemic HRT

Answer 60

Conservative: Allow POC to pass naturally-> repeat scan/pregnancy test Medical: Missed: mifepristone and misoprostol Incomplete: misoprostol only

Answer 61

Stimulates cervical ripening and myometrial contractions

Answer 62

Painless vaignal bleeding <24 weeks(usually 6-9 weeks) Bleeding but often less than menstruation Cervical os closed

Answer 63

ReassuranceIf heavy: admit and observe If >12 weeks, and rhesus negative: Anti D

Answer 64

Heavy bleeding Clots Pain Cervical os open

Answer 65

Reassurance, if heavy bleeding then admit and observe If >12 weeks and rhesus negative : Anti D Likely to proceed to a complete/incomplete miscarriage

Answer 66

Gestational sac containing a dead fetus <2 weeks without symptoms of expulsion Cervical os closed Asymptomatic, light bleeding, discharge, pregnancy symptoms which disappear

Answer 67

Missed: mifepristone then misoprostol 48 hours later

Answer 68

POC partly expelled Symptom of bleeding/clots Cervical os open

Answer 69

History of bleeding Clots POC Pain Symptoms settled

Answer 70

Discharged to GP

Answer 71

Infected POC Rigors Fever Bleeding Leukocytosis Increased CRP

Answer 72

IV antibiotics and fluids Medical/surgical treatment

Answer 73

Pelvic pain: can be unilateral Shoulder tip pain-irritation of diaphragm by intra-abdominal bleeding Vaginal discharge/bleeding-decidua breaking down

Answer 74

Close follow up and repeat B-HCG's Not usually done

Answer 75

IM methotrexate Regular B-HCG checks : >15% decline by day 4/5 or repeat methotrexate

Answer 76

Disrupts folate dependent cell division

Answer 77

Tubal ectopics: laparoscopic salpingectomy (remove ectopic and tube) If only one tube left: salpingotomy (cut in fallopian tube and remove ectopic) B-HCG follow up until <5iU(negative)-> check for residual trophoblast

Answer 78

Volune increases until 33 weeks Platueaus at 33-38 weeks Decreases at term to reach 500ml

Answer 79

Fetus breathes and swallows fluid, processed and voided through the bladder Predominantly fetal urine output with some fetal secretions and placenta

Answer 80

Blood flows to brain instead of kidneys so there is a lower fetal urine output

Answer 81

Potter's syndrome: Fetal compression: clubbed feet, facial deformity, congenital hip dysplasia Lack of amniotic fluid: pulmonary hypoplasia in fetus

Answer 82

Treat underlying cause and optimise gestation of delivery Maternal rehydration to increase amniotic fluid volume if mild Amnioinfusion: saline into amniotic fluid to increase volume Deliver: may be induced-C-section

Answer 83

If 2nd trimester: poor prognosis If premature delivery and pulmonary hypoplasia: respiratory distress at birth PLacental insufficiency: higher rate of preterm deliveries

Answer 84

50-60%: Idiopathic 1) Escess production due to increased fetal urination: -Maternal diabetes -Fetal anaemia -Fetal renal disorders -Twin to twin transfusion syndrome 2)Insufficient removal due to decreased fetal swallowing: -Oesophageal duodenal atresia -Diaphragmatic hernia -Anencephaly -Chromosomal disorders

Answer 85

USS: Measure amniotic fluid: AFI/MPD

Answer 86

Primiparous: 1cm every 2 hours Multiparous: 1cm every hour

Answer 87

Hormones(mostly prostaglandins and oxytocin) stimulate regular uterine contractions That and pressure from presenting part of foetus->progressive dilation of the cervix

Answer 88

Regular, painful contractions Progressive cervical dilation Passage of blood stained mucus-'show' Rupture of membranes Descent of foetal head into pelvis

Answer 89

Pain relief-> epidural analgesia, nitrous oxide, opioids Encourage mobility and changes in position to facilitate labour progression Ensure hydration and nutritional support Regular monitoring

Answer 90

Instrumental delivery C-section

Answer 91

Natural: 30-60 minutes With oxytocin: 5-10 minutes

Answer 92

Controlled cord traction->gently to avoid uterine inversion/PPH If retained placenta: manual removal or curettage may be necessary

Answer 93

Membrane sweep: insert finger into extenral os and separate membranes from cervix Vaginal prostalgandins: Used to ripen cervix and induce contractions Amniotony: artificial rupture of membranes Ballon catheter: mechanically dilates cervix

Answer 94

Overstretching of uterus: multiple pregnancy, polyhydramnios Foetal risk complications: pre-eclampsia, placental abruption Uterus/cervical problems: fibroids, malformations Infections: chorioamnionitis, sepsis, group B strep etc Maternal co-morbidity: htn, diabetes etc

Answer 95

Regular uterine contractsion/changes in cervical effacement or dilation/rupturing of membranes before onset of contractions

Answer 96

Corticosteroids: betamethasone/dex to assist foetal lung maturation IV abx if increased risk of infection(penicillin) Tocolytic agents may be used(nifedipine), risk of side effects

Answer 97

Clinically: absence of menarche for 12 months in someone >45 If <40: test FSH etc

Answer 98

Conservative: Lifestyle: regular exercise, weight loss, good sleep Medical:HRT, SSRI's Vaginal lubricants/moisturisers Clonidine for vasomotor

Answer 99

Cyclically: perimenopausal women still having periods Continuously: Post menopausal not having periods

Answer 100

Monthly: oestrogen every day of months and progesterone for last 14 days Every 3 months: Oestrogen very day for 3 months and progesterone for the last 14 days

Answer 101

Vaginal dryness from reduced oestrogen

Answer 102

Caused by epithelial thinning as a result of decline in oestrogen

Answer 103

Moderate oestrogen levels-> negative feedback on HPG High oestrogen with no progesterone-> positive feedback on HPG Oestrogen +progesterone-negative feedback on HPG Inhibin selectively inhibits FSH at anterior pituitary

Answer 104

Common Affects up to 1/4 of women during reproductive years

Answer 105

Hormonal imblanaces-unknown? Hyperandrogenism Insulin resistance Elevated levels of LH Raised oestrogen

Answer 106

Oligomenorrhoea Subfertility Acne Hirsutism Obesity Mood changes: depression, anxiety Male pattern baldness Acanthosis nigracans->secondary to insulin resistance

Answer 107

>=2 of: Polycystic ovaries(>12 cysts on imaging or ovarian volume >10cubic cm) Oligo/an ovulation Clinical or biochemical features of hyperandrogenism

Answer 108

Conservative:Weight loss, exercise, educate on risks of diabetes.cvr.endometrial cancer Medical for those not planning pregnancy:COCP Metformin Medical for those wanting to conceive: Clomiphene-induces ovulation Metformin Gonadotrophins-induce ovulation Surgical for those wanting to conceive: Ovarian drilling: laparoscopic-damages hormone producing cells of ovary

Answer 109

Damages basal layer of endometrium->heals abnormally creating adhesions connecting areas of the uterus that aren't normally connected Adhesions can bind uterine walls together or might seal the endocervix shut

Answer 110

Can cause physical obstruction and distort pelvic organs->menstrual abnormalities, infertility and recurrent miscarriages

Answer 111

Secondary amenorrhoea(absent periods) Significantly lighter periods Dysmenorrhoea Infertility In a patient with prior pelvic surgery

Answer 112

Hysteroscopy: GS-can also treat adhesions Hysterosalpingography Sonohysterography MRI

Answer 113

Dissect adhesions during hysteroscopy

Answer 114

USS Hysterosapingography MRI-considered best

Answer 115

Surgical intervention

Answer 116

Complete failure of duct fusion: double vagina, double cervix, double uterus Septate uterus arcuate uterus

Answer 117

Vaginal agenesis Vaginal atresia Mullerian aplasia-normal external genitalia but absense of vagina transverse vaginal septa

Answer 118

Obstruciton of menstrual flow after puberty

Answer 119

Involves oestrogen->stimulates endometrial growth Can arise from hyperplasia of basal layer of endometrium

Answer 120

Speculum exam USS

Answer 121

ASX in premenopausal: monitor Symptomatic/postmenopausal/atypical: removed via hysteroscopic polypectomy Histology of removed polyp to exclude malignancy

Answer 122

Bilateral abdominal pain Vaginal discharge Post-coital bleeding Adnexal tenderness Cervical motion tenderness Fever Dysuria and menstrual irregularities

Answer 123

Normal LFTs US rule out stones Definitive dx: laparoscopy Tx: abx

Answer 124

IM ceftriaxone+14 days oral doxycycline+metronidazole 2nd line: oral ofloxacin+oral metronidazole Consider removal of IUD Avoid unprotected sexual intercourse

Answer 125

CommonM>F >65 yrs Can be both renal and ureteric

Answer 126

Calcium oxalate-mc Calcium phosphate Cystine Uric acid Struvite Indinavir

Answer 127

Severe intermittent loin pain that can radiate ot the groin Restlessness Haematuria N+V Sedoncary infection of stone->fever/sepsis

Answer 128

Analgesia Wait if <5mm Medical expulsive therapy Extracorporeal shockwave lithotripsy Uteroscopy-pregnancy women Prevention

Answer 129

Size -micro(<1cm) or macro(>1cm) Hormonal status (secretory vs non secretory)

Answer 130

Macroadenomas: Headache Visual disturbance-bitemporal hemianopia Hypopituitarism signs and sx Excess prolactin: Impotence Loss of libido Galactorrhoea

Answer 131

Macroadenomas: Headache Visual disturbance-bitemporal hemianopia Hypopituitarism signs and sx Excess prolactin: Amenorrhoea Infertility Galactorrhoea Osteoporosis

Answer 132

Dopamine agonists: cabergoline, bromocriptine(inhibits release of prolactin) Trans-sphenoidal surgery: those who can't tolerate therapy

Answer 133

Lateral border of sternum at mid axillary line 2nd and 6th costal cartilages Superficial to pectoralis major and serratus anterior muscles Circular body Axillary tail

Answer 134

Modified sweat glands-> ducts and secretory lobules Each lobule consists of many alveoli drained by a lactiferous duct

Answer 135

Fibrous and fatty component Fibrous stroma condenses to form suspensory ligaments Attach and secure breast to dermis and underlying pectoral fascia Separate secretory lobules of breast

Answer 136

Flat sheet of connective tissue associated with pec major Retromammaroy space-> layer of loose conective tissue between breast and pectoral fascia(used in reconstruction)

Answer 137

Internal thoracic(mammary) artery->branch of subclavian

Answer 138

Lateral thoracic and thoracocromial branches-> axillary Lateral mammary branches->posterior intercostal arteries Mammary branch-> anterior intercostal artery

Answer 139

Blockages of lymphatic drainage->lymph builds up in SC tissues->nipple deviation and retraction, peau d'orange Metastasis can occur through lymph nodes->axillary mx, then can spread to liver, bones and ovary

Answer 140

Anterior and lateral cutaneous branches of 4th-6th IC nerves(autonomic and sensory nerve fibres)

Answer 141

Young women-early 20s

Answer 142

Firm, non-tender breast mass Rounded and smooth edges Highly mobile on palpation-'rubbery' <3cm in diameter(mc 2.5cm)Usually slow growing and solitary

Answer 143

Conservative: Leave, usually regress naturally post menopause Surgical excision: considered if large, growing, causing significant symptoms or diagnostic uncertainty

Answer 144

Most common benign breast condition 20-50 years

Answer 145

Cumulative effect of cyclical hormone Mostly oestrogen and progesterone-> multiple cysts and proliferative changes

Answer 146

Bilateral 'lumpy' breasts, most commonly in upper outer quadrant Breast pain Sx worsen with menstrual cycle and peak 1 week before menstruation

Answer 147

Encourage use of soft, well-fitting bra Analgesia for pain relief Most resolve after menopause

Answer 148

Commonest cancer in UK in women 2nd most common cause of cancer deaths

Answer 149

Genetic mutations and damaged cellular signalling-> generation of malignant cells-> metastasise

Answer 150

Invasion through basement membrane Intravasation(entry into circulation) Circulation Extravasation Colonisation

Answer 151

From epithelial cells Confined to ducts

Answer 152

Area of abnormal cell growth that increases risk of developing invasive breask cancer later

Answer 153

Mc Starts in epithelial cells in milk duct-> invades fatty tissue of breast

Answer 154

Younger people Higher grade than invasive ductal carcinoma

Answer 155

Unexplained breast/axillary mass in those >30 years Nipple discharge Nipple retraction Skin changes-p'eau d'orange Metastatic features: weight loss, bone pain, SOB

Answer 156

1st line: imaging:>30yrs and clinical suspicion: mammogram <30yrs: USS of axilla 2nd line: biopsy Fine needle aspiration and cytology Others: Oestrogen/progesterone receptor testing, HER2 receptor testing CT if metastatic disease suspected

Answer 157

1A: <2cm, isolated to breast 1B: <2cm, minor axillary LN spread 2A: <2cm, spread to 1-3 ipsilateral lymph nodes 2B: 2-5cm, minor axillary node spread or >5cm with no nodal spread 3A: 4-9 ipsilateral LN spread/>5cm with 1-3 ipsilateral nodes 3B: Spread to skin, chest wall 3C: >10 axillary nodes/supraclavicular/parasternal/axillary spread 4: metastatic spread to other organs

Answer 158

Can help reduce recurrence in node-positive cancers

Answer 159

Fibroadenomas-overgrowth of glandular and connective tissue resulting in blocked breast ducts and subsequent fluid accumulation

Answer 160

Reassurance: often only need monitoring Antibiotics: for infections like mastitis Analgesics Surgery: e.g. large fibroadenomas, persistent cysts, symptomatic intraductal papillomas

Answer 161

Rare: <5% of all breast cancer patients Most common in postmenopausal women

Answer 162

2 theories: Epidermotrophic: underlying breasst cancer cells migrate to the nipple Intraepidermal origin: originates in nipple itself

Answer 163

Eczema like rash on skin of nipple/areola(often crusty, red, inflamed, itchy) Bloody nipple discharge Non-healing skin ulcer Changes to nipple-> retraction/inversion Pain Breast lump

Answer 164

Mammography/US Punch biopsy of affected skin, nipple discharge cytology MRI for staging in uncertain cases

Answer 165

Paget's involves the nipple primarily and only latterly spreads to the areolar(opposite way around in eczema)

Answer 166

Depends on underlying lesion Simple mastectomy: remove entire breast and nipple and areeola Modified radical mastectomy: remove some axillary lymph nodes Lumpectomy Chemo, radiation, hormonal

Answer 167

Contractions(may be irregular) Mucoid plug Cervix beginning to efface and dilate(0-4cm) Can last up to 2-3 days

Answer 168

Starts in the fundus(pacemaker) Retraction/shortenng of muscle fibres Build in aplitude as labour progresses Fetus forced down causing pressure on the cervix

Answer 169

Inlet is slightly transverse oval Sacrum wide with average concavitiy and inclination Side walls straight with blunt ischial spines Wide suprapubic arch

Answer 170

Gentle downward traction to assist with delivery of shoulder below suprapubic arch Gentle upwads traction to assist delivery of posterior shoulder

Answer 171

Lobes which attach to the uterine wall Connected to fetus via umbilical cord whcih has 2 arteries and a vein

Answer 172

Cup is applied with centre over flexion point on fetal skull During uterine contractons, traction applied perpendicular to cup

Answer 173

From 10 weeks

Answer 174

11-14 weeks gestation

Answer 175

Postpartum: 10-20% prevalence Usually in first 6 weeks post birth Increased risk in 1st time mothers and previous hx of mastitis

Answer 176

Milk stasis->inflammatory response and potential secondary infection Cracked/sore nipples-> S.aureus-> infective mastitis

Answer 177

Localised: painful, red, tender, hot breast Systemic: fever, rigors, myalgia, fatigue nausea and headache Usually unilateral-presents 1st week post partum

Answer 178

Mostly clinical US to ID if suspicion of abscess-> done in secondary care

Answer 179

Reassure lactating women they can continue to breastfeed Advice on methods to faciliate milk expression Analgesia Oral/IV abx, surgery if abscess

Answer 180

S.aureus mc through crack in nipple/through milk duct Accumulation of milk, trauma to nipple skin from incorrect latch/pump

Answer 181

Fever/rigors Malaise Pain and erythema over an area of the breast Possible presence of a fluctuant mass->might not be palpable Hisotry of recent/ongoing mastitis

Answer 182

Breast USS-> visualise abscess and guide drainage Diagnostic needle aspiration-> culture organism and evacuation

Answer 183

Incision and drainage/needle aspiration(with/out US guidance) Abx therapy targeted towards most likely causative organism

Answer 184

Mc cause of abnormal dishcarge in women of childbearing age More common in sexually active women but not an STI

Answer 185

Disturbance of normal vaginal flora->decrease in number of lactobacilli bacteria

Answer 186

Screening done antenatally and quick treatment if needed Lower doses of metronidazole in lactating women

Answer 187

Highlyy prevalent: 20% of women/yr Most women will experience it at some point in their lifetime

Answer 188

Candida albicans- replicated by budding Opportunistic infection vs hypersensitivity reaction

Answer 189

Pruritus vulvae Vaginal discharge-white, curd like Dysuria

Answer 190

Usually history/clinical Vaginal smear and mc+s-> blastospores, pseudohyphae and neutrophils

Answer 191

Oral fluconazole single dose Clotrimazole pessayr if CI(including pregnancy) Vulval sx: consider topical imidazole

Answer 192

Clotrimzole pessary DO NOT use oral antifungals Advise care with intravaginal treatment applicator Saftynetting if not resolved in 7-14 days

Answer 193

Most common STD in UK Highest prevalence in 15-24 yr olds

Answer 194

Via unprotected vaginal, oral, anal sex Skin to skin contact of genitalsVertical(mother to baby during delivery)

Answer 195

Often asymptomatic: incubation period 7-21 days Urethritis: dysuria, urethral discharge Epididymo-orchitis: testicular pain Epididymal tenderness Mucopurulent discharge

Answer 196

Asymptomatic often: incubation period 7-21 days Dysuria Discharge Intermenstrual bleeding Pain/tenderness

Answer 197

Pneumonia Conjunctivitis

Answer 198

Women: vulvovaginal swab Men: first catch urine sample Analyze using nucleic acid amplification tests

Answer 199

Doxycycline: 100mg twice daily for 7 days

Answer 200

Azithromycin/erythromycin

Answer 201

Oral erythromycin

Answer 202

2nd most common STI after chlamydia-increased prevalence in 15-24yrs->Higher prevalence in MSM

Answer 203

Unprotected vaginal/oral/anal sex Vertical transmission

Answer 204

Gram negative diplococcus neisseria gonorrhoea Causes acute inflammation-> uterus, urethra, cervix, fallopian tube, ovaries, rectum, testicles, eyes, throat

Answer 205

Males: urethral discharge, dysuria Women: discharge, dysuria, dyspareunia, pain Dishcarge tends to be thin, watery green/yellow Asymptomoatic especially when rectal/pharyngeal infection

Answer 206

Females: endocervical/vaginal/urethral swab Males: first pass urine(NAAT), urethral/meatal swab Microsopcy, culture and NAAT

Answer 207

Singled dose 1g IM ceftriaxone Screen/treat other infections-test of cure recommended

Answer 208

Tenosynovitis Migratory polyarthritis Dermatitis

Answer 209

Prophylactic abx+tx in pregnancy->ceftriaxone

Answer 210

Urgent referral and treatment Long term damage and blindness

Answer 211

Very common 15-24yrs

Answer 212

After infecting surface-> travels up to meet nearest ganglion and stays there until reactivated

Answer 213

Asymptomatic Small, painful red blisters around genitals, can form open sores Vaginal/penile discharge, dysuria, urinary retention Flu like sx-> fever ,muscle aches, malaise, headaches After 20 days: lesions crust and heal-> end of viral shedding

Answer 214

Usually shorter and less severe than initial infection Burning, itching, painful red blisters

Answer 215

Clinical hz and exam Swab from base of ulcer-> NAAT

Answer 216

Primary infection: aciclovir 400mgTD 5 days Recurrent outbreaks: OTC analgesia, ice, topical lidocaine Regular episodes: episodic aciclovir tx when sx begin

Answer 217

Low risk of transmission with vaginal birth Referral to GUM clinic and treat with aiclovir if 1st time HSV infection If contracted in last trimester: antibodies not developed-> C-section

Answer 218

Skin/eyes/mouth herpes(SEM)-antiviral tx Disseminated herpes(DIS)-internal organs CNS herpes-> encephalitis DIS and CNS herpes associated with increased mortality

Answer 219

90% HPV 6/11-low risk, not associated with cancer

Answer 220

Asx Painless warts of scrotum, penis, vagina, cervix, perianal skin, anus Warts can be keratinised(hard) or non-keratinised(soft) Extra-genital lesions: oral cavity, larynx, nasal cavity, conjunctivae

Answer 221

Usually from clinical exam/hx Proctoscopy/vaginal speculum exam to check for internal warts Biopsy for atypical lesions/suspected intraepithelial neoplastic lesions

Answer 222

Tx not always needed, can resolve spontaneously Topical:Podophyllotoxin: antiviral to destroy clusters(BD 3 days then 4 days rest) Imiquimod: immune response modifier for larger keratinised warts(3 times/week) Physical:Cryotherapy Surgical excisionElecrto/laser-surgery

Answer 223

No risk to babies but maternal warts can multiply/enlarge during pregnancy

Answer 224

Penetrates host CDD4 cell and empties its contents. Single strands of viral RNA converted to double stranded DNA by reverse transcriptase and combined host DNA using integraseInfected cell divides, viral DNA read->creates viral protein chains and immature virus pushes out of cell, retaining some membranes Virus matures when protease cuts viral protein chains and assemble to create a working virus, destroying a host cell

Answer 225

Seroconversion(producing anti-HIV antiibodies during primary infection)->flu-like sx->decrease in CD4 levels due to initial rapid replication-> extremely infectious Latent phase: months-yrs: initial asx but increased susceptibility to infections

Answer 226

Unprotected sexual intercourse Sharing needles Medical procedures Vertical transmission

Answer 227

2-6 weeks post exposure Fever Muscle aches Malaise Lymphadenopathy Maculoapular rash Pharyngitis

Answer 228

Weight loss High temperature Diarrhoea Frequent opportunistic infections

Answer 229

Advanced stage: immune system significantly weakened Deveopment of AIDS defining illnesses/infections/malignancies

Answer 230

4th generation tests:ELISA-> test for serum/salivary HIV antibodies and p24 antigen Reliable results 4-6 weeks post exposure Contact tracing

Answer 231

HAART: highly active antiretroviral therapy >=3 drugs: usually 2 nRTIs and 1 PI/NNRTI Decreases viral replication and reduces risk of viral resistance emerging

Answer 232

non-nucleoside reverse transcriptase inhibitors E.g. nevirapineSE: P450 enzyme interaction, rashes

Answer 233

E.g. indinavir, nelfanivir SE: diabetes, hyperlipidaemia, central obesity, P450 enzyme inhibitirion

Answer 234

E.g. raltegravir, elvitegravir Block the action of integrase(viral enzyme that inserts the viral genome into the DNA of the host cell)

Answer 235

Can be transmitted in utero, at delivery and through breast-feeding Risk reduction strategies C-section non longer recommended if undetectable viral load

Answer 236

Anttenatal antiretroviral therapy during pregnancy and delivery Avoidance of breastfeeding Neonatal post-exposure prophylaxis

Answer 237

Painless vaginal bleeding <24 weeks(usually 6-9 weeks) Bleeding often less than menstruation

Answer 238

Idiopathic Excess production due to increased fetal urination Insufficient removal due to decreased fetal swallowing

Answer 239

Uterus feels tense/large for dates Difficult to feel fetal parts on abdominal palpation

Answer 240

Usually no intervention needed Treat underlying cause Severe only: amnioreductionIndomethacin

Answer 241

Enhances water retention and decreases fetal urine output

Answer 242

Membrane sweeps-40 wks nulliparous, 41 wks in parous Induction of labour-41/42 weeks gestation If 2 declined: twice weekly CTG monitoring and US with amniotic fluid measurement to predict fetal distress. Might need C-section

Answer 243

Painless bright red vaginal bleeding after 24 weeks Sometimes pain if in labour Can present with signs of shock if severe blood loss Malpresentation of fetus due to abnormal placental position

Answer 244

ABCDE approach If bleeding not controlled/in labour: C-section Anti-D within 72 hours of bleeding onset if rhesus D negative

Answer 245

Placenta praevia minor: rpt scan at 36 weeks-likely to move Major: rpt at 32 weeks and plan for delivery-> usually elective c-section Advice about pelvic rest: no penetrative sexual intercourse and go hospital if major bleeding

Answer 246

Rupture of maternal vessels in basal layer of endometrium-> blood gathers and splits placental attachment from basal layer Detached portion unable to function-> rapid fetal compromise

Answer 247

Painful vaginal bleeding If in labour: may have pain between contractions Abdominal pain: often sudden and severe Hypovolaemic shock disproportionate to amount of vaginal bleeding visible

Answer 248

ABCDE resus including anti D if rh D negative Tx dependent on health of fetus Emergency delivery: usually C section, even if in-utero death Induction of labour at term to avoid further bleeding if haemodynamically stable

Answer 249

20% breech at 28weeks Most revert to cephalic presentation spontaneously with only 3% still breech at term

Answer 250

Clinical:Head felt in upper uteris, buttocks and legs in pelvis Fetal heart auscultates higher on maternal abdomen on US 20% not diagnosed until labour

Answer 251

Fetal distress->meconium stained liquor Vaginal exam: sacrum/foot felt through cervical opening

Answer 252

External cephalic version: offered at 37 weeks to primiparous women C-section Vaginal breech birth

Answer 253

Abdominal exam Confirm with US-> also ID predisposing abnormalities

Answer 254

External cephalic version(ECV)-> 36-38 weeks gestation

Answer 255

Breech: ECV before labour, vaginal birth, C section Brow: c-section Shoulder: c -section Face: chin posterior: c section, chin anterior: attempt normal labour

Answer 256

90% spontaneously rotate during labour If not: operative vaginal delivery/C-section

Answer 257

High resistance, low flow uteroplacental circulation develops as constrictive muscular walls of spiral arterioles are maintained Increase in BP, hypoxia-> systemic inflammatory response

Answer 258

Headaches visual changes Epigastric pain Sudden onset non-dependent oedema Hyper-reflexia

Answer 259

Serial monitoring: BP, urinalysis, fetal growth scans, CTG VTE-LMWH Anti-hypertensives-labetalol, nifedipine, methyldopa Delivery(give IM steroids if <35 weeks) Post-natal: monitor for 24 hours post partum and BP for 5 days

Answer 260

Post-natal: mc-44% Antepartum: 38% Intrapartum: 18%

Answer 261

New onset tonic clonic seizure in presence of pre-eclampsia Lasts 60-75 secs then post-ictal phase May cause fetal distress and bradycardia

Answer 262

Rescuscitation ABCDE approach Pt lie in left lateral position and secure airway and O2 therapy Seizure control:Magensium sulphate Monitor for signs of magensium poisoning BP control:IV labetalol and hydralazine Delivery of baby and placenta:Usually C-section Monitoring:Fluid balance: prevent pulmonary oedema and AKI Monitor platelets, transaminases and creatinine

Answer 263

48 hours after last seizure

Answer 264

Predominanly sexual

Answer 265

Mc non-viral STI globally

Answer 266

Profuse, frothy, yellow vaginal discharge Vulvovaginitis Dyspareunia Strawberry cervix-may be seen pH>4.5 Asx

Answer 267

Usually asymptomatic Non-gonococcal urethritis

Answer 268

Direct microscopy and culture of the causative organism-> motile trophozoites pH>4.5 Test for other STIs

Answer 269

Oral metronidazole for 5-7 days or single dose of 2g orally Abstain from sex for a week Screen for others Contact tracing

Answer 270

Global incidence decreasing Mc in tropical areas and greenland

Answer 271

Painful genital ulcers which may bleed on contact-ulcers are sharply defined, ragged, undermined border Painful inguinal lymphadenopathy Sx 4-10 days after bacterium exposure

Answer 272

Usually clinical Can culture and use PCR

Answer 273

Antibiotics: ceftriaxone/azithromycin/ciprfloxacin Analgesics Incision/drainage of buboes

Answer 274

Stage 1: small painless pustule which later forms an ulcer Stage 2: painful ingional lymohadenopathy-may from fistulaitng buboes Stage 3: proctocolitis(can include rectal pain and discharge)

Answer 275

PCR from swab of genital ulcer

Answer 276

oral doxycuclin 100mg twice daily for 21 days Can also use: tetracycline, erythromycin

Answer 277

Normal chalmydia: urethritis and PID: Chlamydia trachomatis serovars D-> Klymphogranuloma venereum: serovards L1, L2, L3

Answer 278

Mc: infective: bacterial and candidal Autoimmune causes

Answer 279

Usually clinical-hx and exam Swab for mc+s/PCR->bacteria or candida albicans If doubt/extensive skin changes: biopsy

Answer 280

Gentle saline washes Wash properly under foreskin 1%hydrocortisone for a short period Treat underlying cause

Answer 281

Mild potency steroid- hydocortisone

Answer 282

High potency topical steroids Clobetasol Circumcision can help

Answer 283

Topical clotrimazole for 2 weeks

Answer 284

Direct contact with syphilis sores or rash during vaginal, anal or oral sex Vertical: mother to child

Answer 285

Chancre-painless ulcer at the site of sexual contact Local non-tender lymphadenopathy Often not seen in women(lesion can be on the cervix)

Answer 286

Painless Round, indurated base Heals spontaneously within 3-8 eeks

Answer 287

Systemic: fevers, malaise etc Rash on trunks, palms and sores buccal 'snail track' ulcers Condylomata lata (painless warty lesions on genitalia)

Answer 288

Gummas(granulomatous lesions of skin and bones) Ascending aortic aneurysms neurological: demenita, paresis, tabes dorsalis, argyll-robertson pupil)

Answer 289

Presents shortly after birth or later in infancy Rash: palms/soles, mucous patches/leisons in motuh/nose/genitals Feever Blunted upper incisor teeth(Hutchinson's teeth), 'mulberry' molars Rhagaades( linear scars at angle of mouth) Keratitis Saber shins Saddle nose Neruological; seizures, developmental delay

Answer 290

Non-treponemal tests Treponemal specific tests

Answer 291

Not-specific for syphilis: false positives Based on reactivity of serum from infected patients to a cardiolipin cholesterol-lecithin antigen Negative after treatment

Answer 292

More complex and expensive but sspecific for syphilis Positive for life-even after treatment Qualitative

Answer 293

IM benzathine penzylpenicillin Tertiary/late latent: longer course of IM penicillin Neurosyphilis: IV penicillin G for 10-14 days Backup for penicillin allergy: doxycycline

Answer 294

Bloody discharge from the nipple With/without a palpable mass May have breast tenderness

Answer 295

Often surgery recommended

Answer 296

Microcysts: seen on imaging but too small to be felt Macrocysts: 1-2cm: large enough to be felt

Answer 297

Tender lump arounf areola +/- thick green nipple discharge If ruptures: local inflammation-> 'plasma cell mastitis'

Answer 298

Surgical intervention may be needed if symptomatic

Answer 299

Rare Significant cause of maternal and perinatal morbidity/mortality

Answer 300

Unknown Related to abnormal placentation, endothelial cell injury and generalized inflammatory response

Answer 301

N+V RUQ pain-> liver distention Lethargy Headaches Blurred vision Peripheral oedema

Answer 302

Definitive: deliver baby Steroids: accelerate fetal lung maturation Blood transfusions to manage anaemia and thrombocytopenia

Answer 303

Relatively rare Higher risk in breech presentations and multiple pregnancies

Answer 304

Usually membrane rupture-> amniotic fluid egress-> descent of umbilical cord Cord compression-> against maternal soft tissues or bony pelvis->fetal hypooxia

Answer 305

Abnormal fetal heart rate: mc varibable/prolonged decelerations Palpable umbilical cord Sudden onset of sympotms post rupture of membranes Patient reported sensation

Answer 306

Clinical USS Cardiotocoography(CTG) Speculum exam

Answer 307

Immediate delivery of fetus-> instrumental or C section 'knees chest' or 'all fours' position to reduce pressure on cord Elevation of presenting part Avoid exposure and handling of cord, reducing into vagina Use of tocolytics like terbutaline to stop uterine contractions

Answer 308

Fetal vessels run close to or over the internal cervical os-> prone to rupture when membranes rupture as not protected by umbilical cord or placental tissue->fetal haemorrhage/death

Answer 309

Type 1 and Type 2 Ramified or funic

Answer 310

Triad of: Painless vaginal bleeding Rupture of membranes Fetal bradycardia/resulting fetal death Also:Foetal anaemia

Answer 311

Transabdominal/TV USS-most cases now diagnosed antenatally Can use MRI and prenatal testing

Answer 312

Elective C-section prior to rupture of membranes: 35-36 weeks gestation Emergency C-section if premature labour or membranes rupture Prompt neonatal resus

Answer 313

Rare: 1-2/1000 childbirths

Answer 314

Unknown Hormonal changes post childbirth Genetics Psychosocial stressors Sleep deprivation

Answer 315

Paranoia Delusions: Capgras Hallucinations-command Manic episodes Depressive episodes Confusion

Answer 316

Clinical Thorough psych evaluation Rule out: thyroid disorders, sepsis etc

Answer 317

Admit to mother/baby mental health unit: especially if Capgras/command hallucinations Antipsychotics: olanzapine and quetiapine Mood stabilisers in some cases CBT

Answer 318

Prevalent: 10-20% of mothers

Answer 319

Multifactorial Biological: hormones, melatonin, cortisol, inflammatory processes, genetics Psychological Social

Answer 320

Persistents low mood and anhedonia Low energy Sleep issues-important to distinguish between baby's fault and depression Poor appetite Concerns relating to bonding with baby, caring for baby etc

Answer 321

MIlder: mood swings, irritability, anxiety and tearfullness Sx present within first 2 weeks after birth and resolve spontaneously

Answer 322

Clinical Edinburgh postnatal depression scale >13 ule out risk of psychosis-risk assessment really important Physical exam: anaemia, hypothyroidism to rule out organic causes

Answer 323

Self-help, CBT, ITP(interpersonal therapy) Antidepressants(SSRIs)-paroxetineand sertraline safe for breastfeeding Severe: admission to mother baby mental health unit

Answer 324

Reassurance and support Regular health visitor checks to check in with mother

Answer 325

Onset of regular uterine contractions accompanied by cervical changes occuring before 37 weeks gestation

Answer 326

Delivery of a baby 20-37 weeks gestation

Answer 327

Rupture of membranes at least one hour before onset of contracitons

Answer 328

Rupture of membranes over 24 hours before onset of labour

Answer 329

Early rupture of the membranes before 37 weeks gestation

Answer 330

Occurs in around 2% of all pregnancies Associated with 40% of preterm delvieries

Answer 331

Sterile speculum exam: look for pooling of amniotic fluid in posterior vaginal vault Avoid digital exam: risk of infection If no pooling: test fluid for placental alpha microglobulin protein(PAMG-1) or insulin like growth factor binding protein 1 USS-oligohydramnios

Answer 332

Admission Regular observations to check for chorioamnionitis Oral erythromycin for 10 days Antenatal corticosteroids: reduce risk of respiratory distress syndrome Delivery should be considered at 34 weeks gestation

Answer 333

4T's:Tone: mc: uterine atony(failure of uterus to contract after delivery) Trauma(tears) Tissue(retained placenta etc) Thrombin(clotting/bleeding disorder)

Answer 334

Life threatening emergency: ABCDE approach 2 14 gauge large bore peripheral cannulas Lie flat Bloods including group and save Commence warm crystalloid infusion

Answer 335

Palpate uterine fundus and rub it to stimulate contractions Catheterisation to prevent bladder distention and monitor urine output

Answer 336

IV oxytocin: slow IV injection then infusion; ergometrine slow IV(unless hx of htn) carboprost IM(unless hx of asthma) sublingual misprostol

Answer 337

If medical options fail to control bleeding: Intrauterine balloon tamponde-if uterine atony as cause B-lynch suture, ligation of uterine/internal iliac arteries If severe: hysterectomy as life-saving procedure

Answer 338

24hrs-12 weeks Depends on underlying cause Abx for infection Surgical evacuation for retained products of conception

Answer 339

15% of mothers rhesus negative If rh negative mother delivers a rh positive child, a leak of fetal red blood cells can occur Causes anti D-IgG antibodies to form in mother Maternal anti-D antibodies can cross placenta in subsequent pregnancies and cause rhesus haemolytic disease if baby is rhesus positive Can also occur in first pregnancy due to leaks

Answer 340

Antepartum haemorrhage Placental abruption Abdo trauma ECV Miscarriage if gestation >12 weeks Termination of pregnancy Delivery of rh positive infant Ectopic pregnancy Amniocentesis, CVS, fetal blood sampling

Answer 341

Test for D antibodies in all rhesus negative mothers at booking Anti-D given to non-sensitised rh negative mothers at 28 and 34 weeks-prophylaxis(once sensitisation occurs can't be undone)

Answer 342

Screening/prevention strategies Give Anti-D immunoglobulin as soon as possible but always within 72 hours when a sensitisation even occurs

Answer 343

Mifepristone(first orally) then misoprostol 24-48 hours after Misoprostol can be repeated 3 hourly(max 5) until expulsion Takes time: hours to days Pregnancy test required in 2 weeks: multi-level pregnancy test-measures level of HCG not just positive or negative

Answer 344

Same: oral metronidazole 400-500mg twicce a day for 5-7 days High dose not recommended in pregnancy/breastfeeding(no 2g single dose)

Answer 345

Sudden severe abdominal pain which persists between contractions Shoulder tip pain-diaphragmatic irritation) Vaginal bleeding

Answer 346

O/E: regression of presenting part Abdominal palpation: scar tenderness and palpable fetal parts Fetal monitoring: fetal distress/absent heart sounds Significant haemorrhage: signs of shock: tachycardia, hypotension

Answer 347

ABCDE appproach C-section Uterus either repaired or removed Decision-incision interval should be under 30 minutes

Answer 348

Glucose intolerance on OGTT with: Fasting blood glucose >=5.6mmol/L 2 hour plasma glucose levels >=7.8mmol/L

Answer 349

5% of pregnancies 2nd most common medical disorder complicating pregnancies

Answer 350

Often asx Polyuria Thirst Fatigue

Answer 351

OGTT: fasting >=5.6, 2 hour: >=7.8-REMEMBER 5,6,7,8 HbA1c: distinguish between gestational and pre-existing diabetes early on Urinalysis: check for glycosuria

Answer 352

Fasting glucose <7mmol/L: lifestyle : diet and exercise. Give it 1-2 weeks then metformin if targets not met, then insulin added >=7mmol/L: start insulin (short acting not long acting) 6-6.9mmmol/L + complications like macrosomia or hydramnios: offer insulin Glibenclamide only for women who can't use metormin/doesn't work and decline insulin

Answer 353

Weight loss if BMI >27 Stop oral hypoglycaemimcs except metformin and start insulin Folic acid 5mg/day until 12 weeks Detailed anomaly scan at 20 weeks including 4 chamber view of heart and outflow tracts Tight glycaemic control reduces complication rates Treat retinopathy: can worsen in pegnancy

Answer 354

Usually falls in the 1st trimester and continues to fall until 20-24 weeks After this: BP usually increases to pre-pregnancy levels by term

Answer 355

Pre-existing hypertension Pregnancy induced hypertension/gestational hypertension Pre-eclampsia

Answer 356

STOP ACE inhibitor or angiotensin 2 receptor SWAP for alternative: labetalol whilst waiting specialist review Nifedipine if asthmatic

Answer 357

Hypertension occuring in the 2nd half of pregnancy(after 20 weeks) No proteinuria, no oedema5-7% of pregnancies

Answer 358

Oral labetalol/nifedipine/hydralazine Typically resolves within 1 month after birth

Answer 359

Pregnancy induced hypertension associated with proteinuria(>0.3g/24hrs) Oedema may occur but less commonly used now as a criteria 5% of pregnancies

Answer 360

Mc asx commensal bacterium in GI and GU tracts 25% of pregnant women estimated to be carriers Can cause severe illness to mother and infant during transmission during delivery

Answer 361

No current routine screening test for pregnant women as colonisation status can change through pregnancy GBS culture may be done in certain cirumstances

Answer 362

Intrapartum antibiotic prophylaxis-benzylpenicillin Abx IV during labour and delivery

Answer 363

5mg folic acid not 400mcg Screening for gestational diabetes with OGTT at 24-28 weeks BMI >35: Birth in consultant led obstetric clinicBMI>=40: Antenatal coonsultation with ostetric anaesthetist and plan made in advance

Answer 364

Trial of labour Instrumental vaginal delivery-may need episiotomy C-section

Answer 365

ID causes and evaluate progress of labour Medical:Artificial rupture of membranes IV oxytpcin to augemnt contractions Pian management: epidural, nitrous oxide etc Surgical:Operative delivery C-section Postpartum:Monitor closely for infection Active management of 3rd stage of labour: uterotonic agents Ensure adequate analgesia

Answer 366

Pruritus: intense-typically worst in palms, soles, abdomen Jaundice: dark urine and pale stools in about 20% of patients General fatigue and malaise GI sx: nausea and appetite lossRUQ abdominal pain Raised bilirubin in >90% of cases

Answer 367

Chlorphenamine and emollients to reduce itching Induction of labour at 37-38 weeks Ursodeoxycholic acid Vitamin K supplementation->minimise risk of bleeding

Answer 368

High recurrence: 45-90% in subsequent pregnancies

Answer 369

Bacteria ascending from vagina into uterus Mc: Group B strep, E.coli and anaerobic bacteria

Answer 370

Usually clinical Blood tests and cultures to confirm and ID causative organism

Answer 371

IV broad sectrum abx: sepsis 6 protocol Monitoring of fetus and mother for complications Early delivery might be needed-C section

Answer 372

Illegal in UK-immediate child protection referrral if child at risk Anterior episiotomy during second stage of labour under local anaesthetic or regional block Deinfibulation surgery: important to protect urethra

Answer 373

Difficult delivery of fetal face/chin Retraction of fetal head-turtle neck sign Failure of restitution Failure of descent of fetal shoulders following delivery of head

Answer 374

Immediately call for senior help Do not apply fundal pressure-can lead to uterne rupture McRoberts maneouevre All fours position Internal rotational manoeuvers Episiotomy-won't remove bony obstruction but will allow space for internal manoeuvers Cleidotomy/symphysiotomy: not 1st line-associated with significant maternal morbidity] Zavanelli manoeuvre-also dangerous

Answer 375

Hb:1st trimester: <110g/L 2/3 triester: <105g/L Postpartum: <100g/L

Answer 376

Asx Dizziness, fatigue, dyspnoea: normal pregnancy Pallor Koilonychia Angular cheilitis

Answer 377

FBC Folate to check for folate deficiency Check for beta thalassaemia and sickle cell

Answer 378

Risk high as 90% in first 8-10 weeks Damage rare after 16 weeks

Answer 379

Rare now due to MMR vaccine

Answer 380

Virus can cross the placenta and affect the developing fetus

Answer 381

Serology to confirm rubella infection-IgM raised in women recently exposed to virus Audiology tests for hearing impairment Opthalmology for eye abnormalities Echos for congenital heart defects

Answer 382

During pregnancy: discuss with local health protection unit Advised to keep away from people who might have rubella Offer MMR vaccine in post natal period Neonates: primarily supprotive and symptomatic-monitor progress and manage long-term complications

Answer 383

1st, 2nd, 3rd, 4th degree

Answer 384

Superficial damage with no muscle involvement Do not require any repair

Answer 385

Injury to perineal muscle but not involving the anal sphincter Require suturing on ward by suitably experienced midwife or clinician

Answer 386

Injury to perineum involving the anal sphincter complex(external anal sphincter(EAS) and internal anal sphincter(IAS) 3a: <50% EAS thickness torn 3b: >50% EAS thickness torn 3c: IAS torn Require repair in theatre by suitably trained clinician

Answer 387

INjury to perineum involving the anal sphincter complex(EAS and IAS) and rectal mucosa Require repair in theatre by suitably trained clinician

Answer 388

1st degree: no repair 2nd: suturing 3rd/4th: surgical repair under regional or general anaesthetic Broad spectrum abx and laxatives given post surgery

Answer 389

Rare but significant cause of maternal morbidity and mortality

Answer 390

Not known fully Amniotic fluid can enter maternal circulation and form embolism-> block circulation like a blood clot especially in lung Fluid also triggers inflammatory response within mother's immune system-> DIC

Answer 391

Tachypnoea Tachycardia Hypotension Hypoxia DIC Cyanosis and MI Chills, shivering, sweating, anxiety and coughing

Answer 392

Clinical Exclude other causes-no definitive diagnostic test

Answer 393

Immediate transfer to ICU, MDT care Oxygen, fluid resus Correction of any coagulopathy FFP if prolonged PT Cryoprecipitate for low fibrinogen Platelet transfusion for low platelets

Answer 394

Simple:Rest and avoid trigggers Bland, plain food, ginger P6(wrist) acupressure1st line meds:antihistamines: oral cyclyzine/promethazinephenothiazines: oral prochlorperazine or chlorppromazine 2nd line:Oral odansetron Oral metoclopramide/domperidone-5 DAYS MAX Thiamine and folic acid supplementation Atacids Thromboembolic stockings and LMWH -dehydration

Answer 395

Normal saline with added potassium for rehydation Antiemetics

Answer 396

Levothyroxine: usual dose increased by 25-50mcg due to increased metabolic demand

Answer 397

LCHAS mutation->accumulation of fatty acid metabolites in placenta->shunted into maternal circulation and accumulate in maternal liver

Answer 398

Raised:AST/ALT Bilirubin Creatinine Ammonia Lactate Serum uric acid Leukocytosis, low-normal platelets, normocytic normochromic anaemia Coagulopathy: prolonged PT, hypofibrinogenaemia and elevated D dimer

Answer 399

Curative: delivery of the fetus Maternal stabilisation: correct hypoglycaemia, coagulopathy and hypertension After delivery: close monitoring-if ongoing deteriorattion in liver function post birth-transfer to liver transplant facility

Answer 400

Propanolol for sx control Not usually treated with anti-thyroid drugs as thyroid not overactive

Answer 401

Usually treated with thyroxine

Answer 402

Widest diameter of fetal sckull remains stationary above the pelvic brim Prolonged labour: >12 hours Premature rupture of membranes Mother has abnormal vital signs Bandls' ring Foul smelling meconium from mother's vagina Oedema of vulva/cervix Caput Malpresentation/malposition of fetus Poor cervical effacement Assess using vaginal exam

Answer 403

Saline for dehydration catheter to drain bladder May need C section or instrumental delivery

Answer 404

3-7% of newborns Increased prevalence in low/middle income countries->maternal malnutrition and infection

Answer 405

Decreased fetal movement Abnormal fundal height for gestational age Complications like pre-eclampsia and stillbirh

Answer 406

Close monitoring of fetal growth and wellbeing Management of maternal conditions contributing Consideration for early delivery if fetus is in distress/conditions worsens

Answer 407

Excessive response to hormones->multiple follicles mature and enlarge->all transform into corpus luteum->overproduction of oestrogen, progesterone and local cytokines, especially vascular endothelial growth factor->increased membrane permeability and loss of fluid from intravascular compartment

Answer 408

Bloating Abdo pain Oedema Pleural effusions Ascites Weight gain

Answer 409

Routine bloods: evaluate haemoconcentration and detect potential organ dysfunction CXR: ID pleural effusion

Answer 410

Supportive-tailored to severity of condition Simple analgesia for discomfort Might need ICU and close monitoring if severe

Answer 411

Skin scarring Eye defects: microphthalmia Limb hypoplasia Microcephaly Learning difficulties

Answer 412

If doubt about previous infection: check blood urgently for varicella antibodies Oral aciclovir now first choice for post exposure prophylaxis(used to be VZIG)-should be given day 7-14 after exposure not immediately

Answer 413

Seek specialist advice Oral aciclovir >=20 weeks and presents within 24hrs of rash onset <20 weeks: aciclovir 'considered with caution

Answer 414

Placental vascular remodeling is affected-> placental functioning progressively deteriorates. This process affects the placental blood flow, leading to fetal hypoxemia, or low levels of oxygen in the blood, and restriction of fetal growth.

Answer 415

Usually no observable sx Decreased fetal movement Intrauterine growth restriction Prematurity Stillbirth

Answer 416

Doppler USS: evaluate fetal and placental circulations-> regular screening MRI if inconclusive

Answer 417

<34 weeks: delay delivery: low dose aspirin, vitamin C and E, heparin >34 weeks: prompt delivery

Answer 418

LMWH throughout antenatal period and input from experts

Answer 419

LMWH from 28 weeks and continued nutil 6 weeks postnatal

Answer 420

At least 3 months

Answer 421

Zygosity Chorionicity Amnionicity

Answer 422

Dichorionic + daimniotic: 2 different sacs Monochorionic + diamniotic: same outer sac, two inner sacs Monochorionic + monoamniotic: same sacs

Answer 423

2/3: dizygotic 1/3: monozygotic ^When conceived naturally

Answer 424

Rest USS for diagnosis and monthly checks Additional iron and folate More antenatal care(weekly when >30 weeks) Precautions at labour(2 obstetricians present) 75% of twins deliver by 38 twins, if longer, most twins are induced at 38-40 weeks

Answer 425

Precipitated by anastamoses of umbilical vessels betwween 2 fetuses in the placenta of monochorionic twins

Answer 426

Monochorionic twins: regular USS to monitor Observe fluid levels in each amniotic sac, measure size of twins and assess blood flow in umbilical cord and placenta

Answer 427

Laser transection of problematic vessels in utero-can increase survival rate, high mortlaity for both twins without tx

Answer 428

Frequent urination Dysuria Lower abdo pain Fever Haematuria

Answer 429

Nitrofurantoin and cefalexin mc used If Group B strep ID d: intrapartum prophylactic abx to reduce risk of transmission

Answer 430

nitrofurantoin for 7 days(avoid at term) Amoxicillin/cefalexin

Answer 431

Fever Abdo pain Tachycardia Abnormal discharge Foul smelling lochia(postpartum bleeding) Tenderness/pain in pelvic area Sepsis signs: hypotension, tachypnoea etc

Answer 432

Abx-broad spectrum initially: ceftriaxone and metronidazole Fluids Analgesia Prevention: good hygiene practices during childbirth and postpartum care Close monitoring Drainage of abscesses if needed

Answer 433

Raised LH Raised FSH

Answer 434

Low LH Low FSH

Answer 435

Oestrogen: sex development-females Progesterone: uterine development Testosterone: sex development males FSH and LH: ovarian functionality

Answer 436

Primary hypo: COCP Primary hyper: GnRH analogue

Answer 437

Lifestyle: stress/weight management Treat underlying cause Surgical: tumour/cyst removal

Answer 438

2 years despite sex 3-4 times/wweek

Answer 439

Genetics Ovulation/endocrine Tubal abnormalities Uterine abnormalities Endometriosis Cervical abnormalities Testicular disorders Ejaculatory disorders

Answer 440

PCOS Pituitary tumours Sheehan's syndrome Hyperprolactinaemia Cushing's Premature ovarian failure

Answer 441

Congenital anatomical abnormalities Adhesions Can be secondary to PID(- gonorrhoea, chlamydia)

Answer 442

Bicronate uterus Fibroids Asherman's syndrome

Answer 443

Bedside:Thorough hx including PMH, sexual history and past pregnancies Speculum and bimanual exam-e.g. fibroids STI screen Bloods:Serum progesterone testing Prolactin LH/FSH Anti-mullerian hormone TFTsImaging: TV USS Hysterosalpingography Laparoscopy and dye

Answer 444

Bedside:Thorough hx including PMH, sexual history past children Testicular exam: e.g. varicocele Semen analysis: evaluate sperm count, motility and morphology Bloods:Serum testosterone LH/FSHTFTs

Answer 445

Folic acid Weight loss: BMI 20-25 Smoking cessation and alcohol advice Stres reduction strategies Advice sexual intercourse every 2-3 days

Answer 446

Bacterial infection

Answer 447

Benign tumour of breast ducts

Answer 448

benign sclerosing breast lesion

Answer 449

response to adipose tissue damage

Answer 450

Increased hormonal response response resulting in inflammation and fibrosis

Answer 451

Inflammation and dilation of large breast ducts

Obs and Gynae anki 1 Flashcards

(479 cards)