Obs & Gynae Flashcards
(133 cards)
1
Q
which anti-epileptic drug cannot be used in pregnancy and for what reason?
A
sodium valproate
causes neural tube defects
2
Q
what antibiotic causes dental staining in pregnancy
A
tetracyclines
3
Q
isotretenoin is not given in pregnancy for what reason?
A
causes congenital facial dysmorphogenesis eg. absent or defective ears
4
Q
ACE inhibitors and angiotensin 2 receptor blockers are associated with what in pregnancy
A
oligohydramnios
5
Q
bright red vaginal bleeding after 20 week pregnancy
PAINLESS
A
PLACENTA PREVIA
6
Q
PAINFUL vaginal bleeding after 20 week pregnancy
‘woody’ uterus
A
placental abruption
7
Q
IVF treatment requirements
A
trying for 2 years, not obese and not smoking
8
Q
pregnant woman, has BP>140/90
no other symptoms
don’t have leaky capillaries
no protein in urine
A
pregnancy induced hypertension
9
Q
pregnant woman
BP >140/90
BUT HAS OTHER SYMPTOMS EG headache, epigastric pain and visual problems
A
pre eclampsia
10
Q
emergency contraception tablet that can be taken within 5 days of unprotected sex
CANNOT GIVE WITH ASTHMA
A
ELLAONE
11
Q
emergency contraceptive pill
given within 72 hours
A
LEVONORGESTREL
LEVONENE
12
Q
PT missed progesterone only pill
what should they do
A
take the missed pill
use condom for 2 days
13
Q
what contraception can be used after pregnancy while breast feeding
A
progesterone only pill
14
Q
when can the IUD be inserted in a woman who has given birth
A
after 48 hours of delivery or 4 weeks post partum
15
Q
what is the best emergency contraception
A
IUD
can be used up to 5 days after having unprotected sex
16
Q
which contraceptive pill helps with acne
lightens periods and doesn’t cause weight gain
A
combined pill
17
Q
pt comes in with abdominal pain
bloating
menopause at 54
next step
A
serum 25
18
Q
painful periods that before used to be painless
gets better over the period
what can this be a cause of
A
endometriosis
19
Q
patient smokes and is older than 35
why is the patient not suitable for the combined contraceptive pill?
A
because the patient smokes
20
Q
patient is post menopausal
on HRT
more bloating
more frequency to urinate
more urgency
what is it
A
ovarian cancer
21
Q
placenta grows too much into the myometrium
when giving birth - too much bleeding and hysterectomy needs to be done
A
placenta acreta
22
Q
red ring/grazae on cervix is what?
A
ectropion - proliferated cells on the cervix
23
Q
what’s an ectropion
A
squamous cells of the cervix grow outside the cervix
common in females on hormonal contraception
bleeding after sex
24
Q
labetalol is first line management for?
A
pre-eclampsia
25
snow storm appearance in the uterus on the scan
a uterus that is bigger than it should be
- what is it
trophalastic disease
- abnormal trophoblast cells grow outside the uterus after conception
26
what is a molar pregnancy
problem with fertilised egg so the foetus and placenta doesnt grow the way it should
- baby can not survive
-'woody uterus'
- bright red blood bleeding from the uterus in the first 3months
- grape-like cysts come out
27
the oral contraceptive pill increases the chances of which cancer?
breast and cervical cancer
28
the oral contraceptive pill decreases the chances of which cancer?
endometrial cancer
29
what is a risk factor in pregnancy for venous thromboembolism?
multiple pregnancies
30
what is bartholins' gland?
- it is a gland that is located on vaginal opening - labia minora
- it produces lubrication for the vagina
- if it the path from the duct to the vagina gets blocked, it becomes a cyst
- if this gets infected - becomes abscess - very painful
31
symptoms of bartholins abscess
red lump in the opening of vagina
pain during sex
oozing from the abscess
32
when women take the oral combined pill what factor should be monitored?
their blood pressure
OCCP holds a risk of hypertension
33
what medication holds a risk of developing gynaecomastia
spironolactone
34
what anti-epileptic drug should be given to pregnant women?
diazepam
35
cyclical oestrogen-only HRT is used when?
used for women who menstruated LESS THAN A year ago
only those who DONT have uterus
36
continuous combined HRT is used when?
stopped menstruation OVER A YEAR AGO
and HAVE A UTERUS
contains oestrogen and progesterone which protects the endometrium from hyperplasia
37
continuous oestrogen only HRT is used when?
this increases the risk of endometrial cancer in women who have uterus
ONLY GIVEN TO WOMEN WITHOUT UTERUS
38
Cyclical combined HRT is used when?
stopped menstruation LESS THAN A YEAR AGO
and HAVE A UTERUS
39
smokers over what age who smoke >15 cigarettes a day cannot be given oral combined pill?
over 35
40
abdominal pain in pregnant women can be due to what reasons?
preterm labour
abruption
and other causes like:
41
what is placental abruption
bleeding behind the placenta - this can build up in the uterus and increase pressure
- so it is very painful
- blood flow to baby gets restricted
42
what are the two causes of vaginal bleeding in pregnancy?
placenta previa
placental abruption
cervial polyps
43
what is vasa previa
- the placenta is like a disc that sits on the uterine wall
- blood vessels travel from the placenta to the umbilical cord of the baby
- these vessels can rupture and cause bleeding
- blood loss can be fatal to the baby
- requires emergency c-section
44
placenta previa
- the placenta lies in the way of the cervical opening
- can easily bleed (generally after 20 weeks of gestation)
- can be complete: the placenta fully covers the internal os
- partial: only partially covers the cervial os
- as the uterine cavity grows it can cause damage to the blood vessels in the placenta - causes painless bright red bleeding
45
what is placenta accreta
a complication of placenta previa
when the placenta joins with the myometrium and cannot seperate
- requires c-section
46
common cause of still births?
reduced foetal movements
these need to be monitored closely
how?:
checke fluid around the baby as this is a clear indication of blood supply to baby
to cardiograph - check oxygen levels in baby
47
what is pre-eclampsia
specific to pregnancy
increased blood pressure AND protein urea
- affects multiple organs
- raised ALT
- eGFR goes down
- Increased creatinine
48
what is HELLP syndrome
(hemolysis, elevated liver enzyme levels, and low platelet levels)
complication of pre-eclampsia
- can cause nausea and vomiting
- cannot be fully treated until the placenta is there
- it goes away when the placenta is delivered
- beta-blockers and CCBs are given to manage the hypertension
- don't give too much fluid to the mum as it can make the hypertension worse
49
which antihypertensives are given to mothers during pregnancy?
beta blockers
CCBs
other hypertension drugs can cause hard to the foetus
50
what is gestational diabetes?
- diabetes that comes along with pregnancy
- can be due to mum being overweight and not physically active
- the raised blood sugars in the mum can cross the blood into the baby
- the increased blood sugars in the babies blood can cause increased amounts of insulin to be produced
- insulin is a growth hormone and causes babies to grow really fat and large
- this increases the chances of shoulder dystocia as the baby is large
- higher risk of still birth
- this also means that the babies pancreas gets used to producing so much insulin which increases tolerance, can cause child to develop diabetes when they are born
- baby can also get hypoglycaemia
- gestational diabetes goes away after delivery, so any anti-diabetic drug that is given to mum during pregnancy should be taken off
51
pre-labour rupture of membranes - what is it
this is when there is rupture of the membranes in the uterus but labour doesn't follow
- it generally happens after 37 weeks
- when this happens - always check for infection as this can be dangerous
- if there is no infection then just try and induce labour and get the baby out as fast as possible
52
what should fundal height in babies be?
how do you work it out
fundal height should be 1cm above or below the number of weeks
53
what is an inevitable miscarriage
- heavy uterine bleeding
- painful
- cervical os is open
- explosion of the embryo up to 24 weeks
it is 'inevitable' that the foetus will be lost
54
what is threatened miscarriage
- mild bleeding symptoms
- generally happens in 6-9 weeks
- cervical os is closed so the foetus is contained within the uterine cavity
- little or no pain
- there is the THREAT that a miscarriage will happen but not too sure
55
what is a complete miscarriage
- when the interuterine pregnancy has fully miscarried
- all products of the conception have expelled and the uterus is empty
- so the os will be closed
- there would have been pain and bleeding prior to this
56
what is a missed miscarriage
- there is still some foetus tissue in the uterus but the foetus is no longer alive
- cervical os is closed
- 'missed' because the mother is not able to tell that something has happened
57
what is a septic miscarriage
- the products of conception are still inside the uterus
- this is can get infected and get septic
- mother can get sepsis
- but the mother will have symptoms of fever etc
58
group B septococcus infection in mother who is pregnant - what are the risks
- this bacteria lives in the gut and many mothers are carries
- there is the risk of giving the infection to the baby during delivery
- so prophylaxis is given to the mother during delivery
- so intrapartum prophylaxis
- give penicillin
- vancomycin if mother is allergic to penicillin
59
what is bacterial vaginosis
- happens when there is an imbalance in PH
- gives a fishy odour
- green/yellow/copper discharge
give metronidazole
60
what is candial thrush
can get it due to diabetes/combined pill/anitbotics and pregnancy
- white spots on the genital area or mouth
- white curd like discharge
- can be due to frequent washing and sex
- if post menopausal women get it then it means they have diabetes
- treat with fluconazole
61
uvuodynia
painful vulva
62
what is lichen planus
chronic skin condition
plain purple papules
very itchy
happens in the ankles and wrists
63
what is done in shoulder dystocia?
McRobert's manoeuvre
-bring mothers legs into hyperflexion, into the abdomen
- this releases pressure from the shoulders
64
what is the most common gynaecological cancer
endometrial cancer
1 in 41 women
incidence has increased - increase in obesity
and ageing population
causes 26% deaths
65
what is the most common type of cervical cancer
squamous cell carcinoma
in the transformation zone - where the cells transform from glandular to squamous
66
risk factors of cervical cancer
HPV
most common type 16 and 18
genital warts are caused by 6 and 11
multiple sexual partners
smoking - weakens immune system
lower income
those on immunosuppressent meds
COCP
67
what is cervical intraepithelial neoplasia
CIN 1, 2 and 3 - stages of the HPV virus and the cancer
68
presentation of cervical cancer
abnormal bleeding (after sex)
abnormal discharge
bleeding after urine or poo
leg oedema
white and red patches on the cervix
69
if smear is HPV positive but cytology negative?
do another screening in one year
70
if HPV and cytology is positive
do colposcopy
71
staging of cervical cancers
stage 1 - a: 4mm or smaller b: larger than 4mm
stage 2 - grown to the top part of the vagina
72
common type of ovarian cancer
epithelial cancer - serous is the most common type
73
risk factors for ovarian cancer
BRCA 1 gene
lyches disease
smoking
HRT
protective factors - COCP and breast feeding
74
presentation of ovarian cancer
- abdo discomfort
ascites
weight loss
fatigue
bloating
uringe urgency and frequency
diagnosis happens a lot later
75
investigations for ovarian cancer
AFP
ca 125
76
staging for ovarian cancer
Figo staging
stage 1a - cancer is in the ovaries
1b - it is in both the ovaries
1c - a bit further than that
2 - spread to the bowel or bladder
3 - in the abdo
in the peritoneum
lymph nodes
4 - spread to other organs
77
endometrial cancer
very fast detection of it
- removal of the uterus cures the cancer
78
most common type of endometrial cancer
adenocarcinoma
79
types of endometrial cancers
type 1 - oestrogen dependent
type 2 - oestrogen independent
80
risk factor for endometrial cancer
nulliparous
obesity
hyperplasia
PCOS
81
presentation of endometrial cancer
post menopausal bleeding !!!!
2ww
82
staging of endometrial cancer
1 - cancer has grown into muscle wall/halfway into the muscle wall
2 - grown into cervix (take out uterus to treat this)
3 - spread to ovaries and vagina
4 - other organs
83
vaginal cancer
squamous cell carcinoma
- posterior wall of the upper third of the vagina
84
presentation of vaginal cancer
bleeding
abnormal discharge
refer for colposcopy
examine and vulva
treatment - depends on stage of the cancer
radio/chemo
85
vulvar cancer
very rare
squamous cell
melanoma can happen in the vulva
labia majora - happens here
lichen scleoris - this can cause vulvar cancer
86
which twin pregnancy carries the greatest risk
monochronioinic-monoamniotic twins
- these twins share the same amniotic sac and placenta but with two seperate umbilical cords
greater risk of entanglement and spreading syndrome from one twin to another
87
uterine rupture in labour
presents with sudden abdo pain and loss of contractions and history of foetal distress makes this diagnosis likely
in this case - emergency c-section should be done - laparotomy
88
GBS infection in babies
babies can get infected with this during delivery as the bacteria (group b step) lives in the genitals of the mother
- causes respiratory distress in neonates
89
what is lichen sclerosus
inflammatory skin condition that affects genitals and anal area
causes itchiness, pain during sex and white patches
treat with topical corticosteroids
if left untreated, it can cause vulvar cancer
90
what is an imperforate hymen
when the hymen blocks the entrance to the vagina
in young girls it can mean that their period blood is not able to leave the vagina but instead builds up
- this can cause bloating
-blue, bulging mass that is protruding
91
what are the best analgesics for Dysmenorrhoea ?
NSAIDs like ibuprofen or mefenamic acid
92
painless bleeding post sex - most common cause
ectropion
- common in women taking hormonal contraceptive
93
medication given to induce pregnancy?
prostaglandin
94
medication given to delay delivery?
tocolysis
BUT DO NOT:
- give before 24 weeks
- use after 33 weeks
- do not give in pre-eclampsia
or placental abruption
or if mother is infected
95
what is gestational trophoblastic disease
Gestational trophoblastic disease is a rare complication of pregnancy in which trophoblastic cells of the placenta invade the uterine wall and become cancerous. Gestational trophoblastic disease is characterised by very high serum hCG concentrations, and hyperemesis gravidarum is commonly seen.
96
hormone levels in menopause
progesterone and oestrodiol production is reduced and FSH and LH production is increased
97
for what purpose in oxytocin given after labour
it is given if the mother has a risk of post partum haemorrhage
it helps contract the uterus and prevent bleeidng
98
what test is done to determine how much anti-D immunoglobulin is required to Give to the mother
it is the Kleihauer test
it is done in a rhesus negative woman to know how much anti-D antibody she requires before another pregnancy
99
polyhydrominnos is a risk for?
oesophageal atresia because too much amniotic fluid poses a risk to the foetus swallowing the fluid
- makes it more likely to get infections and other abnormalities
100
what is Obstetric Cholestasis
it is an issue where the liver produces too many bile salts
this can make the patient very ithy
101
first line for morning sickness
anti-histamine - promethazine
102
what is the purpose of cervical cancer screening - what is it testing for?
it is testing for high risk HPV virus and if this returns abnormal then test for abnormal cytology is done
25-64 years
103
management of stress incontinece
1. pelvic floor excises
2. surgery - mid urtheral tape
or duloxetine if they don't want surgery
104
management of urge incontinence
1. bladder retainment - so fluids that don't irritate the blader
2. oxybutynin
105
what are some physiological changes found in pregnancy?
increased ventilation
increased RBC count
106
what is the pathology of haemolytic disease in pregancy
Haemolytic disease of the newborn is an alloimmune condition that develops due to the maternal production of IgG Ab against fetal red blood cells.
107
what are the symptoms of gonnorrhea
- rectal pain
- green discharge
- one of the causes behind PID
- gram-negative diplococci,
- abnormal bleeding
- dysuria in men.
The discharge comes from the Bartholin's gland
- and managed by ceftriaxone
108
What are the symptoms of chlamydia?
- Chlamydia is an STI caused by Chlamydia trachomatis bacteria.
- Men may experience clear or cloudy discharge from the penis with a foul odor or watery/milky color.
- Women may experience thin, watery, yellow or green vaginal discharge with an unusual odor.
- Additional symptoms may include pain or burning during urination, testicular pain or swelling in men, lower abdominal pain, pain during intercourse, or bleeding between periods in women.
- Some individuals may have mild or no symptoms, so testing is important for diagnosis.
- If left untreated, chlamydia can lead to serious health problems such as pelvic inflammatory disease, infertility, and increased risk of HIV transmission.
managed with doxycycline
109
what are the symptoms of trichomonias
sexual STD
yellow discharge
burning after urination
manage with metronidazole
110
What are the symptoms of candiadis
It is common in pregnancy,
causes: dysuria, redness, and swelling, white, white spots on mouth that can be wiped away
curdd like discharge
managed with fluconazole.
If postmenopausal women presents with candy it is, then most likely she has diabetes.
111
What are the symptoms of bacterial vaginosis?
A grey/brown discharge with the fishy odour, foul-smelling manage with clindamycin or metronidazole
112
What is atrophic vaginitis
- Atrophic vaginitis - low estrogen levels in the body, thinning and drying of the vaginal walls.
- symptoms - vaginal dryness, itching, burning, pain during intercourse, and vaginal discharge
- Treatment options - vaginal lubricants or moisturizers, estrogen therapy, or low-dose vaginal estrogen.
113
what kind of environment does atrophic vaginitis cause in the vagina
creates alkaline environment which is prone to infection
oestrogen causes acidic environment which protects against infection
114
what is the process for cervical smears and referalls
1, if smear is normal then no further test
2. if smear shows risk of high risk HPV then do cytology
3. if cytology shows normal - then come back again in 6 months
4. if cytology shows dyskaryosis and high risk HPV then refer for colonoscopy
115
what is Chorioamnionitis
It is an infection of the amniotic fluid in pregnant women, which can cause severe pain, fever and abdominal tenderness. It can also cause increased fetal heart rate.
Give antibiotics or deliver baby
The major risk factor for this condition is premature rupture of membranes
116
What is a molar pregnancy?
This is when an empty egg is fertilised by sperm, much than duplicates forming 46 paternal chromosomes.
This then grows and becomes a benign tumour like mass.
Complete molar pregnancy. There is no fetus and only the placenta grows and becomes a mass in partial molar pregnancy put the fetus and the placenta grow abnormally.
117
presentation of molar pregnancy
Severe morning sickness, bleeding in the first trimester
uterus large for dates - the size of the uterus is larger than normal at that stage
very high levels of HCG hormone
118
What is endometriosis characterised by?
deep dyspareunia and pain on defecation
vague pelvic pain
cyclical with periods
periods are still regular
119
what condition causes hypergonadotropic hypogonadism?
Hypergonadotropic hypogonadism is a failure of the gonads to respond to gonadotropins secreted by the anterior pituitary gland.
- gonads (ovaries or testes) do not develop properly - low sex steroid levels, even though LH and FSH is high,
- these are released by the anterior pituitary gland as part of a feedback response
- The elevated levels of LH and FSH are an attempt to stimulate the underdeveloped gonads to produce sex hormones, but the gonads do not respond properly
- In females - causes primary amenorrhea, underdeveloped breasts, and infertility
In males - cause delayed puberty, underdeveloped testes, and infertility
Treatment options for gonadal dysgenesis may include hormone replacement therapy, surgery to remove the underdeveloped gonads, or assisted reproductive technologies.
120
how much folic acid should be taken by women who are trying to conceive
400micrograms daily for 3 months before conception - take it until 12 weeks of pregnancy
121
what is the most common cause of post partum haemorrhage
Atony of the uterus - normally after childbirth the uterus contracts and goes back to the size, it was before, but in this condition, the uterus does not do that which can cause bleeding
122
other causes of postpartum haemorrhage
Tone (uterine atony): the vast majority of cases
Trauma (e.g. perineal tear)
Tissue (retained placenta)
Thrombin (e.g. clotting/bleeding disorder)
123
Management of postpartum haemorrhage
IV oxytocin: slow IV injection followed by an
IV infusion ergometrine slow IV or IM (unless there is a history of hypertension)
124
What is the mechanism of action of anastrozole?
It is an aromatase inhibitor which inhibits peripheral oestrogen synthesis
125
jaundice in the new born
Jaundice appearing within 24 hours of age;
Haemolytic disease of the newborn
Infections
G6PD deficiency
Jaundice appearing between 24-72 hours;
Physiological
Sepsis
Polycythaemia
Jaundice appearing after 72 hours
Extrahepatic biliary atresia
Sepsis
Congenital hypothyroidism
Breastfeeding
126
what is the common cause of prolonged jaundice in new borns
breastfeeding
127
what deficiency is associated with neural tube defects
folic acid
128
Causes of folic acid deficiency
phenytoin
methotrexate
pregnancy
alcohol excess
129
Which combination of maternal and fetal Rh statuses would pose a risk of Rhesus disease?
Rh negative Mum and RH positive baby
130
What is one of the rest of a molar pregnancy?
Choriocarcinoma
131
recurrent nose bleeds, and heavy periods is associated with what condition
von Hillebrands disease - if suspected then do clotting screen
132
which contraceptive pill can be used while breast feeding
progesterone only pill
133
what is associated with uterine fibroids
enlarged uterus, heavy periods
infertility
