Obs and Gynae anki 2

Question 1

What group is urinary incontinence most common in?

Answer 1

Elederly females

Question 2

Name some risk factors for developing urinary incontinence

Answer 2

Advancing age
Previous pregnancy/childbirth
High BMI
Hysterectomy
Family history

Question 3

Name the reversible causes of urinary incontinence

Answer 3

DIAPPERSD:
delirium
infection
atrophic vaginitis or urethritis
P-Pharmaceuticals-meds)
P-Psychiatric disorders
E-Endocrine disorders-diabetes etc
R-Restricted mobility
S-Stool impaction

Question 4

What causes urge incontinence?

Answer 4

Detrusor overactivity

Question 5

What is functional incontinence?

Answer 5

Comorbid physical conditions impair the patient’s ability to get to a bathroom in time
Causes: dementia, medications, injury/illness causing impaired mobility

Question 6

What is a cystometry?

Answer 6

Investigation to measure bladder pressure whilst voiding

Question 7

What is a cystogram?

Answer 7

Contrast instilled into the bladder and a radiological image is obtained to see if the contrast travels anywhere else

Question 8

What are the surgical management options for treating urge incontinence?

Answer 8

Bladder instillation
botox injection to paralyse detrusor muscle
Sacral neuromodulation->only in tertiary centres where all other treatments have failed

Question 9

What causes overflow incontinence?

Answer 9

Either:
1. Underactivity of the detrusor muscle e.g. from neurological damage OR
2. Urinary outlet pressures are too high e.g. constipation or prostatism

Question 10

What is a genital or pelvic organ prolapse?

Answer 10

Descent of one or more pelvic structures from their normal anatomical position moving towards or through the vaginal opening

Question 11

Name some risk factors for developing a genital prolapse

Answer 11

-Vaginal childbirth, especially with traumatic or complicated deliveries
-Increasing age
-Menopause
-Hysterectomy
-Obesity
-Chronic cough
-Heavy lifting
-Connective tissue disorders
-Spina bifida

Question 12

What are the types of anterior vaginal wall prolapse?

Answer 12

Cystocele-bladder
Urethrocele-urethra
Cystourethrocele-both bladder and urethra

Question 13

What is a cystocele? What condition can it lead to?

Answer 13

Bladder prolapse
Stress incontinence

Question 14

Name the posterior wall prolapses

Answer 14

Enterocele-small intestine
Rectocele-rectum

Question 15

Name the atypical vaginal wall prolapses?

Answer 15

Uterine prolapse-uterus
Vaginal vault prolapse-roof of the vagina

Question 16

What are some differential diagnoses for a uterogential prolapse?

Answer 16

Gynecologic malignancy: associated with abnormal vaginal bleeding, weight loss, and pelvic pain
Cervicitis: characterized by vaginal discharge, bleeding, and pelvic pain
Urethral diverticulum: presents with dysuria, recurrent UTIs, and a palpable anterior vaginal mass

Question 17

Name some investigations to diagnose a genital prolapse

Answer 17

-Pelvic exam
Imaging if complex or required for surgical planning
Urodynamic studies if co-existing urinary symptoms

Question 18

What is a vaginal fistula?

Answer 18

Unusual opening that connects your vagina to another organ
Can link vagina to bladder, ureters, urethra, rectum, intestines

Question 19

Name some of the causes of a vaginal fistula?

Answer 19

Childbirth
Abdominal surgery
Pelvic, cervical or colon cancer
Radiation treatment
Bowel disease-Crohn’s or diverticulitis
Infection

Question 20

Name some complications of a vaginal fistula

Answer 20

Vaginal/urinary tract infections that keep returning
Stool or gas that leaks through the vagina
Irritated/swollen skin around vagina/anus
Abscesses

Question 21

What are fibroids?

Answer 21

Benign smooth muscle tumours originating from the myometrium of the uterus.

Question 22

What do uterine fibroids develop in response to and how does incidence change with age?

Answer 22

Oestrogen
Increases with age until reaching menopause

Question 23

In which group of people are uterine fibroids most common?

Answer 23

More common in Afro-Caribbean women

Question 24

Name some symptoms of uterine fibroids

Answer 24

-Asymptomatic
-Menorrhagia and dysmenorrhoea-.can cause iron deficiency anaemia
-Bloating
-Lower abdominal pain, cramps
-Urinary symptoms
-Subfertility
Rare: polycythaemia

Question 25

Name some differential diagnoses for uterine fibroids

Answer 25

Endometrial polyps: Present with irregular menstrual bleeding and spotting Endometriosis: Characterized by dysmenorrhoea, deep dyspareunia, chronic pelvic pain, and infertility

Question 26

Name some complications of uterine fibroids

Answer 26

-Subfertility -Iron deficiency anaemia -Red degeneration-> haemorrhage into tumour>commonly occurs during pregnancy

Question 27

What are the types of uterine fibroids?

Answer 27

1. Intramural 2. Subserosal 3. Submucosal 4. Pedunculated

Question 28

Where do intramural fibroids grow?

Answer 28

Within the myometrium, -> can distort the uterus

Question 29

Where do subserosal fibroids develop

Answer 29

Just below the outer layer of the uterus Can fill the abdominal cavity

Question 30

What is red degeneration of fibroids

Answer 30

-Ischemia, infarction, and necrosis of the fibroid due to disrupted blood supply -MC in 2nd/3rd trimester of pregnancy -fibroid rapidly enlarges during pregnancy-> outgrows blood supply, uterus changes shape and expands during pregnancy

Question 31

What is an ovarian cyst?

Answer 31

Fluid filled sac that develops within or on the surface of an ovary.

Question 32

What are some differential diagnoses for ovarian cysts?

Answer 32

Ovarian torsion: Characterised by sudden, severe pain, often accompanied by nausea and vomiting. Ectopic pregnancy: Symptoms include abdominal pain, amenorrhea, and vaginal bleeding. Appendicitis: Presents with abdominal pain that begins near the navel and then moves lower and to the right, loss of appetite, nausea, and vomiting.

Question 33

What investigations are done into a suspected ovarian cyst?

Answer 33

Pregnancy test to exclude ectopic Diagnostgic laparoscopy->especially if haemodynamically unstable Ultrasound Bloods: Ca125: tumour marker for ovarian cancer LDH, AFP, HCG to assess for germ cell tumour

Question 34

What are the main possible complications of an ovarian cyst?

Answer 34

Torsion Haemorrhage into the cyst Rupture with bleeding into the peritoneum

Question 35

What are the types of physiological/functional cysts?

Answer 35

Follicular cysts Corpus luteum cysts

Question 36

What are serous cystadenomas?

Answer 36

Benign tumours of the epithelial cells

Question 37

What are mucinous cystadenomas

Answer 37

Benign tumours of the epithelial space which can grow very large and take up lots of space in the pelvis and abdomen

Question 38

What are sex cord stromal tumours?

Answer 38

Rare tumours that can be benign or malignant Arise from stroma of connective tissue or sex cords (embryonic structures associated with the follicles) Several types: Sertoli=-Leydig cell tumours and granulose cell tumours

Question 39

Name some risk factors for ovarian malignancy

Answer 39

Age Postmenopause Increased number of ovulations Obesity Hormone replacement therapy Smoking Breastfeeding (protective) Family history and BRCA1 and BRCA2 genes

Question 40

Name some protective factors for ovarian cancer

Answer 40

Anything that will reduce the number of ovulations: Later onset of periods (menarche) Early menopause Any pregnancies Use of the combined contraceptive pill

Question 41

Name some non-malignant causes of a raiserd CA125

Answer 41

Endometriosis Fibroids Adenomyosis Pelvic infection Liver disease Pregnancy

Question 42

In women under 40 with a complex ovarian mass what tests should be done?

Answer 42

Tumour markers for a possible germ cell tumour: Lactate dehydrogenase(LDH) Alpha-fetoprotein;(α-FP) Human chorionic gonadotropin(HCG)

Question 43

What is ovarian torsion usually due to?

Answer 43

Ovarian mass >5cm-mc with benign tumours and in pregnancy

Question 44

Name some risk factors for developing ovarian torsion?

Answer 44

Ovarian mass Being of reproductive age Pregnancy Ovarian hyperstimulation syndrome

Question 45

Name some complications of an ovarian torsion

Answer 45

Fertility not typically affected as other ovary can compensate If only a functioning ovary removed->infertility and menopause If necrotic ovary not removed: Infection Abscess Sepsis If it ruptures-> peritonitis and adhesions

Question 46

What is lichen sclerosus?

Answer 46

Inflammatory dermatological condition

Question 47

What is Koebner phenomenon?

Answer 47

When the signs and symptoms worsen with friction to the skin

Question 48

Name a few things that cane make lichen sclerosus worse

Answer 48

Friction to the skin Tight underwear Sex Urinary incontinence Scratching the affected area

Question 49

Name some differential diagnoses for lichen sclerosus

Answer 49

Lichen planus: Characterized by purplish, itchy, flat-topped bumps, and white lacy patches in the mouth or on the skin. Psoriasis: Manifests as red patches with silver scales, typically on the scalp, elbows, knees, and lower back. Vitiligo: Presents as patchy loss of skin color, usually first on sun-exposed areas of the skin.

Question 50

Name some complications of lichen sclerosus

Answer 50

5% risk of developing squamous cell carcinoma of the vulva Pain and discomfort Sexual dysfunction Bleeding Narrowing of vaginal/urethral openings

Question 51

Name some risk factors for developing cervical cancer

Answer 51

HPV 16 and 18 infection or anything that increases the risk of this (early sexual activity, not suing condoms, increased number of sexual partners) Smoking Immunosuppression Non engagement with cervical screening Using COCP for >5yrs

Question 52

Name some differential diagnoses of cervical cancer

Answer 52

Vaginitis: itching, burning, pain, and abnormal discharge Cervicitis: abnormal discharge, pelvic pain, and postcoital bleeding Endometrial cancer: abnormal vaginal bleeding, pelvic pain, and unintentional weight loss Cervical polyps: abnormal vaginal bleeding, discharge, and pain during intercourse

Question 53

What characteristics of a cervix would be worrying and prompt an urgen colposcopy?

Answer 53

Ulceration Inflammation Bleeding Visible tumour

Question 54

What does cervical screening involve?

Answer 54

Speculum exam Collection of cells from the cervix Cells examined for precancerous changes(dyskaryosis) Transporting the cells: liquid based cytology

Question 55

Name some exceptions to the usual cervical screening programme

Answer 55

Women with HIV are screened annually Women over 65 may request a smear if they have not had one since aged 50 Women with previous CIN may require additional tests (e.g. test of cure after treatment) Certain groups of immunocompromised women may have additional screening (e.g. women on dialysis, cytotoxic drugs or undergoing an organ transplant) Pregnant women due a routine smear should wait until 12 weeks post-partum

Question 56

Name 3 infections that can be identified from smear testing for cervical cancer

Answer 56

Bacterial vaginosis Candidiasis Trichomoniasis

Question 57

Describe the management of smear results

Answer 57

Inadequate: rpt in 3 months, then colposcopy Positive with normal cytology: rpt in 12 months( x 2 then colposcopy) Negative HPV: normal recall

Question 58

What is a colposcopy?

Answer 58

Inserting a speculum and using a colposcope to magnify the cervix. Allows epithelial lining of cervix to be examined

Question 59

What tests are used in a colposcopy

Answer 59

1. Acetic acid: abnormal cells appear white-CIN and cervical cancer 2. Schiller's iodine test: stain cells of cervix: healthy cells brown, abnormal cells won't stain 3. Punch biopsy, Large loop excision of transformation zone

Question 60

What is a Large Loop Excision of the Transformation Zone (LLETZ)

Answer 60

-Loop biopsy with local anaesthetic during colposcopy -Loop of wire with electrical current to remove abnormal epithelial tissue on cervix -May increase risk fo preterm labour -SE: bleeding and discharge-avoid intercourse and tampons to reduce infection risk

Question 61

What are the main risks associated with a cone biopsy?

Answer 61

Pain Bleeding Infection Scar formation with stenosis of the cervix Increased risk of miscarriage and premature labour

Question 62

Describe the cervical cancer staging

Answer 62

FIGO: Federation of gynae and obstetrics staging: Stage 1: confined to cervix Stage 2: Invades uterus or upper 2/3 of vagina Stage 3: Invades pelvic wall or lower 1/3 of vagina Stage 4: Invades bladder, rectum or beyond pevlis

Question 63

Describe the management of cervical cancer and cervical intraepithelial neoplasia

Answer 63

Stage 1A: LLETZ or cone biopsy 1B-2A: Radical hysterectomy and removal of local lymph nodes with chemo and radiotherapy 2B-4A: Chemo and radiotherapy 4B: Surgery, chemo and palliative care

Question 64

What do HPV strains 6 and 11 cause?

Answer 64

Genital warts

Question 65

Name some risk factors for developing endometrial cancer

Answer 65

Nulliparity Obesity Early menarche Late menopause Polycystic ovary syndrome Oestrogen-only hormone replacement therapy Tamoxifen

Question 66

Name some protective factors against endometrial cancer

Answer 66

multiparity combined oral contraceptive pill smoking;(the reasons for this are unclear)

Question 67

Name some symptoms of endometrial cancer

Answer 67

Postmenopausal bleeding(usually slight and intermittent then becomes heavier) Abnormal vaginal bleeding, such as intermenstrual bleeding Dyspareunia Pelvic pain-uncommon apart from in later stages Abdominal discomfort or bloating Weight loss Anaemia

Question 68

Name some differentials for endometrial cancer

Answer 68

Uterine fibroids: Characterised by heavy menstrual bleeding, pelvic pressure or pain, frequent urination, and constipation. Endometrial polyps: Symptoms may include irregular menstrual bleeding, bleeding between menstrual periods, excessively heavy menstrual periods, and vaginal bleeding after menopause. Cervical cancer: Signs can include abnormal vaginal bleeding, postmenopausal bleeding, and pelvic pain.

Question 69

What is endometrial hyperplasia?

Answer 69

Precancerous thickening of the endometrium

Question 70

What are the 2 types of endometrial hyperplasia

Answer 70

Hyperplasia without atypia Atypical hyperplasia

Question 71

How does Type 2 diabetes increase the risk of endometrial cancer

Answer 71

Increased production of insulin-> stimulates endometrial cells and increases risk of endometrial hyperplasia and cancer

Question 72

How does tamoxifen affect the risk of endometrial cancer

Answer 72

Anti oestrogenic effect on breast tissue but eostrogenic effect on endometrium-> increased risk

Question 73

What are the NICE suspected cancer referral guidelines concerning endometrial cancer?

Answer 73

Urgent 2 week wait: women with postmenopausal bleeding Transvaginal US in women >55yrs with: Unexplained vaginal discharge Visible haematuria+raised platelets, anaemia or elevated glucose levels

Question 74

Describe endometrial cancer staging

Answer 74

FIGO staging: Stage 1: confined to uterus Stage 2: Invades the cervix Stage 3: Invades ovaries, fallopian tubes, vagina or lymph nodes Stage 4: Invades bladder, rectum or beyond pelvis

Question 75

What are the different types of ovarian cancers?

Answer 75

Epithelial-mc Germ cell Sex cord

Question 76

What group of people do ovarian germ cell tumours typically arise from?

Answer 76

Young women-mc atypical for most cases of ovarian cancer

Question 77

What are the tumour markers for ovarian germ cell tumours?

Answer 77

Alpha fetoprotein and B-HCG

Question 78

What is a Krukenbery tumour?

Answer 78

'Signet ring' sub-type of tumour typically GI in origin whcih has metastasised to the ovary

Question 79

Name some risk factors for developing ovarian cancer

Answer 79

Advanced age Smoking Increased number of ovulations (early menarche, late menopause) Obesity HRT Genetics: BRCA1&BRCA2

Question 80

Name some protective factors against ovarian cancer

Answer 80

Childbearing Breastfeeding Early menopause Use of COCP

Question 81

Name some differentials for developing ovarian cancer

Answer 81

Gastrointestinal conditions (e.g., irritable bowel syndrome): Characterised by abdominal pain, bloating, and changes in bowel habits Fibroids: May cause heavy menstrual bleeding, pelvic pressure or pain, frequent urination, and constipation Ovarian cysts: Can cause pelvic pain, fullness or heaviness in the abdomen, and bloating Other cancers (e.g., bladder, endometrial): May present with symptoms such as abnormal bleeding, pelvic pain, and urinary symptoms

Question 82

What investigations are done to diagnose ovarian cancer?

Answer 82

CA125 blood test Pelvic and abdominal US scan CT scans for staging AFP and B-HCG in younger women-germ cell tumours Laparotomy for tissue biopsy

Question 83

Name some conditions aside from ovarian cancer that can raise the CA125 level

Answer 83

Endometriosis Menstruation Benign ovarian cysts

Question 84

Describe ovarian cancer staging

Answer 84

Stage 1: limited to ovaries Stage 2: One or both ovaries with pelvic extension and/or implants Stage 3: One or both ovaries microscopically confirmed peritoneal implants outside the pelvis Stage 4: One or both ovaries with distant metastasis

Question 85

What are the NICE suspected cancer guidelines relating to ovarian cancer?

Answer 85

2 week wait if: Ascites Pelvic mass Abdominal mass Further investigations includng CA125 if: New symptoms of IBS/change in bowel habit Abdominal bloating Early satiety Pelvic pain Urinary frequency/urgency Weight loss

Question 86

What does the risk of malignancy index relating to ovarian cancer take into account?

Answer 86

Estimates the risk of an ovarian mass being malignant Menopausal status Ultrasound findings CA125 level

Question 87

Name some risk factors for developing vulval cancer

Answer 87

Advancing age HPV infeciton Vulval intraepithelial neoplasia(VIN) Immunosuppression Lichen sclerosus

Question 88

Name some differential diagnoses for vulval cancer

Answer 88

Vulval intraepithelial neoplasia: This precancerous condition can cause itching, burning, skin changes, and discomfort. Lichen sclerosus: itching, pain, and white patches on the vulva. Bartholin's cyst: This may present as a lump or swelling on the vulva, and can cause discomfort or pain.

Question 89

What investigations might be done to diagnose vulval cancer?

Answer 89

Thorough exam of vulva Biopsy Imaging/blood tests to assess extent of disease and staging

Question 90

What are the treatment options for VIN

Answer 90

Watch and wait;with close followup Wide local excision(surgery) to remove the lesion Imiquimod cream Laser ablation

Question 91

What age group(s) are most at risk of developing a molar pregnancy?

Answer 91

Extreme ends of the fertility age range<16yrs&>45yrs

Question 92

What is a complete molar pregnancy?

Answer 92

Formation from a single sperm and empty egg with no genetic material Sperm replicates to provide a normal number of chromosomes-all paternal foetal tissue, only proliferation of swollen chorionic villi

Question 93

What is a partial molar paregnancy?

Answer 93

Formed from 2 sperm and a normal egg Both paternal and maternal genetic materials present Variable evidence of foetal parts

Question 94

Name some differential diagnoses for a molar pregnancy

Answer 94

Ectopic pregnancy: Symptoms include lower abdominal pain, vaginal bleeding, and amenorrhea. Miscarriage: Symptoms include vaginal bleeding, abdominal pain, and passage of tissue. Normal pregnancy: Typically characterized by a positive pregnancy test, absence of menstruation, and possible morning sickness.

Question 95

Name 2 complications of molar pregnancies

Answer 95

Choriocarcinoma Mole can metastasise->patient may require systemic chemotherapy

Question 96

What is endometriosis?

Answer 96

Growth of ectopic endometrial tissue outside of the uterine cavity

Question 97

Name some theories thought to explain the cause of endometriosis

Answer 97

Retrograde menstruation Coelomic metaplasia Lymphatic/vascular dissemination of endometrial cells

Question 98

Name some differential diagnoses for endometriosis

Answer 98

Primary dysmenorrhoea: characterised by crampy pelvic pain at the onset of menses with no identifiable pelvic pathology. Uterine conditions (e.g. fibroids, adenomyosis): these can cause heavy menstrual bleeding and pelvic discomfort. Adhesions: pelvic pain and possible bowel obstruction. Pelvic inflammatory disease (PID): presents with lower abdominal pain, fever, abnormal vaginal discharge, and possible dyspareunia.

Question 99

What investigations are used to diagnose endometriosis?

Answer 99

Transvaginal US-> Often normal but may ID an ovarian endometrioma GS: Diagnostic laparoscopy

Question 100

Name a complication of endometriosis

Answer 100

Infertility Poor quality of life due to chronic pain

Question 101

Describe the staging of endometriosis

Answer 101

Stage 1: small superficial lesions Stage 2: Mild but deeper lesions Stage 3: Deeper lesion with lesions on ovaries and mild adhesions Stage 4: Deep and large lesions affecting ovaries with extensive adhesions

Question 102

What is adenomyosis?

Answer 102

Presence of endometrial tissue within the myometrium

Question 103

In which group of people is adenomyosis most common in?

Answer 103

Multiparous women towards the end of their reproductive years

Question 104

What conditions can adenomyosis occur with?

Answer 104

Endometriosis Fibroids

Question 105

What investigations are done to diagnose adenomyosis?

Answer 105

1st line: transvaginal US of pelvis If unsuitable: MRI and transabdominal USGS: Histological exam of the uterus after a hysterectomy(mostly unsuitable)

Question 106

What complications relating to pregnancy can adenomyosis cause?

Answer 106

Infertility Miscarriage Preterm birth Small for gestational age Preterm rupture of membranes Malpresentation Need for C section Postpartum haemorrhage

Question 107

What is atrophic vaginitis?

Answer 107

Inflammation and thinning of the genital tissues due to a decrease in oestrogen levels

Question 108

What causes atophic vaginitis?

Answer 108

Decline in oestrogen levels, typically post-menopause

Question 109

On examination, what might you find in a patient with atrophic vaginitis?

Answer 109

Pale and dry vagina Loss of pubic hair Thinning of vaginal mucosa Narrowed introitus Loss of vaginal rugae

Question 110

Name some differentials for atrophic vaginitis

Answer 110

For postmenopausal bleeding: malignancy, endometrial hyperplasia For genital itching/discharge: sexually transmitted infection, vulvovaginal candidiasis, skin conditions such as lichen sclerosis, lichen planus, diabetes For narrowed introitus: female genital mutilation For urinary symptoms: urinary tract infection, bladder dysfunction, pelvic floor disfunction, cystitis For dyspareunia: malignancy, vaginismus

Question 111

What investigations should be done in a patient presenting with likely atrophic vaginitis?

Answer 111

Clinical examination, including speculum examination if tolerated, to look for vaginal signs of atrophy Transvaginal ultrasound and endometrial biopsy, if necessary, to exclude endometrial cancer An infection screen if itching or discharge is present A biopsy of any abnormal skin lesions, if needed

Question 112

What is a miscarriage?

Answer 112

Loss of pregnancy <24 weeks gestation

Question 113

Name some risk factors for having a miscarriage

Answer 113

Maternal age >30 Previous miscarriage Obesity Smoking APS Uterina abnormalities Coagulopathies Previous uterine surgeries Chromosomal abnormalities

Question 114

Name some symptoms of a miscarriage

Answer 114

Often found incidentally on US Vaginal bleeding-clots/conception products If lots of bleeding: signs of haemodynamic instability: pallor, dizziness, SOB suprapubic, cramping pain

Question 115

Name some signs of a miscarriage

Answer 115

Haemodynamic instability: tachy, hypotension, tachycardia Abdo exam: distended, local areas of tenderness Speculum: cervical os, POC, bleeding Bimanual exam: uterine tenderness, adnexal masses/collections

Question 116

Name some differentials for a miscarriage

Answer 116

Ectopic pregnancy Hydatidiform mole Cervical/uterine cancer

Question 117

What blood might be done in a patient suspected of having a miscarriage?

Answer 117

b-HCG- important to also assess the possibility of an ectopic pregnancy

Question 118

What are the different kinds of miscarriage?

Answer 118

Threatened Inevitable Missed/delayed Incomplete Complete Septic

Question 119

What is an ectopic pregnancy?

Answer 119

Embryo implants and beigns to grow outside fo the uterine cavity, usually in the fallopian tuubes

Question 120

Name some of the causes/risk factors for having an ectopic pregnancy

Answer 120

Pelvic inflammatory disease Endometriosis Genital infections Previous ectopic pregnancies Having an IUD/coil in situ Assissted reproduction like IVF

Question 121

Name some differentials for an ectopic pregnancy

Answer 121

Miscarriage UTI Appendicitis Diverticulitis PID Ovarian accident

Question 122

What investigations should be done in a patient with a suspected ectopic pregnancy?

Answer 122

B-HCG-POSITIVE Pelvic US Transvaginal US Can't find evidence of pregnancy on any scans Serum B-HCG

Question 123

Describe the level of serum B-HCG in suspected ectopic pregnancy:

Answer 123

>1500iU: ectopic-diagnostic laparoscopy <1500iU: if stable, can repeat in 48 hours

Question 124

Using B-HCG monitoring how can you tell if a patient is having a miscarriage or has a viable pregnancy?

Answer 124

Viable pregnancy: will double every 48 hours Miscarriage: halves every 48 hours

Question 125

What complications can arise from an ectopic pregnancy

Answer 125

Fallopian tube rupture->hypovolaemic shock->organ failure>death

Question 126

Name some causes of oligohydramnios

Answer 126

Pre-term rupture of membranes Non-functional kidneys Renal agenesis(Potter's) Obstructive uropathy Placental insufficiency Chromosomal abnormalities Viral infections

Question 127

What are the most common causes of oligohydramnios?

Answer 127

Pre-term rupture of membranes Placental insufficiency

Question 128

What causes symptoms in patients with oligohydramnios?

Answer 128

Decreased space around fetus Lack of amniotic fluid for fetal growth and development

Question 129

What investigations are typically done to diagnose oligohydramnios?

Answer 129

USS:Reduced amniotic fluid index Reduced max pool depth(MPD) or single deepest pocket(SDP) To ID underlying cause:Maternal bloods KaryotypingIf membrane rupture suspecteD:IGFBP-1 or PAMG-1(usually in amniotic fluid)

Question 130

What is important to remember if delivering a baby early via C-section due to oligohydramnios?

Answer 130

Give a course of steroids for fetal lung development and antibtiotics to lower risk of infection

Question 131

What complications can arise from oligohydramnios and why?

Answer 131

Amniotic fluid allows fetus to move in utero No fluid-> no exercise-> muscle contractures-> disability after birth

Question 132

What investigations might be done in a patient with polyhydramnios?

Answer 132

USS-diagnostic To look for cause:Maternal glucose tolerance test Fetal anaemia Karyotyping Fetal anatomy for structural cause Viral screen(TORCH)

Question 133

What si the pregnancy viral screen-TORCH

Answer 133

Toxoplasmosis Parvovirus Rubella CMV Hepatitis

Question 134

What are the 2 stages of labour?

Answer 134

Latent phase: 0-3cm cervical dilation Active phase: 3-10cm cervical dilation

Question 135

Name some differentials for the first stage of labour

Answer 135

Braxton Hicks Preterm labour

Question 136

What investigations might be done if a woman is in the first stage of labour?

Answer 136

Regular assessment of maternal and foetal vital signs Frequent exam to determine cervical dilation and effacement Palpation to assess position and descent of foetus

Question 137

Name some signs and symptoms of the second stage of labour

Answer 137

Foetal head flexion, descent and ngagement into the pelvis Foetal internal rotation to face maternal back Foetal head extension to deliver head Foetal external rotation after delivery of head, positioning of shoulders in AP position Delivery of anterior shoulder first then rest of foetus Maternal desire to push

Question 138

Name some signs indicative of the 3rd stage of labour

Answer 138

Gush of blood from vagina Lengthening of umbilical cord Ascension of uterus in abdomen

Question 139

Name some indications for inducing labour

Answer 139

Post dates:>41 weeks gestationPreterm prelabour rupture of membranes Intrauterine foetal death Abnormal CTG Maternal conditions like pre-eclampsia, diabetes, cholestasis

Question 140

Name some contrainidctaions for inducing labour

Answer 140

Previous classical/vertical incision during C-section Multiple lower uterine segment C-sections Transmissible infections Placenta praevia Malpresentations Severe fetal compromise Cord prolapse Vasa Previa

Question 141

What investigations might be carried out prior to starting inductino of labour?

Answer 141

US: confirm gestational age, foetal position and placental location Bloods: Check mother's health status-pre-eclampsia/diabetes

Question 142

Name some differentials for pre-term labour

Answer 142

Braxton Hicks UTI Placental abruption Uterine rupture

Question 143

What investigations might be done in a patient presentign with pre term labour

Answer 143

Foetal fibroenctin tes(fFN)- assesss risk of pre term elivery after onset of pre-term labour

Question 144

What age does menopause usually happen?

Answer 144

45-55Average in UK: 52yrs

Question 145

Name some symptoms of menopause

Answer 145

Vasomotor: hot flushes, night sweats Sexual dysfunction: vaginal dryness, reduced libido, problems with orgasm Psychological: depression, anxiety, brain fog

Question 146

Name some differentials for menopause

Answer 146

Hyperthyroidism Depression premature ovarian insufficiency

Question 147

What are the types of HRT

Answer 147

Oestrogens-can be oral, transdermal or topical Progestogens-oral, transdermal, intrauterine

Question 148

Name some benefits of HRT

Answer 148

Relief of vasomotor sx Relief of urogential sc Reduced risk of osteoporosis

Question 149

Name some things HRT can increase the risk of?

Answer 149

Breast cancer Endometrial cancer(especially if given alone)VTE

Question 150

Name some contraindications for prescribing HRT

Answer 150

Breast cancer Oestrogen dependednt cancer Vaginal bleeding of unknown cause Pregnancy Untreated endometrial hyperplasia VTE Liver disease with abnormal LFTs

Question 151

Name some complications of menopause

Answer 151

Osteoporosis Cardiovascular disease Dyspareunia Urinary incontinence

Question 152

What does GnRH do for the menstrual cycle?

Answer 152

Released from the hypothalamus and stimulates LH and FSH release from anterior pituitary

Question 153

What are the phases of the ovarian cycle?

Answer 153

Follicular Ovulation Luteal

Question 154

What happens during the follicular phase of the ovarian cycle?

Answer 154

Follicles begin to mature and prepare to release an oocyte At the start: low ovarian hormone production: little negative feedback at HPG axis so increase in FSH and LH Only 1 follicle can reach maturity, other follicles form polar bodies Oestrogen becomes high enough to initiate positive feedback, increases everything, especially LH but increased inhibin means FSH doesn't surge(inhibin selectively inhibits FSH) Granulosa cells express LH receptors

Question 155

What happens during the ovulaton stage of the ovarian cycle

Answer 155

Response to LH surge: follicle ruptures and oocyte assisted to fallopian tube by fimbria->viable for fertilisation for 24 hours After ovulation, follicle remains luteinised, secreting oestrogen and progesterone

Question 156

What happens in the luteal phase of the ovarian cycle?

Answer 156

In absence of fertilisation: corpus luteum regresses after 14 days, fall in hormones relieving negative feedback

Question 157

What happens to the corpus luteum if fertilisation occurs?

Answer 157

HCG is produced exerting a luteinising effect to maintain the corpus luteum

Question 158

What are the stages of the uterine cycle?

Answer 158

Proliferative Secretory Menses

Question 159

What happens in the proliferative phase of the uterine cycle?

Answer 159

Runs alongside follicular phase Prepares reproductive tract for fertilisation and implantation Oestrogen initiates fallopian tube formation->endometrium thickening->increased growth and motility of myometrium and productive of thin alkaline cervical mucus

Question 160

What happens during the secretory phase of the uterine cycle?

Answer 160

Runs alongside luteal phase Progesterone stimulates thickening of endometrium into glandular secretory form, thickening of myometrium, reduction of motility in myometrium, thick acidic cervical mucus production(prevent polyspermy)

Question 161

What are the main hormones involved in:a)proliferative phaseb)secretory phase?

Answer 161

a)oestrogen b)progesterone

Question 162

Name some differentials for PCOS

Answer 162

Menopause Congenital adrenal hyperplasia Hyperprolactinaemia Androgen secreting tumour Cushing's

Question 163

What investigations might be done to diagnose PCOS?

Answer 163

Bedside: clinical exam to look for features of hyperandrogenism/insulin resistance Bloods: LH:FSH ratio, total testosterone, fasting/oral glucose tolerance, TFT, prolactin, cortisol Imaging: transabdominal/transvaginal USS

Question 164

What diagnostic criteria is used for PCOS?

Answer 164

Rotterdam diagnostic criteria

Question 165

Name some complications of PCOS

Answer 165

Infertility Metabolic syndrome and dyslipidaemia T2DM CVD Hypertension Obstructive sleep apnoea

Question 166

What is Asherman's syndrome?

Answer 166

Adhesions(synechiae) form within uterus following damage to the uterus

Question 167

Name some common causes of Asherman's syndrome

Answer 167

Pregnancy related dilatation and curettage procedure Post uterine surgery Pelvic infections

Question 168

Name some complications of Asherman's syndrome

Answer 168

Menstruation abnormalities Infertility Recurrent miscarriages

Question 169

What are congenital malformations of the female genital tract?

Answer 169

Deviations form normal anatomy resulting from embryonic maldevelopment of Mullerian or paramesonephric ducts

Question 170

What are the most common types of congenital uterine abnormalities caused by?

Answer 170

Incomplete fusion of mullerian or paramesonephric ducts

Question 171

Name some complications of congenital uteirne abnormalities

Answer 171

Dysmenorrhoea Haematoemtra Complicaitons during pregnancy and labour Congenital renal abnormalities often co-exist

Question 172

What are endometrial polyps?

Answer 172

Benign growths of endometrial lining of the uterus, consisting of glandular epithelium, stroma and blood vessels

Question 173

What age groups are endometrial polyps found in?

Answer 173

Reproductive age women Can occur post menopausal

Question 174

Name some risk factors for polyps

Answer 174

Obesity Htn Tamoxifen HRT

Question 175

Name some differentials for a polyp

Answer 175

Fibroid Adenomyoma Endometrial carcinoma Gestation trophoblastic disease

Question 176

Name some complications fo endometrial polyps

Answer 176

Small percentage may have atypical hyperplasia/endometrial carcinoma Anaemia due to chronic blood loss in those with heavy menstrual bleeding

Question 177

Name the causative organisms of PID

Answer 177

Chlamydia trachomatis-most common cause Gonnorhoea Mycoplasma genitalium Mycoplasma hominis Sometimes no pathogen isolates

Question 178

What is Fitz Hugh Curtis syndrome?

Answer 178

Adhesions form between anterior liver capsule and anterior wall/diaphragm in context of PIC

Question 179

Name some differential diagnoses for PID

Answer 179

Appendicitis Ectopic Endometriosis Ovarian cyst UTI

Question 180

What investigations are used to diagnose PID

Answer 180

Pregnancy test to exclude ectopic Swabs for gonorrhoea and chlamydia or urine NAAT Bimanual exam: cervical motion tenderness Bloods: FBC+WCC+CRP Imaging: TV USS

Question 181

Name some complications of PID

Answer 181

Chronic pelvic pain-tubal damage from inflammation Infertility Ectopic pregnancy Fitz-High Curtis syndrome

Question 182

What condition might Fitz Hugh Curtis syndrome be confused with?

Answer 182

Cholecystitis

Question 183

Name some risk factors for developing renal stones

Answer 183

Obesity Dehydration Diet rich in oxalate foods like fruit, nuts, cocoa Previous stones Anatomical abnormalities FHx

Question 184

Name some differentials for urinary tract calculi

Answer 184

Pyelonephritis Appendicits Diverticulitis Ovarian torsion Ectopic pregnancy AAA

Question 185

What investigaitons might be done to diagnose renal stones?

Answer 185

Urinalysis Uirne mc+s Observations to check for sepsis FBC, UE, calcium and uric acid GS: non contrast helical CT KUB

Question 186

What is a prolactinoma?

Answer 186

Benign tumour of the pituitary gland-secretes excessive prolactin

Question 187

What does the aerola contain and how do they change during pregnancy?

Answer 187

Contain sebaceous glands Enlarge during pregnancy and secrete an oily substance that acts as a protective lubricant

Question 188

What are the 3 main parts that make up the anatomical structure of the breast

Answer 188

Mammary glands Connective tissue stroma Pectoral fascia

Question 189

What are the groups of lymph nodes that receive lymph from breast tissues?

Answer 189

Axillary nodes(75%) Parasternal nodes(20%) Posterior intercostal nodes(5%)

Question 190

What is a fibroadenoma?

Answer 190

Benign tumour consisting of a mixture of fibrous and epithelial tissue

Question 191

Name some differentials for fibroadenomas

Answer 191

Breast cyst Invasive breast cancer Intraductal papilloma Lipoma

Question 192

What investigations might be done in a patient presenting with a likely fibroadenoma?

Answer 192

Triple assessment:Clinical exam Imaging: US/Mammogram Needle biopsy-fine needle aspiration/core biopsy

Question 193

What is fibrocytic breast disease?

Answer 193

Benign condition->presence of fibrous tissue and cysts in the breast Considered a variation of normal breast tissue

Question 194

Name some differentials for fibrocystic breast disease

Answer 194

Breast cancer Cysts Fibroadenoma Mastitis/abscess

Question 195

What investigations might be used to diagnose fibrocystic breast disease

Answer 195

Clinical exam Mammogram and US Biopsy: exclude malignancy if suspicious findings

Question 196

What genetic mutations are implicated in breast cancer?

Answer 196

BRCA1/2

Question 197

Name some risk factors for developing breast cancer

Answer 197

High hormone exposure: Endogenous oestrogen: early menarche, nulliparity, late menopause Exogenous oestrogen and progestin: COCP, HRT Inherited gene mutations: BRCA1/2 Increasing age F history/personal history of breast cancer Alcohol/tobacco use

Question 198

What are the subtypes of breast cancer?

Answer 198

Pre-invasive: Ductal carcinoma in situ Lobular carcinomaa in situ Invasive: Invasive ductal carcinoma Invasive lobular carcinoma Medullary carcinoma Others: Inflammatory Mucinous Tubular HER2 positive breast cancer Triple negative breast cancer

Question 199

Name some differentials for breast cancer

Answer 199

Fibroadenoma Cysts Mastitis Lipoma

Question 200

Name 2 methods for staging breast cancer

Answer 200

TNM staging(tumour node metastasis) Stage 1A/B/2A/B/ETC

Question 201

What are some methods used to treat breast cancer?

Answer 201

Surgery Radiotherapy Hormone therapy Biological therapy Chemotherapy

Question 202

What are some features that wwould favour a mastectomy instead of awide local excision?

Answer 202

Multifocal tumour rather than solitary lesion Central tumour rather than peripheral Large lesion in small breast rather than small lesion in large breast DCIS >4CM rather than<4cm

Question 203

Name a biological therapy that might be used in breast cancer treatment and when it might be used?

Answer 203

Trastuzumab(Herceptin)-used in HER2 positive tumours Can't be used in patients with heart disorders

Question 204

Name some examples of hormonal therapies that might be used in patients with breast cancer

Answer 204

Tamoxifen: pre/peri menopausal women Anastrozole: aromatose inhibitors: post-menopausal women

Question 205

Name some side effects of tamoxifen

Answer 205

Increased risk of endometrial cancer VTE Menopausal symptoms

Question 206

Name some differentials for Paget's disease of the nipple

Answer 206

Atopic dermatitis/contact dermatitis/psoriasis Intraductal papilloma Mastitis/abscess

Question 207

What is cervical effecement?

Answer 207

Also called cervical ripening Thinning of the cervix Before: shaped like a bottleneck and up to 4cm Through pregnancy: cervix tightly closed and protected by mucus plug

Question 208

What are the 7 mechanisms of labour?

Answer 208

Descent Flexion Internal rotation Extension Restitution External rotation Delivery of body

Question 209

What happens during the 'descent' stage of labour?

Answer 209

Fetus descends into pelvis

Question 210

What encourages the 'descent' stage of labour?

Answer 210

Increased abdominal muscle tone Increased frequency and strength of contractions

Question 211

What happens during the 'flexion' stage of labour?

Answer 211

Fetus descends through pelvis->uterine contractions exert pressure down fetal spine towards occiput forcing the occiput to come into contact with pelvic floor Fetal neck flexes allowing the circumference of the head to reduce-easier to pass through pelvis

Question 212

What happens during the internal rotation stage of labour?

Answer 212

With each contraction, fetal head is pushed onto pelvic floor, supporting a small degree of rotation Regular contractions eventually lead to head completing 90 degree turn

Question 213

What happens during the 'extension' phase of labour?

Answer 213

Fetal occiput slips beneath suprapubic arch allowing the head to extend-fetal head born and usually facing maternal back

Question 214

What happens during the 'restitution/external rotation' stage of labour?

Answer 214

fetus naturally aligns head with shoulders Visually head may be seen to externally rotate face to right or left

Question 215

What is delayed cord clamping?

Answer 215

Umbilical cord not immediately clamped and cut at point of birth but allowed >1 minute to transfuse blood to baby Baby can receive up to 214g of blood

Question 216

Name some benefits of delayed cord clamping

Answer 216

Allows baby time to transition to extra-uterine life Increase in RBC, irone and stem cells Reduced need for inotropic support

Question 217

What are some benefits of an upright birth?

Answer 217

Increases diameter of pelvic inlet Less risk of compressing mother's aorta Encourages stronger and longer contractions Gravity

Question 218

What are the advantages of using entotox as pain relief in labour?

Answer 218

Fast acting-20-30 seconds Can be used alongside analgesia Does not require further fetal monitoring

Question 219

What is an epidural?

Answer 219

Mix of bupivacaine and fentanyl Epidural catheter inserted by anaesthetist and drugs administered through pump

Question 220

Name some pros and cons of using an epidural

Answer 220

Pros: Total pain relief in 90% of cases Effect will last until baby is born Cons: Reduced mobility Cant take up to an hour to take effect Will need urinary catheter Can slow down labour if not already established

Question 221

What is an operative vaginal delivery?

Answer 221

Use of an instrument to aid delivery of the fetus

Question 222

What are the 2 main instruments used in operative deliveries?

Answer 222

Ventouse Forceps

Question 223

What are ventouse deliveries associated with?

Answer 223

Lower success rate Less maternal perineal injuries Less pain More cephalhaematoma More subdural haematoma More fetal retinal haemorrhage

Question 224

What are forceps and how are they used for delivery?

Answer 224

Double bladed instruments Inserted into pelvis, applied round sides of fetal head with blades locked together Gentle traction applied during uterine contractions

Question 225

What are forceps associated with?

Answer 225

Higher rate of 3rd/4th degree tears Less often used to rotate Doesn't require maternal effort

Question 226

Name some indications for performing an assisted vaginal delivery

Answer 226

Maternal: Maternal exhaustion Maternal medical conditions that mean active pushing should be avoided(intracranial pathologies, severe heart disease/htn) Fetal: Suspected fetal compromise in 2nd stage of labour0 CTG monitoring/abnormal fetal blood sample Cinical concerns like significant antepartum haemorrhage

Question 227

Name some absolute contraindications to an instrumental delivery

Answer 227

Unengaged fetal headIncompletely dilated cervix True cephalo pelvic disproportion Breech and face presentation Preterm gestation(<34 weeks)

Question 228

What are the pre-requisites for intstrumental delivery?

Answer 228

Fully dilated Ruptured membranes Cephalic presentation Defined fetal position Fetal head at least at level of ischial spines and no more than 1/5 palpable per abdomen Empty bladder Adequate pain relief Adequate maternal pelvis

Question 229

Name some fetal complications from an instrumental deliver

Answer 229

Neonatal jaundice Scalp lacerations Cephalohaematoma Subgaleal haematoma Retinal heamorrhage Skull fractures

Question 230

Name some maternal complications of instrumental deliveries

Answer 230

Vaginal tears: 3rd/4th degree VTE Incontinence PPH Shoulder dystocia Infection

Question 231

What results of a quadruple test might indicate a higher risk of Down's syndrome?

Answer 231

AFP: Low hCG: high Inhibin A: high Unconjugated oestriol: low

Question 232

What are the 2 types of invasive prenatal diagnostic testing?

Answer 232

Chorionic villus testing(CVS) Amniocentesis

Question 233

What is CVS?

Answer 233

US guided smapling of placental tissue by insterting a fine needle through abdomen and into uterus Rules out mosaicism-if positive will need amniocentesis

Question 234

What is amniocentesis?

Answer 234

US guided insertion of fine needle through abdomen into uterus to take a sample of amniotic fluid-contains baby's cells so is a true reflection of baby's DNA

Question 235

Name some risks of invasive prenatal testing

Answer 235

Miscarriage Infection

Question 236

What does the anomaly scan screen for?

Answer 236

11 physical confitions Some associated with Down's-congenital heart disease, abdominal wall defects

Question 237

Name some risk factors for mastitis

Answer 237

Poor breastfeeding technique Nipple damage Maternal stress Previous hx of mastitis

Question 238

Name some differentials for mastitis

Answer 238

Breast abscess Breast cancer Breast engorgement-> bilateral, associated with milk stasis and tense breasts

Question 239

Name a complication of mastitis

Answer 239

Breast abscess

Question 240

What is a breast abscess?

Answer 240

Accumulation of pus within an area of breast tissue, often a complication of infectious mastitis

Question 241

What is bacterial vaginosis?

Answer 241

Bacterial imblaance of the vagina cuased by an overgrowth of anaerobic bacteria and loss of lactobacilli

Question 242

What are the features of lactobacilli bacteria?

Answer 242

Rod-shaped Produce hydrogen peroxide->keeps vaginal pH >4.5 which inhibits growth of other organisms

Question 243

Name some risk factors for bacterial vagnosis

Answer 243

Sexual activity Receptive oral sex Presence of an STI Smoking Recent antibiotic use Ethnicity(higher in black women) Vaginal douching/use of scented soaps/vaginal deoderants

Question 244

Name some differentials for bacterial vaginosis

Answer 244

Vulvovaginal candidiasis Trichomonas vaginalis infection Chlamydia/gonorrhoea Atrophic vaginitis

Question 245

What investigations are done to diagnose bacterial vaginosis?

Answer 245

Ansel criteria: 3/4 of: pH>4.5grey/milky discharge clue cells on wet mount(vaginal epithelial cells studded with gram variable coccobacilli) KOH whiff test Microscopy: high vaginal smear: clue cells, decreased lactobacilli and no pus cells

Question 246

Name some complications for bacterial vaginosis

Answer 246

Pregnancy related-> premature birth, miscarriage, chorioamnionitis risks

Question 247

Name some risk factors for vulvovaginal candidiasis

Answer 247

Pregnancy Diabetes Antibiotic use Corticosteroid use/immunosuppression

Question 248

Name some signs of vulvovaginal candidiasis

Answer 248

Erythema/swelling of vulva Discharge Satellite lesions-red, pustular lesions with superficial white/creamy pseudomembranous plaques

Question 249

What is chlamydia?

Answer 249

STD caused by obligate intracellular bacteria chlamydia trachomatis

Question 250

What are the different serotypes of chlamydia and what infections do they cause?

Answer 250

A-C: Ocular infection: chlamydial conjunctivitis D-K: classical GU infection L1-L3: Lymphogranuloma venereum(LGV), MSM, proctitis

Question 251

What group of people is L1-L3 chalmydial infections found in most commonly?

Answer 251

MSM

Question 252

Name some risk factors for chlamydia

Answer 252

<25yrs Recent change in sexual partner/infected partner Co-infection with other STIs Non-barrier contraception

Question 253

What does chlamydia in rpegnancy increase the risk of?

Answer 253

Low birth weight Miscarriage

Question 254

What contact tracing should be done in patient with chlamydia?

Answer 254

Men with urethral sx: all partners 4 weeks prior to sx onset asx men and women: last 6 months r most recent partner

Question 255

Name some complicatons of chlamydia

Answer 255

Reactive arthritis Infertility Epididymitis PID Endometritis Increased incidence of ectopics Perihepatitis

Question 256

Name some risk facotrs for gonorrhoea

Answer 256

<25yrs MSM High density urban areas Previous gonorrhoea infections Multiple sexual partners

Question 257

Name some complications of gonorrhoea

Answer 257

PID Epididdymo-orchitis prostatitis Dissminated gonococcal infection

Question 258

Name some complications of disseminated gonococcal infection

Answer 258

Septic arthriits: mc cause of septic arthritis in young people Endocarditis Perihepatitis Fitz-Hugh-Curtis syndrome

Question 259

What is gonorrhoea in pregnancy associated with?

Answer 259

Perinatal mortality Spontaneous abortion Premature labour fetal membrane rupture Vertical transmission->gonococcal conjunctivitis

Question 260

What are gential herpes?

Answer 260

Infectious disease that causes painful sores/ulcers on the genitalsHSV1/2

Question 261

What does HSV1 cause?

Answer 261

Oral/genital herpes-coldsores

Question 262

What does HSV2 cause?

Answer 262

Anogenital herpes

Question 263

Name some risk factors for developing gential herpes

Answer 263

Multiple sexual partners Oral sex with partner with cold sores

Question 264

What are genital warts?

Answer 264

Benign epithelial/mucosal outgrowths caused by HPV

Question 265

Name some risk factors for developing genital warts

Answer 265

Early age at 1st sex Multiple partners Smoking Immunosuppression Diabetes-> persistence of warts

Question 266

Name some differentials for genital warts

Answer 266

Molluscum contagiosum Condyloma lata(secondary syphilis) Genital herpes Skin tags

Question 267

What is a risk of gential warts in pregnancy?

Answer 267

Very low risk of transmission during birth-can cause respiraotry papillomatosis

Question 268

What is HIV?

Answer 268

Single stranded RNA retrovirus that infects and replicates in CD4(T helper) cells

Question 269

Name some risk factors for developing HIV

Answer 269

MSM IVDU High prevalence areas Other STDs, breaks in skin

Question 270

What are the different stages of HIV infection?

Answer 270

Seroconversion illness Symptomatic HIV AIDS defining illness

Question 271

Name some AIDS defining illnesses/infections/malignancies

Answer 271

Pneumocystis jiroveci Non-Hodgkin's lymphoma TB

Question 272

What are NRTI's?

Answer 272

nuceloside analogue reverse transcriptase inhibitors E.g. zidovudine, abacavir etc General SE: peripheral neuropathy

Question 273

Is the cervical os open or closed in a threatened miscarriage?

Answer 273

Closed

Question 274

What are the surgical options for miscarriage management?

Answer 274

<12 weeks: manual vacuum aspiration >12 weeks: evacuation of retained products of conception(ERPC)

Question 275

Name some causes of polyhydramnios

Answer 275

Idiopathic: 50-60% of cases Excess production due to increased fetal urination: Maternal diabetes mellitus Fetal renal disorders Fetal anaemia Twin to twin transfusion syndrome Insufficiency removal due to decreased fetal swallowing: Oeosphageal/duodenal atresia Diaphragmatic disorders Anencephaly Chromosomal disorders

Question 276

What are some risks of amnioreduction in patients with polyhydramnios?

Answer 276

Infection Placental abruption->sudden increase in intrauterine pressure

Question 277

What are the risks of indomethacin for polyhydramnios?

Answer 277

Associated with premature closure of ductus arteriosus(<32 weeks only)

Question 278

Name some complications of polyhydramnios

Answer 278

Higher incidence of preterm labour Malpresentation-fetus has more space to move within uterus Higher risk fo cord prolapse and postpartum haemorrhage

Question 279

What is a prolonged pregnancy?

Answer 279

5-10% of pregnancies that persist after 42 weeks gestation

Question 280

Name some risk factors for a prolonged pregnancy

Answer 280

Nulliparity Maternal age &>40yrs Previous prolonged pregnancy/fhx High BMI

Question 281

Name some symptoms patient with a prolonged pregnancy might experience

Answer 281

Static growth/macrosomia Oligohydramnios Decreased fetal movements Presence of meconium Dry/flaky skin with reduced vernix

Question 282

What investigations might be done in a patient with a prolonged pregnancy?

Answer 282

Dating between 11+0 and 13+6 wk gestation during 1st triemster scan US scanning to check growth and liquor volume-> poor prognostic value in determining placental function and predicting fetal distress

Question 283

What are the 2 main types of placenta praevia?

Answer 283

Minor placenta praevia: placenta is low but not coverig cervical Major placenta praevia: placenta lies over internal cervical os

Question 284

What are the risks associated with placenta praevia?

Answer 284

Defective attachment to uterine wall-> increased risk of haemorrhage Bleeding can be spontaneous or from mild trauma Placenta can be damaged as fetus moves into lower uterine segment

Question 285

Name some risk factors for placenta praevia

Answer 285

High parity Age >40yrsPrevious hx Hx of endometritis Curettage to endometrium post miscarriage

Question 286

What investigations might be done for a patient with suspected placenta praevia?

Answer 286

TV USS; short distance between lower edge of placenta and internal os Further USS at 37 weeks to reassess placental position Kleihauer test if RH negative dose anti D for feto-maternal haemorrhage <26 weeks: CTG to assess fetal wellbeing

Question 287

What are the 2 kinds of placental abruption

Answer 287

Revealed: bleeding tracks down and drains through cervix->vaginal bleeding Concealed: Bleeding stays in uterus and forms clot retroplacentally->not visible: can cause systemic shock

Question 288

Name some risk factors for placental abruption

Answer 288

ABRUPTION Abruption previously B: BP-hypertension/pre-eclampsia R: ruptured membranes P-premature/prolonged uterine injury Polyhydramnios Twins/multiple gestation Infection-chorioamnionitis Older age: >35yrs Narcotic use +smoking

Question 289

Name some differentials for placental abruption

Answer 289

Placenta praevia Vasa praevia Marginal placental bleeed Uterine rupture Local genital causes

Question 290

What investigations might be used in a patient with suspected placental abruption?

Answer 290

CTG US-retroplacental haematoma-> poor negative predictive value(shouldn't be used to exclude abruption)

Question 291

What are the different kinds of breech presentation?

Answer 291

Complete(flexed)-cross legged Frank(extended): legs flexed at hip and extended at knees-mc Footling: Atl least one leg extended at hip so foot is presenting part

Question 292

Name some risk factors for breech presentation

Answer 292

Uterine: Multiparity Fibroids Placenta praevia Uterine malformations Fetal: Prematurity Macrosomia Polyhydramnios Twins

Question 293

Name some differentials for breech presentation

Answer 293

Oblique lie Transverse lie Unstable lie(position changes)

Question 294

Name some complications of external cephalic version

Answer 294

Transient/persistent heart rate abnormalities Placental abruption

Question 295

Name some specific manouvers used during a vaginal breech birth

Answer 295

Flexing fetal knees Lovsett's manoeuver(rotate body and deliver shoulders) Mauriceau-Smellie-Veit(MSV) manoeuver fails: forceps'hands off': no tractions: fetal head would extend and get trapped

Question 296

Name some complications of a breech presentation

Answer 296

Cord prolapse Fetal head entrapment Birth asphyxia->usually secondary from delay in delivery Premature rupture of membranes Intracranial haemorrhage->rapid head compression during delivery Developmental dysplasia of the hip

Question 297

What are the different kinds of fetal lies

Answer 297

Longitudinal Transverse Oblique

Question 298

What are the different kinds of fetal presentation?

Answer 298

Cephalic-mc and safest Shoulder face brow breech

Question 299

What are the different kinds of fetal position?

Answer 299

Occipito-anterior: mc and ideal Occipito posterior Occipito transverse

Question 300

Name some risk factors for abnormal fetal lie/malpresentation/rotation

Answer 300

Prematurity Multiple pregnancy Fetal abnormalities Placenta praevia Primiparity Uterine abnormalities(fibroids, partial septate uterus)

Question 301

Name some contraindications for external cephalic version

Answer 301

Recent APH Rutpured membranes Uterine abnormaliites Prior C section

Question 302

Name some moderate risk factors for pre-eclampsia

Answer 302

Nulliparity >40yrs High BMI Multiple pregnancy

Question 303

Name some high risk factors for pre-eclampsia

Answer 303

Chronic hypertension Previous eclampsia/pre-eclampsia Diabetes CKD AI diseases: SLE, APS

Question 304

Name some differentials for pre-eclampsia

Answer 304

Essential hypertension Pregnancy induced hypertension Eclampsia

Question 305

What investigations might be done in a patient with suspected pre-eclampsia?

Answer 305

BP and proteinuria measurements FBC: low Hb, low plateletsU&Es: high urea, high creatinine, low urine output LFTs: high ALT, high AST

Question 306

Name some maternal complications of pre-eclampsia

Answer 306

Eclampsia Organ failure DIC HELLP syndrome

Question 307

Name some fetal complications of pre-eclampsia

Answer 307

Intrauterine growth restriction Pre-term delivery Placental abruption Neonatal hypoxia

Question 308

What is eclampsia?

Answer 308

Occurence of one or more seizure in a pre-eclamptic women in the absence of another cause

Question 309

What investigations might be done in a patient with eclampsia?

Answer 309

Exclude other reversible causes of seizure and assess for complications: blood glucose, neuro workup Abdo USS->rule out placental abruption

Question 310

Name some signs of magnesium sulfate toxicity

Answer 310

Hypo-reflexia Respiratory distress

Question 311

What are the risks of BP treatment for a patient with eclampsia

Answer 311

If drop in BP is too rapid->fetal HR abnormalities-> continuous CTG monitoring

Question 312

Name some differentials for eclampsia

Answer 312

Hypoglycaemia Stroke Head trauma Pre-existing epilepsy Meningitis Medication induced

Question 313

Name some differentials for trichomoniasis

Answer 313

Bacterial vaginosis Candidiasis Gonorrhoea Chlamydia

Question 314

Name some complications in females of trichomoniasis

Answer 314

Perinatal complications HIV transmission PID Bacterial vaginosis Cervical cancer risk Infertility

Question 315

Name some complications in males of trichomoniasis

Answer 315

Prostatitis HIV transmission Prostate cancer risk Infertility

Question 316

What is chancroid?

Answer 316

STI of the genital skin

Question 317

What causes chancroid?

Answer 317

Gram negative bacillus haemophilius ducreyi

Question 318

Name some risk factors for chancroid

Answer 318

Tropical areas Poor living conditions Lack of public health infrastructure

Question 319

Name some differentials for chancroid

Answer 319

HSV Syphilis Lymphogranuloma venereum

Question 320

Name some risk factors for lymphogranuloma venereum

Answer 320

MSM Tropics Developed countries: concurrent HIV infection more common

Question 321

Name some differentials for lymphogranuloma venereum?

Answer 321

Primary syphilis HSV Chancroid

Question 322

What is balanitis?

Answer 322

Inflammation of the glans penis Balanoposthitis: extends to underside of foreskin

Question 323

Name some causes of balanitis

Answer 323

Candidiasis Dermatits Bacterial-mc Staph spp Anaerobic Lichen planus Lichen sclerosus

Question 324

What are the different stages of syphilis?

Answer 324

Primary Secondary Tertiary

Question 325

Name some differentials for syphilis

Answer 325

Primary: Herpes Lymphgranuloma venereum Malignancy Secondary: HIV Mono Malignancy Tertiary: Dementia Psych conditions Chronic granulomatous lesions

Question 326

Name some causes of a false positive non-treponemal test for syphilis

Answer 326

Pregnancy SLEAPSTB Leprosy Malaria HIV

Question 327

What conclusion could be drawn from a positive non-treponemal test and positive treponemal test for syphilis?

Answer 327

Consistent with active syphilis infection

Question 328

What conclusion could be drawn from a positive non-treponemal test and negative treponemal test for syphilis?

Answer 328

False positive syphilis result

Question 329

What conclusion could be drawn from a negative non-treponemal test and positive treponemal test for syphilis?

Answer 329

Successfully treated syphilis

Question 330

What is a Jarisch-Herxheimer reaction?

Answer 330

May occur on treatment initiation for syphilis Rash, fever, tachycardia after 1st dose NO wheeze/hypotension Due to release of endotoxins following bacterial death Tx: reassuring and antipyretics

Question 331

Name some complications of syphilis

Answer 331

Neurosyphilis: general paresis, tabes dorsalis, meningitis, ocular/auditory abnormalities CVR: aortic aneurysm, regurg, angina, heart failure Gummatous syphilis: granulomatous lesions affecting skin and bone HIV transmission facilitation

Question 332

Name some complications of syphilis in pregnancy

Answer 332

Hydrops Preterm labour Low birth weight Fetal loss Congeital syphilis of the newborn

Question 333

What is intraductal papilloma?

Answer 333

Benign tumour: local areas of epithelial proliferation in large mammary ducts Hyperplastic lesions rather than malignant

Question 334

What is a breast cyst?

Answer 334

Benign fluid-filled sacs inside the breast

Question 335

What groups of people are more likely to get breast cysts?

Answer 335

Women before menopause: <50yrs Post menopausal women on HRT

Question 336

What is HELLP syndrome?

Answer 336

Complication of pregnancy characterised by hemolysis(H), elevated liver enzymes(EL) and low platelets(LP)

Question 337

What can HELLP syndrome follow on from?

Answer 337

Severe pre-eclampsia: 10-20% of patients go on to get HELLP Considered separate disorder

Question 338

Name some differentials for HELLP syndrome

Answer 338

Acute fatty liver of pregnancy ITP TTP

Question 339

Name somme investigations for HELLP syndrome

Answer 339

FBC: low platelets, hemolysis LFTs: elevated liver enzymes Coags: assess for DIC US: liver abnormalities and placental abruption

Question 340

Name some maternal complications of HELLP syndrome

Answer 340

Organ failure Placental abruption DIC

Question 341

Name some fetal complications of HELLP syndrome

Answer 341

Intrauterine growth restriction Preterm delivery Neonatal hypoxia

Question 342

What is cord prolapse?

Answer 342

Umbilical cord descends through the cervix into the vagina before the presenting part of the feotus

Question 343

Name some risk factors associated with cord prolapse

Answer 343

Abnormal lie: breech, transverse Multiple pregnancy Polyhydramnios High fetal head at delivery Multiparity Low birth weight Prematurity Premature rupture of membranes

Question 344

Name some differentials for cord prolapse

Answer 344

Cord presentation Funic presentation Vaginal bleeding or unkown origin

Question 345

Name some risk factors for vasa praevia

Answer 345

Multiparity Previous C section IVF Velamentous cord insertion-BIG one

Question 346

Name some differentials for vasa praevia

Answer 346

Placenta praevia-no change in fetal hr unless maternal haemorrhage Placental abruption Premature rupture of membranes

Question 347

Name some complications of vasa praevia

Answer 347

Fetal exsanguination: rupture or unprotected vessels Hypoxic ischaemic encephalopathy Preterm labour Intrauterine growth restriction-> compromised placental perfusion

Question 348

Name some risk factors for peruperal psychosis

Answer 348

Hx of schizophrenia Hx of bipolar affective disorder FHx/hx of postpartum psychosis

Question 349

Name a differential for peurperal psychosis

Answer 349

Postpartum depression Baby blues

Question 350

Name 2 antipsychotics that are safe for use in breastfeeding

Answer 350

olanzapine quetiapine

Question 351

Name some risk factors for postpartum depression

Answer 351

Low socioeconomic status History of mental health disorders Lack of social support

Question 352

Name some differentials for postpartum depression

Answer 352

Baby blues Postpartum psychosis Adjustment disorders GAD

Question 353

Name some fetal complications of PPROM

Answer 353

Prematurity Infection Pulmonary hyoplasia

Question 354

Name a maternal complication of PPROM

Answer 354

Chorioamnionitis

Question 355

Name some risk factors for primary postpartum haemorrhage

Answer 355

Previous PPH Prolonged labour Pre-eclampsia Increase maternal age Polyhydramnios Emergency C-section Placenta praevia/accreta BMI>35 Instrumental delivery and episiotomy

Question 356

What investigations might be done in a patient with postpartum haemorrhage

Answer 356

Bloods for group/save and crossmatch Consider FFP if clotting abnormalities Secondary: US looking for retained products of conception Endocervical/high vaginal swabs-infection

Question 357

What health professionals are needed for a termination of pregnancy?

Answer 357

2 registered medical practitioners mmust sign legal document(only one needed in emergency) Must be performed by a registered medical practitioner and done in an NHS hospital or licensed premise

Question 358

What advice is there regarding anti D and termination of pregnancy?

Answer 358

Anti-D prophylaxis should be given to women who are rhesus D negative and having an abortion after 10 weeks gestation

Question 359

Name some side effects/complications of medical termination of pregnancy

Answer 359

Severe nausea Cramps Diarrhoea Vaginal bleeeding Incomplete termination of pregnancy->must be maanaged surgically

Question 360

Name some side effects/complications of surgical termination of pregnancy

Answer 360

Retained products of conception Haemorrhage Infection Perforation

Question 361

Name some risks of trichomoniasis vaginalis in pregnancy

Answer 361

Premature births Low birth weight Maternal postpartum sepsis

Question 362

What is a uterine rupture?

Answer 362

Full-thickness disruption of the uterine muscle and overlying serosa Can extend to affect bladder and broad ligament

Question 363

What are the 2 main types of uterine rupture?

Answer 363

Incomplete: peritoneum overlying uterus is intact-uterine contents remain inside Complete: peritoneum is torn and uterine contents can escape into peritoneal cavity

Question 364

Name some risk factors for uterine rupture

Answer 364

Previous C-section(especially classical/vertical incision) Previous uterine surgeryInduction(esp prostaglandins or augmentation of labour) Obstruction of labour Multiple pregnancy Multiparity

Question 365

Name some differentials for a uterine rupture

Answer 365

Placental abruption Placenta praevia Vasa praevia

Question 366

What investigations might be done for a patient with a suspected uterine rupture

Answer 366

USS: abnormal fetal lie/presentation, haemoperitoneum and absent uterine wall CTG ; changes in fetal heart rate pattern and prolonged fetal bradycardia: early indicators for uterine rupture

Question 367

Name some causes of folic acid deficiency

Answer 367

Phenytoin Methotrexate Pregnancy Alcohol excess

Question 368

Name some connsequences of folic acid deficiency

Answer 368

Macrocytic, megaloblastic anaemia Neural tube defects

Question 369

What advice should be given around pregnancy and folic acid?

Answer 369

All women should take 400mcg folic acid until 12th week of pregnancy Women at higher risk of children with neural tube defects should take 5mg folic acid from before conception to 12th week

Question 370

Name some risk factors for developing gestational diabetea

Answer 370

BMI>30kg/m2 Previous macrosomic baby weighing >4.5kg Previous gestational diabetes 1st degree relatives with diabetes Ethnic backgrounds with high prevalence of diabetes(middle easterm south asian, afro-caribbean) Hx of stilllbirth/perinatal death

Question 371

Name some fetal complications of gestational diabetes

Answer 371

Macrosomia(birthweight >4.5kg)->shoulder dystocia, birth injuries and C section Sacral agenesis->Pre-term delivery and neonatal respiratory distress syndrome Neonatal hypoglycaemia Increased risk of T2DM later in life

Question 372

Name some maternal complications of gestational diabetes

Answer 372

Increased risk of hypertension and pre-eclampsia Increased risk of T2DM and gestational diabetes in subsequent pregnancies

Question 373

What is hypertension defined as in pregnancy?

Answer 373

Systolic >140mmHg or diastolic <90mmHg OR Increase above booking readings of >30 systolic or >15 diastolic

Question 374

What are women with pregnancy induced hypertension more at risk of later in life?

Answer 374

Future pre-eclampsia Future hypertension

Question 375

Name some risk factors for Group B strep infection

Answer 375

Prematurity Prolonged rupture of membranes Previous sibling GBS infection Maternal pyrexia (e.g. secondary to chorioamnionitis)

Question 376

Name some clinical features of Group B strep infection in the newborn

Answer 376

Sepsis Pneumonia Meningitis

Question 377

Name some maternal risks of obesity in pregnancy

Answer 377

Miscarriage VTE Gestational diabetes Pre-eclampsia Postpartum haemorrhage Wound infections Higher C section rate

Question 378

Name some fetal risks of maternal obesity in pregnancy

Answer 378

Congenital abnormality Prematurity Macrosomia Stillbirth Increased risk of developing obesity and metabolic disorders in childhood Neonatal death

Question 379

What is cephalopelvic disproportion?

Answer 379

Mismatch between size of fetal head and maternal pelvis causing difficulty in the safe passage of the fetus through the birth canal

Question 380

Name some causes of absolute cephalopelvic disproportion

Answer 380

Maternal: Contracted pelvis Spondylolisthesis Fetal: Hydrocephalus Macrosomia

Question 381

Name some causative factors for prolonged labour

Answer 381

Cephalopelvic disproportion Insufficient uterine contractions Fetal malpresentation Macrosomia Anomalies in birth canal

Question 382

Name some complications of prolonged labour

Answer 382

Maternal exhaustion Post partum haemorrhage Post partum infection Fetal distress: hypoxia or acidosis

Question 383

Name some differentials for obstetric cholestasis

Answer 383

Prurigo of pregnancy Pruritus gravidarum Other hepatobiliary dirsorders

Question 384

What investigations might be done for obstetric cholestasis

Answer 384

LFT's-. raissed bilirubin Bile acid measurements Fetal monitoring may be required- due to the risk of spontaneous intrauterine death

Question 385

What is chorioamnionitis?

Answer 385

Bacterial infection that affects the amniotic sac and amniotic fluid within the uterus Life threatening emergency to both mother and fetus

Question 386

What is a major risk factor for chorioamnionitis?

Answer 386

Preterm premature rupture of membranes: expose normally sterile environment of uterus to pathogens

Question 387

Name some signs and symptoms of chorioamnionitis

Answer 387

Fever Abdo pain Offensive vaginal discharge Evidence of preterm rupture of membranes Maternal and fetal tachycardia Pyrexia Uterine tenderness

Question 388

Name some differentials for chorioamnionitis

Answer 388

UTIAppendicitis Placental abruption

Question 389

What is female genital multilation?

Answer 389

Harful practice of injuring or cutting the female genitalia for non-medical reasons

Question 390

Name some risk factors for shoulder dystocia

Answer 390

Maternal gestational diabetes Macrosomia Birthweight >4kg Advanced maternal age Maternal short stature/small pelvis Maternal obesity Post-dates pregnancy/prolonged labour

Question 391

Name some internal rotational manoeuvres used in shoulder dystocia management

Answer 391

Woods' screw: anterior shoulder pushed towards fetal chest and posterior shoulder pushed towards fetal back Rubin 2: rotate anerior shoulder towards fetal chest

Question 392

What is celidotomy?

Answer 392

Division of fetal clavicle

Question 393

Name some maternal complications of shoulder dystocia

Answer 393

PPH Perineal tears Genital tract trauma

Question 394

Name some fetal complications of shoulder dystocia

Answer 394

brachial plexus injury Neonatal death Hypoxic brain damage Humeral/clavicle fractures

Question 395

Name some risk factors for anaemia in pregnancy

Answer 395

Haemoglopinathies: thalassaemia/sickle cell disease Increasing maternal age Low socioeconomic staus Poor diet Anaemia during previous pregnancy

Question 396

Name some differentials for congenital rubella syndrome

Answer 396

Toxoplasmosis CMV HSV Syphillis VZV

Question 397

Name some risk factors for perineal tears

Answer 397

Primigravida Large babies Precipitant labour Shoulder dystocia Forceps delivery

Question 398

What is an amniotic fluid embolism?

Answer 398

Life threatening condition that occurs when amniotic fluid or other debris enters the maternal circulation

Question 399

Name some differentials for an amniotic fluid embolism

Answer 399

Septic shock Anaphylactic shock PE Hypovolaemic shock

Question 400

What is hyperemesis gravidarum?

Answer 400

Severe nausea and vomiting commencing before the 20th week gestation Different to 'morning sickness' -more severe

Question 401

What is hyperemesis gravidarum thought to be related to?

Answer 401

Raised B hCG levels

Question 402

Name some risk factors for hyperemesis gravidarum

Answer 402

Increased levels of B-hCG-multiple pregnancies, trophoblastic disease Nulliparity Obesity Personal/family hx of hyperemesis gravidarum

Question 403

Name a protective factor for hyperemesis gravidarum

Answer 403

Smoking

Question 404

What criteria should be met for a diagnosis of hyperemesis gravidarum?

Answer 404

5% pre-pregnancy weight loss Dehydration Electrolyte imbalance

Question 405

Name some differentials for hyperemesis gravidarum

Answer 405

Infections: gastroenteritis, UTI, hepatitis, meningitis GI: appendicitis, cholecystitis, bowel obstruction Metabolic: DKA, thyrotoxicosis Drug toxicity Molar pregnancy

Question 406

What is a risk of odansetron use in pregnancy?

Answer 406

In first trimester: increased risk of cleft lip/palate

Question 407

Name some complications of hyperemesis gravidarum

Answer 407

AKI Wernicke's encephalopathy Oesophagitis Mallory-Weiss tear VTE

Question 408

What is acute fatty liver of pregnancy?

Answer 408

Severe, rare, liver disease related to pregnancy which can result in hepatic failure and results in immediate medical and obstetric intervention

Question 409

Name some risk factors for acute fatty liver of pregnancy

Answer 409

Fetal homozygous mutation for long chain 3 hydroxyl CoA dehydrogenase Multiple pregnancies Male fetuses

Question 410

Name some signs and symptoms of acute fatty liver of pregnancy

Answer 410

N+V Headache Anorexia Abdo pain Can rapidly progress to liver failure: HE, jaundice, hypoglycaemia and coagulopathy

Question 411

What criteria can be used to diagnose acute fatty liver of pregnancy

Answer 411

Swansea criteria

Question 412

What are the best predictors for the need for liver transplantation or risk of maternal death in acute fatty liver of pregnancy

Answer 412

Elevated lactate levels+hepatic encephalopathy

Question 413

What are the 3 stages of postpartum thyroiditis?

Answer 413

Thyrotoxicosis Hypothyroidism Normal thryoid function(high recurrence rate in future pregnancies)

Question 414

What antibodies are found in postpartum thyroidits?

Answer 414

Thyroid peroxidase antibodies in 90%

Question 415

Name some risk factors for VTE that might suggest the need for postnatal thromboprophylaxis

Answer 415

Previous VTET hrombophilia Medical comorbidities(cancer, heart failure, systemic inflammatory conditions) Age >35yrs Parity >3 BMI>30 Smoking Multiple pregnancy Pre-eclampsia C-section Prolonged labour Obstructed delivery Preterm birth Stillbirth Postpartum haemorrhage >1000mL Other surgical procedures carried out Immobility Systemic infection

Question 416

Name some causes of obstructed labour

Answer 416

Head: large fetal head/cephalopelvic disproportion, hydrocephalus Presentation: brow, face, shoulder, persistent malposition Twin pregnancy: locked/conjoined twins Bony pelvis: contracted(malposition), deformed(trauma, polio) Soft tissue: tumour in pelvis, viral infection from uterus/abdomen, scars(FGM)

Question 417

Name some complications from an obstructed labour

Answer 417

Fistula-mc PPH Sepsis Paralytic ileusnoenatal sepsis Asphyxia of the baby Facila injury of the baby

Question 418

What is intrauterine growth restriction?

Answer 418

Fetus is unable to reach its genetically determined potential size

Question 419

Name some maternal causes of intrauterine growth restriction

Answer 419

Maternal BMI and nutritional status Co-morbidities: diabetes, anaemia, htn, infection, sickle cell, CVR/renal disease, coeliac Cigarette smoking, alchol and substance abuse Structural uterine malformations

Question 420

Name dome fetal causes of intrauterine growth restriction

Answer 420

Chromosomal defects Multiple pregnancy Vertically transmitted infection(CMV, rubella, toxoplasmosis)

Question 421

Name some placental causes of intrauterine growth restriction

Answer 421

Utero-placental insufficiency Pre-eclampsia

Question 422

Name some differentials for intrauterine growth restriction

Answer 422

Normal physiological variation Constitutional smallness-> small for gestational age but healthy Chromosomal abnormalities

Question 423

What investigations might be done for intrauterine growth restriction?

Answer 423

USS: fetal biometry, amniotic fluid volume, placental appearance Doppler studies: blood flow in umbilical artery, middle cerebral and ductus venosus Biophysical profile to assess fetal wellbeing

Question 424

What are the risks to the baby if exposed to VZV in pregnancy?

Answer 424

Fetal varicella syndrome Shingles in infancy evere neonatal varicella

Question 425

Name some risk factors for placental insufficiency

Answer 425

Maternal hypertensive disorders Smoking, alcohol consumption and drug use Primiparity Advanced maternal age Use of antiepileptics/antineoplastics

Question 426

What factor would make a pregnant woman immediately high risk for VTE?

Answer 426

Prevous VTE history

Question 427

What are monozygotic twins?

Answer 427

Identical-fertilisation of one egg and one sperm

Question 428

What are dizygotic twins? Describe the features

Answer 428

Non-identical Fertilisation of 2 different eggs with 2 different sperms All will be dichorionic and diamnotic(2 outer separate sacs and inner sacs) and separate placentas

Question 429

Name some complications associated with monoamniotic monozygotic twins

Answer 429

Increased spontaenous miscarriage Increased malformations, IUGR, prematurity Twin to twin transfusion syndrome

Question 430

Name some predisposing factors for dizygotic twins

Answer 430

Previous twins Fhx Increasing maternal age Multigravida Induced ovulation and IVF Race(Afro-Caribbean)

Question 431

Name some antenatal complications of monozygotic twins

Answer 431

Polyhydramnnios Pregnancy induced hypertension Anaemia Antepartum haemorrhage

Question 432

Name some fetal omplications of monozygotic twins

Answer 432

Perinatal mortality (twins x5, triplets x 10) Prematurity Light for date babies Malformation(x3)

Question 433

Name some labour complications of monozygotic twins

Answer 433

Increased PPH risk(x2) MalpresentationCord prolapse, entanglement

Question 434

Name some differentials for twin-to-twin transfusion syndrome

Answer 434

Anaemia Cardiac failure Hydrops fetalis

Question 435

What is asymptomatic bacteriuria

Answer 435

Positive urine culture without UTI sx

Question 436

What is a puerperal infection?

Answer 436

Occurs when bacteria infect the uterus and surrounding areas after birth

Question 437

What are the types of puerperal infections?

Answer 437

Endometritis-uterine lining Myometritis: uterine muscle Parametritis(aka pelvic cellulitis): supportive tissue around uterus

Question 438

Name some complications of puerperal infection

Answer 438

Sepsis-> organ failure and shock Increased risk of infertility/ectopic pregnancy

Question 439

What is constitutional delay?

Answer 439

Delay in puberty and growth with no medical cause-do reach normal height Check fhx for delay in puberty

Question 440

Name some causes of primary amenorrhoea

Answer 440

Primary hypergonadotropism: Turners Primary hypogonadotropism: Kallmann's Androgen insensitivity syndrome Imperforated hymen

Question 441

What investigations might be done to investigate primary amenorrrhoea

Answer 441

Urine BHcg HbA1c Blood hormones: oestrogen, progesterone, testosterone, FSH ad LH Prolactin, thyroid function, IGF1, estradiol

Question 442

Name some causes of secondary amenorrhoea

Answer 442

Sheehan's Asherman's Breastfeeding Contraceptives Stress/exercise induced PCOS Ovarian failure

Question 443

What is Ashermann's syndrome?

Answer 443

Intrauterine adhesions formed typically as a result of surgery/infeciton and trauma to uterus

Question 444

What investigations might be done for secondary amenorrhoea?

Answer 444

Pregnancy test Bloods including hormones USS/MRI Endometrial biospy

Question 445

Name some causes of menorrhagia

Answer 445

Idiopathic Fibroids Adenomyosis Polyps Endometriosis IUD contraception Bleeding disorders

Question 446

What is infertility?

Answer 446

Diminished ability of a couple to conceive a child Can be from a definable cause: ovulatory, tubal or sperm problems or Unexplained failure to conceive over a two year period despite regular (3-4 times/week) unprotected sexual intercourse

Question 447

Name some factors affecting natural fertility

Answer 447

Increasing age Obesity Smoking Tight fitting underwear Excessive alchohol consumption Anabolic steroid use Illicit drug use

Question 448

Name some genetic causes of infertility

Answer 448

Turner's(XO) Kleinfelter's(XXY)

Question 449

Name some cervical abnormalities that can cause infertility

Answer 449

Cervical damage after biopsy/LLETZ procedure

Question 450

Name some testicular disorders that can result in infertility

Answer 450

Cryptochordism Varcicele Testicular cancer Congenital testicular defects

Question 451

Name some ejaculatory disorders that can cause infertility

Answer 451

Obstruction of ejaculatory system Retrograde ejaculation

Question 452

What does anti-mullerian hormone show?

Answer 452

Measure of ovarian reserve

Question 453

In what condition might you find a 'woody' uterus?

Answer 453

Placental abruption

Question 454

Describe the symptoms of a fibroadenoma

Answer 454

Highly mobile encapsulated breast mass

Question 455

Describe the symptoms of mastitis?

Answer 455

Breast rednesss Mastalgia Malaise Fever

Question 456

How is mastitis treated?

Answer 456

Keep breastfeeding Flucloxacillin

Question 457

Describe the symptoms of an intraductal papilloma

Answer 457

Bloody discharge from nipple No mass

Question 458

Describe the symptoms of a radial scar?

Answer 458

mammogram-stellite pattern-central scanning and glandular tissue

Question 459

Describe the symptoms of fat necrosis

Answer 459

painless breast mass, skin thickening

Question 460

Describe the symptoms of fibrocystic breast disease

Answer 460

breast lumps, pain, tenderness

Question 461

Describe the symptoms of mammary duct ectasia

Answer 461

palpable peri-areolar breast mass, nipple discharge

Question 462

What is most likely in a women a few weeks post breastfeeding with a breast lump?

Answer 462

Galactocele