Obs/Gynae Flashcards

Question

Cervical cancer aetiology

Answer 1

- High risk HPV 16 18

Answer 2

- Radiotherapy - Chemo - Palliative

Answer 3

- itching and soreness - Persistent lump - Bleeding - Pain on passing urine

Answer 4

- No Sx - Bloating/IBS - Abdo pain/discomfort - Change in bowel habit - Urinary frequency - Bowel obstruction

Answer 5

- Characterised by otherwise unexplained pruritus and abnormal LFTs +/- raised bile acids

Answer 6

- later pregancy (28 weeks) - Increased oest and prog levels - genetics - South Asian - Hep C - Multiple preg - OC previously - Gallstones

Answer 7

- Pruritus (palms and soles) - Fatigue - Dark urine - Pale greasy stools - Jaundice

Answer 8

- Sudden stillbirth - Meconium passage - PPH

Answer 9

- LFTs - Bile acids - Rise in ALP with no other abnormal LFTs = placental production

Answer 10

- Ursodeoxycholic acid (UCDA) - Emollients - Antihistamines - Vitamin K 10mg/day from 36 weeks - LFTs weekly and 10 days after delivery

Answer 11

- Carbohydrate intolerance diagnosed in pregnancy which may or may not resolve after pregnancy

Answer 12

- Large for date foetus - Macrosomia - Shoulder dystocia - Congenital abnormalities - Polyhydramnios - Neonatal hypoglycaemia

Answer 13

- Previous GDM - Previous macrosomic baby - BMI >30 - Ethnic origin - FHX diabetes (1st degree)

Answer 14

- OGTT 24-28 weeks gestation - In morning after fasting = drink 75g glucose - Normal results are <5.6mmol/l fasting and <7.8mmol/l at 2 hours

Answer 15

- 4 weekly USS from 28 - 36W - Fasting glucose <7, trial diet and exercise then met then insulin - Above 7 metformin - above 6 plus macrosomia start insulin and metformin - Delivery 37-39W • 1st line - Diet management • 2nd line - If targets not met with 1st line after 1-2 weeks, offer metformin (insulin if contraindicated) - Insulin if pre-meal glucose >6 OR 1hr post-prandial glucose >7.5 • 3rd line - Targets not met with 1+2 then add insulin • Fasting glucose 6-6.9 and complications - Immediate insulin +/- metformin and diet

Answer 16

- Fasting 5.3 - 1h after meal 7.8 - 2h after meal 6.4

Answer 17

- Folic acid pre pregnancy - Sliding scale needed in delivery - Planned delivery - Retinopathy screening

Answer 18

- Anterior shoulder of baby becomes stuck behind the pubic symphysis of the pelvis

Answer 19

- Macrosomia secondary to GDM - Previous dystocia - Obesity

Answer 20

- Failure of restitution - Turtle neck sign

Answer 21

- McRoberts manoeuvre = hyperflexion of hips - Suprapubic pressuer - Episiostomy - Rubins = reach into vagina put presure on anterior shpilder - wood screw = rotate baby

Answer 22

- Foetal hypoxia (cerebal palsy) - Brachila plexus injury and bells palsy - Perineal tears - PPH

Answer 23

- ACEi - Angiotensin receptor blockers - Thiazide diuretics

Answer 24

- Labetalol - CCB - Alpha blockers

Answer 25

- Miscarriage - Anaemia - Small for gestational age - Pre-eclampsia

Answer 26

- Needs to be increased by 25-50mcg (30-50%) - Titrated based on TSH level = measured every 6 weeks - TSH lowers in pregnancy which is why dose increased

Answer 27

- May worsen seizure control = stress, lack of sleep, hormones, altered medicines - Ideally should be controlled with single drug before coming pregnant

Answer 28

- Levetiracetam, lamotrigine, carbamazepine - SV avoid - Phenytoin avoid (cleft)

Answer 29

- Foetal blood vessels run in the membranes in front of the presenting part - Vessels are placed over internal cervical os, before the foetus. therefore outside the protection of the cord or placenta

Answer 30

- Painless, moderate vaginal bleeding at the rupture of the membranes - Severe foetal distress - USS - Antepartum haemorrhage - DVE = pulsating foetal vessels seen in membranes through dilated cervix

Answer 31

- Immediate C section - Asymptomatic - corticosteroids 32 weeks, elective CS

Answer 32

- Type 1 = foetal vessels are exposed as a velamentous umbilical cord - Type 2 = foetal vessels are exposed as they travel to an accessory placental lobe

Answer 33

- Prelabour ROM - Foetal growth restriction - Pre eclampsia - Obstetric cholestasis - DM - IUFD - Bishop score 8 or more

Answer 34

- PGE2 inserted into vagina - Stimulated cervix and uterus to cause osnet of labour

Answer 35

- ARM then oxytocin infusion started within 2 hours if labour not ensued

Answer 36

- Silicone balloon insetred into cervix and gently inflated to dilate

Answer 37

- Blood clotting factors are increased - Fibrinolytic activity reduced - Blood flow altered - Stagnation of blood and hypercoagulable states

Answer 38

- Smoking - Parity >3 - Age >35 - BMI >30 - Reduced mobility - Multiple pregnancy - Pre ec - Varicose veins - FHx - Immobility - IVF

Answer 39

- Chest pain and dyspnoea - Tachy, raised RR and JVP - CXR, ABG and CT - CTPA or VQ

Answer 40

- from 28 weeks if 3 RF - 1st trimester if 4+ RF - LMWH continued throughout antenatal and for 6 weeks post - Temporarily stopped in labour - Mechanical if contraindicated LMWH = pneumatic compression, anti-embolism stockings

Answer 41

- Unilateral - Calf swelling - Dilated superficial veins - Tender calf - Oedema - Colour change - Ix = doppler USS

Answer 42

- LMWH started immediately, before confirming diagnosis - Massive PE and haemodynamic compromise = unfractioned heparin, thrombolysis, surgical embolectomy

Answer 43

- Preterm delivery - Low birth weight - Pre ec

Answer 44

- Bacteria in urine with no Sx - Tested routinely throughout pregnancy

Answer 45

- E coli most common - Klebsiella

Answer 46

- 7 days abx - Nitrofurantoin (avoid in 3rd trimester) - Amoxicillin - Cefalexin - Trimethoprim avoid in early pregnancy

Answer 47

- After rupture of membranes, UC descends below presenting part

Answer 48

- Preterm labour - Breech - Polyydramnios - Abnormal lie - Twins - amniotomy

Answer 49

- Pushed up by finger - Tocolytics can be given (terbutaline) - All fours - Immediate CS

Answer 50

- Muscle layer of uterus (myometrium) ruptures - Incomplete = perimetrium remains intact - Complete = perimetrium ruptures and contents of uterus released into peritoneal cavity

Answer 51

- Previous CS = scar is a point of weakness - Previous surgery - BMI - Parity - Age - Induction

Answer 52

- Acutely unwell mother - Abnormal CTG

Answer 53

- Maternal resuscitation with fluids and blood required - Emergency CS - Repair or removal of uterus

Answer 54

- Fundus inverts into uterine cavity - Haemorrhage, pain and shock - Brief attempt to push fundus up into vagina - Replacement with hydrostatic pressure run past a clenched fist at the introitus into the vagina

Answer 55

- Congenital rubella syndrome caused by maternal infection - Pregnant women should not be given MMR vaccine as it is live = need before or after Features of rubella syndrome - Congenital deafness - Congenital cataracts - Congenital heart disease - Learning disability

Answer 56

- Foetal varicella syndrome = growth restriction, microcephaly, scars, hypoplasia - Severe neonatal varicella infection - Treat with IV varicella immunoglobulins

Answer 57

- Intracranial calcification - Hydrocephalus - Chorioretinitis

Answer 58

- Miscarriage - Severe foetal anaemia - Hydrops fetalis - Maternal pre ec like syndrome

Answer 59

- Neonatal infection rare but high mortality - Vertical transmission at delivery - CS recommended - Exposed neonates given acyclovir

Answer 60

- Stillbirth - Pre ec - Growth restriction - Prematurity - Vertical transmission

Answer 61

- Causes severe illness - Vertical transmission can be prevented by high dose IV penicillin throughout labour - RF = previous, positive culture, preterm labour, ROM >18hrs, maternal fever

Answer 62

A = continuing would risk life of woman more B = necessary to prevent permanent injury to physical or mental health C = not exceeded its 24th week and continuance would be greater risk D = not exceeded 24th week and continuance would be greater to children E = risk that if child would suffer physical or mental abnormalities as to be seriously handicapped

Answer 63

- 2 registered medical practitioners - Registered practitioner in an NHS or approved hospital

Answer 64

- Mifepristone = anti-progestogen = halts pregnancy and relaxes cervix - Misoprostol = prostaglandin analogue = binds to prostaglandin receptors and activates them = soften cervix and stimulate contractions - Used together mif then miso 36-48hrs later - Rh -ve women should have anti D 10 w or above

Answer 65

- Cervix prepared first = misoprostol, mifepristone or osmotic dilators - Dilation and suction - Dilation and forcep evacuation

Answer 66

- Haemorrhage - Infection - Uterine perforation - Cervical trauma

Answer 67

Presence of endometrial tissue inside the myometrium - Associated with endometriosis and fibroids

Answer 68

Painful heavy periods, regular Dyspareunia 1/3 asymptomatic Exam = uterus mildly enlarged and tender, boggy

Answer 69

- TVUSS - MRI

Answer 70

No contraception wanted - TXA when no associated pain - Mefenamic acid when associated pain Contraception - Mirena coil - COP - Progesterone's

Answer 71

- Dryness and atrophy of the vaginal mucosa related to lack of oestrogen - Occurs in women entering menopause = oestrogen falls and mucosa is thinner, less elastic, dry

Answer 72

- Itching and dryness - Dyspareunia - Bleeding due to localised inflammation Exam - Pale mucosa - Thin skin - Reduced folds - Erythema and inflammation - Dryness - Sparse pubic hair

Answer 73

- Lubricant - Topical oestrogen

Answer 74

- Ovulation issues - Male factor problems - Sperm unable to reach egg = tubal, coital, cervical - Implantation

Answer 75

- 400mcg folic acid a day - Health = BMI, smoking, alcohol - Intercourse every 2-3 days

Answer 76

- BMI - Chlamydia screen - Semen analysis - Female hormone testing - Rubella immunity

Answer 77

- Serum LH and FSH days 2-5 of cycle - Serum progesterone on day 21 of cycle - Anti mullerian hormone - TFTs - Prolactin

Answer 78

- High FSH = poor ovarian reserve - High LH = PCOS - Rise in progesterone day 21 = ovulation - AMH = high = good ovarian reserve

Answer 79

- USS pelvis - Hysterosalpingogram - Laparoscopy and dye test

Answer 80

- Weight loss - Clomifene to stimulate ovulation or letrozole - Gonadotrophins - Ovarian drilling

Answer 81

- for unexplained subfertility, cervical, sexual and some male factors - Sperm injected directly into cavity of uterus

Answer 82

- Embryos fertilised outside uterus and transferred back - Normal ovarian reserve needed

Answer 83

- Retrospective diagnosis made after a woman has had no periods for 12 months

Answer 84

- Decline in development of ovarian follicles and without there is a reduced production of oestrogen - Oestrogen and progesterone levels are low - Therefore LH and FSH levels are high, in response to an absence of negative feedback from oestrogen

Answer 85

- Vasomotor symptoms and irregular periods - Hot flushes - Emotional lability - PMS - Joint pains - Period variation - Dryness and atrophy - Reduced libido

Answer 86

- OP = effects reliably reversible with oestrogens - CVD = adverse changes in lipid, increased prevalence with early menopause - Dementia = increased prevalence with early menopause

Answer 87

- Breast cancer - VTE = oral>transdermal - CVD - Stroke (oral)

Answer 88

- Progesterone should be used for at least 12-14 days every 4 weeks = protects endometrium from unopposed oestrogen - Oestrogen = oral, patch, gel, vaginal, implant

Answer 89

- GI upset - Need for steady absorption = migraine, epilepsy - Perceived increased risk VTE - Older women - Medical conditions - Choice

Answer 90

- Chronic inflammatory skin condition that presents with patches of shiny white skin - Affects labia, perineum and perianal skin - Autoimmune condition associated with DM, alopecia, hypothyroid and vitiligo

Answer 91

- Itching - Skin changes - Soreness (may worse at night) - Skin tightness - Superficial dyspareunia - Erosions - Fissures - Koebner phenomenon = worse by friction

Answer 92

- Potent topical steroids = clobetasol propionate 0.005% (dermovate) - Emollients

Answer 93

- Haemolysis - Elevated Liver enzymes - Low platelets - Usually jsut after birth

Answer 94

Headache Nausea and/or vomiting Epigastric pain Right upper quadrant abdominal pain due to liver distention Blurred vision Peripheral oedema Mx = delivery

Answer 95

Hyper inflated lungs and fluid C section Respiratory distress Oxygen support

Answer 96

Fully dilated and in 2nd stage OA presentation Ruptured membranes Cephalic presentation Engaged head Pain relief Sphincter empty

Answer 97

- More than 5% weight loss compared to before pregnancy - Dehydration - Electrolytes

Answer 98

- PUQE score = <7 mild, 7-12 moderate, >12 severe - Urine dip = ketones - Bloods

Answer 99

- unable to tolerate oral antiemetics or keep fluids down - More than 5% weight loss - Ketone urine - Other med conditions

Answer 100

- IV or IM antiemetics - IV fluids = normal saline with KCL - U+E monitoring - Thiamine supplementation to prevent deficiency - Thromboprophylaxis Prochlorperazine (stemetil) Cyclizine Ondansetron Metoclopramide

Answer 101

- PID - Tubal damage - Previous ectopic - Over 35 - Smoking - Ectopic whilst pregnant

Answer 102

- Lower abdo pain - Scant dark vaginal bleeding - Colicky then constant pain - Syncopal episodes and shoulder tip pain - Amenorrhoe 4-10 weeks

Answer 103

- Tachycardia, tender abdo - Cervical excitation - Pregnancy test - USS TV = GOLD - laparoscopy

Answer 104

- Medical = methotrexate (no sig pain, <35mm, hCG <1500) - Surgical = salpingectomy or salpingotomy (>35mm, FHR, hCG >5000)

Answer 105

- Primary = loss of >500ml <24 hrs after - Secondary = 24hrs - 12 weeks after - Minor = <1000ml - Major >1000ml

Answer 106

- Tone = uterine atony - Trauma - Tissue = retained placenta - Thrombin = bleeding disorder

Answer 107

- Tone Trauma Tissue Thrombin - Antepartum haemorrhage - Coag defect - Instrumental delivery - Multiparity - Obesity

Answer 108

- ABCDE - 2 large bore cannulas - Fluid resus - Oxytocin/bolus infusion - Ergometrine - Haemobate/carboprost - TXA - Massage uterus - Catheter - Bimanual compression - Misoprostol PR - Surgery = rusch balloon, b lynch, ligation, hysterectomy

Answer 109

- Anaemia antenatally treated - Give birth with empty bladder - Active Mx 3rd stage = IM oxy - IV TXA

Answer 110

- Implanted in lower segment of uterus - Major = lies over cervical internal os - Minor = leading edge of placenta in lower uterine segment, not covering os

Answer 111

- Intermittent painless bleeds - Increase in severity and frequenct over several weeks - Breech or transverse

Answer 112

- NEVER vaginal exam - 20 week scan = repeat at 32 and 36 - TV USS

Answer 113

- ABCDE - bloods - IV access - Steroids if <34 - Planned delivery - CS if placental edge <2cm from internal os

Answer 114

Part or all of the plcenta separated before delivery of foetus

Answer 115

- IUGR - Pre ec - HTN - Smoking or cocaine use - multiple pregnancy

Answer 116

- painful bleeding due to blood behnd placenta and in myometrium - Dark blood - Hypotension and tachycardia - Woody abdo, tender - CTG distress

Answer 117

- ABCDE - FBC, coag, cross match - Catheterisation - Steroids <34 weeks - IV access, fluids and bloods - Foetal distress = urgent delivery CS - >37 weeks, no distress = induce via amniotomy - Preterm and no distress = steroids

Answer 118

- Accretta = chorionic villi attach to myometrium rather than being restricted in decidua basalis - Increta = chorionic villi invade myometrium - Percreta = invade through myometrium

Answer 119

- Speulum exam = pooling fluid - IGFBP1 +ve - Proph abx = erythromycin 250mg 4XD for 10 days = prevent chorioamnionitis - Induction 34 week

Answer 120

- Acute severe pelvic or abdo pain, unilateral and constant - N+V - Palpable abdo mass - Feeding intolerance - Strenuous exercise - Peritoneal signs - Cervical motion tenderness - Fever

Answer 121

- Clinical suspicion - TV USS = whirlpool sign, free fluid and oedema - Preg test

Answer 122

- Laparoscopic surgery - Oophorectomy

Answer 123

- Vaginal delivery - Congenital factors - Menopause - Chronic cough, constipation, heavy lifting - Obesity

Answer 124

- Dragging sensation - Worse standing or end day - Intercourse disruption - Ulceration - Urinary frewuency and incomplete bladder emptying - Stress incontinene - Rectocele

Answer 125

- Abdo exam - Sim speculum - Urine dip - Bladder diary - USS if mass suspected

Answer 126

- weight loss - physio - pessary - hysteropexy - anterior repair - sacrospinous fixation - colpocleisis

Answer 127

- Lower anterior wall inolving urethra

Answer 128

upper anterio vaginal wall involving bladder

Answer 129

- Disordered LH production and peripheral insulin resistance - Raised LH and insulin = increased ovarian androgen production - Raised insulin = increased adrenal androgens and reduce hepatic SHBG = increased free andorgens - Increased intraovarian androgens disrupt foliculogenesis

Answer 130

- oligo or amennorhoea - infertility - obesity - hirsutism - acne - hair loss - DM - acanthosis nigria=cans - high cholesterol - sleep apnoea - depression and anxiety

Answer 131

- Testosterone (-/up), SHBG (-/low), LH (-) - free androgen index - raised LH:FSH ration - Pelvis and TV USS + GOLD = 12 or more developing follciels in 1 ovary, string of pearls

Answer 132

- Reduce risks associated with obesity - Mirena coil - withdrawal bleed with cyclical progestogens

Answer 133

- Pelvic pain - Bloating - Full abdo - Palpable mass

Answer 134

- Follicular = thin walls and no internal structures, developing follicle - Corpus luteum = fills with fluid instead of breaking down = pelvid discomfort, pain, delayed menstruation

Answer 135

- Epithelial tumours = PM wome - Germ cell tumours = benign, teratomas/dermoid = young pre menopause, teeth and tissue

Answer 136

- Pre menoapusal with <5cm cyst = no need ix - CA125

Answer 137

• Dermoid = gynaecologist • Simple ovarian <5cm = leave to resolve • 5-7cm = routine gynae referral and yearly USS • <7cm = MRI or surgical evaluation

Answer 138

benign tumours of myometrium/smooth muscle grow in response to oestrogen

Answer 139

- HMB - IMB - Dysmenorhoea - Urinary frequency - Bloating - Dyspareunia

Answer 140

- hysteroscopy if submucosal - pelvic uss - mri

Answer 141

- <3cm = same as HMB = Mirena coil, NSAIDS and TXA, COP - Smaller fibroids with HMB = endometrial ablation, resection, hysterectomy - >3cm = same as above along with myomectomy - GnRH agonists can reduce size of fibroids before surgery = induce a menopausal like state and reduce amount of oestrogen maintaining the fibroid

Answer 142

- STI - Unprotected sex with multiple partners - recent instrumentation

Answer 143

- uterine tenderness - lowe abdo paon - abnormal discharge - abnormal bleeding - RUQ pain - Dysmennorhoea - Subfertility - Dyspareunia - Adnexal and CM tenderness

Answer 144

- swabs - wbc, crp - pelvic uss - laparoscopy

Answer 145

- analgesia - cephalosporin - remove iud - 500mg ceftriaxone IM - Doxy 100mg BD and met 400mg BD for 14 days

Answer 146

- 2 separate placentas and 2 separate sacs - membrane between twins with a lamba or twin peak sign in USS - Best outcomes

Answer 147

- single placenta but 2 sacs - Membrane between twins = T signs USS

Answer 148

- Single placenta and single sac - No membrane separating the twins

Answer 149

- Happens when share placenta - 1 foetus may recieve majority of blood while other is starved - Recipient gets majority of blood and can become fluid overloaded = HF and polyhydramnios - Doner = GR, anaemia and oligohydramnios - Tertiary specialist foetal medicine centre - Laser treatment can be used to destroy conenction between 2 blood supplies

Answer 150

- Less acute than transfusion syndrome - 1 anaemic and other polychythaemic

Answer 151

Additional monitoring for anaemia at: - booking - 20 weeks - 28 weeks USS - 2 weekly from 16w for monochorionic - 4 weekly from 20w for dichorionic

Answer 152

trying to conceive without success for 12 months or 6 if >35 and ovarian stores likely reduced

Answer 153

- Ovulatory disorders - Tubal damage - Male infertility - Uterine or peritoneal disorders - 25% unknown

Answer 154

- Group 1 = hypogonadotrophic hypogonadism = hypothalamic pituitary failure - Group 2 = dysfunctions of hypothalamic-pituitary ovarian axis (PCOS) - Group 3 = ovarian failure = high gonadotrophins and hypogonadism

Answer 155

- Pathology of pituitary gland or hypothalamus - Suppression due to stress, chronic conditions or hyperprolactinaemia -Kallman

Answer 156

- Damage to testicle or VD - Ejaculatory duct obstruction - Retrograde ejaculation - Scarring - Absence of VD - Young's syndrome

Answer 157

- Serum LH and FSH on day 2-5 - High FSH = poor ovarian reserve - High LH = PCOS - Serum progesterone on day 21 - AMH = ovarian reserve - TFT - Prolactin

Answer 158

- weight loss - clomifene - letrozole - gonadotrophins - ovarian drilling in pcos

Answer 159

- Abdo pain and bloating - N+V - Diarrhoea - Hypotension and hypovolaemia - Ascites - Pleural effusions, renal failure, prothrombic state

Answer 160

- Abnormal bleeding - Vaginal discharge

Answer 161

- Detects pre malignant screening - Sample is tested for high-risk strains of HPV 1st and cytology only if positive - 25-49 = 3 years - 50-64 = 5 years

Answer 162

- return to normal recall

Answer 163

- Cytology - Abnormal cytology = colposcopy - Normal cytology = repeat at 12 months = if the -ve return to normal. If now +ve and cytology still normal = further tests 12 months later (same process)

Answer 164

- Vague S+S = bloating, pain, urinary - NICE = CA125 done initially and if raised do USS - Surgery and chemo

Answer 165

- <10th centile Asymmetrical - Extrinsic factors - Maternal conditions - Pregnancy conditions - Later stages - 70% of IUGR Symmetrical - Intrinsic factors - Global growth restriction - Increased risk neuro sequalae

Answer 166

- Temp <36 or >38 - Tachycaedia >90 - Tahcypnoea = RR >20 - WCC >12 or <4x10 - Hyperglycaemia >7.7

Answer 167

- Headache worse on sitting or standing - Neck stiff - Avoid lights - Lie flat - Simple analgesia - Epidural blood patch

Answer 168

- Coughing - Sneezing - Effort - Exercise

Answer 169

- Overactive bladder - Sudden urgency - Frequency - Nocturia

Answer 170

- Dipstick - Vaginal examination - Bladder diary

Answer 171

- Bladder retraining - Antimuscarinic drugs - Invasive mx

Answer 172

- Pelvic floor training - Duloxetine - Surgery

Answer 173

- Heartbeat = viable pregnancy - Heartbeat expected when crown-rmp length 7mm - <7mm CR lenght and no HB = repeat after 1 week - CL >7mm and no FHB = 1 week again before confirming - If mean gestational sac diameter of 25mm+ and no foetal pole = after 1 weeks

Answer 174

- Expectant mx if no pain - Repeat urine after 7-10 days

Answer 175

- EPAU = USS - Expectant - Medical = misoprostol - Surgical

Answer 176

- Misoprostol or surgery

Answer 177

- hypogonadic hypogonadism = decreased LH and FSH leads to decreased oestrogen= damage to pituitary, exercise, Kallman's - hypergonadic hypogonadism = turners = increased LH and FSH but decreased oestrogen - not started by 13 and no development - CAH = decreased cortisol and aldosterone

Answer 178

- Dysfunctional uterine bleeding - Fibroids - Endometriosis and adenomyosis - PID - Contraception - Bleeding disorders - PCOS

Answer 179

- Pelvic exam = spec and bimanual - FBC - hysteroscopy if submucosal fibroids, endometrial pathology or persistent IM bleed - USS = palpable mass, adenomyosis, hard to interpret exam

Answer 180

- Hysteroscopy if submucosal and HMB - Pelvis USS if large - MRI beofre surgeyr

Answer 181

- <3cm = mirena, TXA - smaller surgery = ablation, resection - >3cm = gynae referral = mirena, surgery - GnRH agonists used before surgery

Answer 182

- Secondary amennorhoea - Lighter periods - Dysmenorrhoea

Answer 183

- hysteroscopy - hysterosalpingography - sonohysterography - MRI scan

Answer 184

- columnar epithelium of endocervix extends to ectocervix - Postcoital bleed due to fragility - associated with high oestrogen levels - o/e = well demarcated border between columnar epithelium from os and pale pink squamous epitheloim of ectocervix - cauterisation of problematic

Answer 185

- Mandatory to report all cases <18 to police - If unborn child of a pregnant woman at risk referral should be made

Answer 186

- Inguinal hernias - Primary amenorrhoea - Raised LH, normal/raised FSH, raised testosterone and oest in males - Bilateral orchidectomy and oestrogen therapy

Answer 187

- 2 sperm cells fertilise an empty ovum = sperm combine genetic material and divide and grow

Answer 188

- 2 sperm cells fertalise normal ovum = haploid cell and multiplies

Answer 189

- More severe morning sickness - Vaginal bleeding - Increased enlargement of uterus - Abnormally high hCG - Thyrotoxicosis - USS = snowstorm

Answer 190

- Power - Passenger - Passage

Answer 191

- Latent = 0-3cm = 0.5cm/hr - Active = 3-7cm = 1cm/hr - Transition = 7-10cm = 1cm/hr Delay = <2cm in 4hrs or slowing of progress in multiparous woman

Answer 192

- 10cm - delivery of baby - Delay = pushing over 2hrs in nulli and 1hr in multi - Power = give oxytocin - Passenger, presentation and passage

Answer 193

- Delivery of baby to delivery of placenta Delay - >30m with active mx - >60m with physiological mx

Answer 194

- inflammation of the endometrium - Usually caused by infection - common after cs so proph abx given

Answer 195

- Foul smelling discharge or lochia - Bleeding that gets heavier or doesnt improve with time - Lower abdo pain - Fever - Sepsis

Answer 196

- Hb <100g/l = oral iron 3Xd for 3m - <90 = consider iron infusion and oral - <70 = iron infusion and oral

Answer 197

- Conservative = warm showers and analgesia - infection - flucloxacillin or erythromycin - Continue breastfeeding

Answer 198

- Changes in thyroid function within 12m delivery - Thyrotoxicosis, hypothyroidism or both

Answer 199

- thyrotoxicosis - first 3m - hypothyroid 3-6m - gradually return to norml

Answer 200

- anxiety and ittitability - sweating and heat intolerance - tachycardia - wl - frequent loose stool - raised T34 and suppressed TSH

Answer 201

- Wight gain - fatigue - dry skin - coarse hair - low mood - fluid retention - T34 low and tsh high

Answer 202

- 6-8w TFTs thyrotoxicosis = symptoms control with propranolol - hypothyroid = evothyroxin

Answer 203

- Complication of PPH - Dopr in circulating BP leads to avascular necrosis of pituitary gland - only affects anterior pituitary

Answer 204

- Reduced lactation - amennorhoea - Adrenal insufficiency and adrenal crisis - hypothyoirism and low thyroid hormones

Answer 205

- replacement of missing hormones

Answer 206

- nitrofurantoin - amoxicillin - cefalexin

Answer 207

0 = normal 1 = lowest part more than 1cm above introitus 2 = lowest part within 1cm introitus 3 = lowest part >1cm below but not fully descended 4 = full descent with eversion of vagina Beyond introitus = uterine procindentia

Answer 208

- abnormal accumulation of serous fluid in 2+ foetal compartments - Immune or non-immune causes

Answer 209

- Severe anaemia - Cardiac abnormality - Csome disorders - Infection - twin twin transfusion - Chorioangioma

Answer 210

DR = define risk C = contractions BRA = baseline rate = 110-160bpm V = baseline variability = 5-25bpm A = accelerations = 15 lasting 15s+ D = decelerations = 15 for 15 O = overall impression

Answer 211

- ECV from 37 weeks = tocolysis first - Vaginal or CS

Answer 212

- quantifies how much foetal blood is mixed with maternal blood to determine dose of anti D required

Answer 213

At least 2 of - oligoovulation or anovulation - Hyperandrogenism - Polycystic ovaries on USS

Answer 214

- Unruptured - Adnexal mass <35mm - No visible heartbeat - No significant pain - HCG <1500 iu/l

Answer 215

- HCG <5000 - Confirmed absence of intrauterine pregnancy on USS

Answer 216

- Pain - Adnexal mass >35mm - Visible heartbeat - HCG >5000 iu/l - Salpingectomy 1st line - Salpingotomy to preserve fertility

Answer 217

- overactive bladder - sudden need to wee and rush to loo but incontinent before get there - Bladder retrain - Anticholinergic = oxybutynin - Surgery

Answer 218

- Weakness of pelvic floor - Urinary leakage when laugh, cough etc. - Avoid caffeine, diuretics and overfill - Weight loss - PF exercises - Surgery or duloxetine

Answer 219

- Bladder diary - Dipstick - Post void bladder volume - Urodynamic testing (urge not responding to 1st line)

Answer 220

- Manage according to most predominant type of incontinence

Answer 221

- Frenulum of labia minora and suoerficial skin - no suture

Answer 222

Includes perineal muscles but not anal sphincter - on ward

Answer 223

- fascia and muscles of perinium and <50% external anal sphincter - theatre

Answer 224

- fascia and muscles of perineum and >50% anal sphincter

Answer 225

- external and internal anal sphincters torn and anal epithelium - rectal mucosa

Answer 226

- Foetal station - Cervical position - Cervical dilatation - Cervical effacement - Cervical consistency - 8 or more = spontaneous 4

Answer 227

- previous - ID - surgery - coil - older age - smoking - endometriosis - IVF - POP - anything that slows egg movement

Answer 228

- Mirena - COP - POP

Answer 229

- TXA - mefenamic

Answer 230

- 12 weeks - USS for NT = >6 - BHCG = high - PAPPA = low

Answer 231

- 14-20w - BHCG = high - AFP = low - Oestriol = low - Inhibin A = high

Answer 232

- before 15w - 1/11 miscarriage

Answer 233

- 15-20w or alter - 1/200 miscarriage

Answer 234

- cervical length <25mm between 16 - 24w

Answer 235

- cervical length <25mm between 16-24 - previous premature birth or cervical trauma

Answer 236

- erythromycin 250mg 4xday for 10 days

Answer 237

- <16 can consent to own medical treatment

Answer 238

- <16 and contraception

Answer 239

- previous preg - CKD - autoimmune - DM - chronic htn 1+ = aspirin

Answer 240

- 1st preg - 40+ - pregnancy interval 10 yrs - BMI 35 - FHx - multiple preg - 2+ = aspirin

Answer 241

- on anti-epileptic - coeliac disease - DM - BMI >30 - neural tube defect take until 12 weeks

Answer 242

7 days before the start of next period e.g. if someone has a 7/28 cycle measure progesterone on day 21

Obs/Gynae Flashcards

(268 cards)