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Obs & Gynae Flashcards

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0
Q

What is miscarriage?

A

Spontaneous expulsion of products of conception before week 24 of pregnancy

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1
Q

Define menorrhagia?

A

Excessive blood loss >80ml with regular menstruation

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2
Q

What are the maternal cause of miscarriage? General and Local causes. 5 things

A 
GENERAL
Age
Obesity
Septicaemia
Severe hypertension/Renal disease
Diabetes
Hypothyroidism
Trauma

LOCAL
Fibroids
Congenital uterine malformations
Adenomysis
Incompetent internal os
Hormone deficiency
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3
Q

Give 3 fetal causes of miscarriage?

A

Genetic abnormalities
Congenital malformations
Faulty implantation

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4
Q

What are the symptoms of a threatened miscarriage?

A

Scanty uterine bleeding

Pain usually absent; may be slight uterine contractions and backache

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5
Q

On examination, give 2 things that might be seen in a threatened miscarriage?

A

Active breasts (enlarged and tender)
Enlarged uterus
Closed cervix
No pelvic tenderness

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6
Q

What is the management for a threatened miscarriage?

A

Rest until bleeding has ceased. After bleeding, woman to resume normal life

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7
Q

What are symptoms of an inevitable miscarriage?

A

Bleeding

Pain-Crampy low abdominal pains

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8
Q

Give 2 examination findings in an inevitable miscarriage?

A

Uterus enlarged
Internal os of cervix open (products of conception may be felt)
Low BP/Pulse

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9
Q

What is the management of an inevitable miscarriage?

A

Remove any products from the open os

Evacuation of retained products of conception

Excessive bleeding-give Ergometrine

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10
Q

What is an incomplete miscarriage?

A

When some of the products of conception are retained in the uterus

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11
Q

What is the management of an incomplete miscarriage?

A

Prostaglandins to evacuate products

Evacuation of the uterus in the theatre

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12
Q

What is the definition for recurrent miscarriage?

A

3 consecutive spontaneous miscarriages

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13
Q

What are the risk factors for ectopic pregnancy? 4 things

A 
PID
Previous pelvic surgery
Previous ectopic surgery
Intrauterine device
POP
Sterilisation
Emergency contraception
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14
Q

What are the 4 common associations to recurrent miscarriages?

A

Anti phospholipid syndrome
Polycystic ovaries
Incompetent cervix
Fibroids

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15
Q

How do you investigate a couple with recurrent miscarriages?

A

Anti Phospholipid Syndrome: Lupus anticoagulant and anticardiolipin antibodies. 2 positive results

PCOS: LH, FSH and Testerone levels + U/S

Cervical incompetence: Hysterosalpingography and Transvaginal U/S

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16
Q

Give 3 ways a tubal pregnancy can terminate?

A

Absorption

Tubal abortion-products expelled into peritoneal cavity

Tubal rupture

Secondary abdominal pregnancy

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17
Q

What are the causes of infertility in both partners?

A

Mechanical difficulty

Periods of separation

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18
Q

Give 3 causes for infertility in males?

A 
Impotence
Premature ejaculation
Azoospermia/oligospermia (<20)
Poor sperm motility
Abnormal morphology
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19
Q

Give 4 areas where infertility could arise from in females?

A

Fallopian tubes-obstructed by infection

Ovaries-anovulation, PCOS, Peri menopausal

Intact hymen

Vagina-congenital malformation

Uterus-malformation or tuberculous endometritis

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20
Q

What is the action of the COCP?

A

Inhibits ovulation
Modifies endometrium preventing implantation
Thickens cervical mucus

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21
Q

Give 3 advantages of the COCP?

A

Most effective reversible birth control

Method doesn’t affect intercourse

Dysmenorrhea and menorrhagia are eased

Menstruation becomes regular

Hb levels maintained so anaemia less common

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22
Q

What are the risk factors for cervical malignancy? 4 things

A 
High parity
Multiple sexual partners
Early first coitus
Smoking
Long term use of oral contraceptives
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23
Q

Give 2 indications for a colposcopy referral?

A

Two consecutive borderline smears
Dyskaryosis
3 abnormal smears in 5 years
2 consecutive smears inadequate for assessment

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24
Give 3 side effects of the COCP?
Fluid retention and weight gain Thromboembolism Skin pigmentation Migraine aggravation
25
When should emergency contraception be administered?
Within 72 hours
26
Give 4 contraindications to COCP use?
History or FHx. of thrombophlebitis, severe heart disease or cerebrovascular accidents 40y/o+, obese and heavy smoker Liver damage Hx. of breast cancer >30 BMI Moderate hypertension (>160 systolic)
27
Give 3 types of barrier contraception?
Condoms Cervical diaphragm Female condom Spermicide
28
Give 3 problems attached with using a copper intrauterine device?
Expulsion from uterus Pelvic infection Dysmenorrhea/Menorrhagia
29
State 3 contraindications to using an intrauterine device?
Pregnancy Current pelvic/ST infection Gynaecological cancer
30
Give 4 symptoms of endometriosis?
Dysmennorrhea Deep dyspareunia Ovulation pain Infertility
31
State 3 investigations in endometriosis?
Laparoscopy (gold standard) USS MRI
32
Give 3 ways to manage endometriosis?
Medical: simple analgesia, hormones (COCP, POP, GnRH) Surgical: excision, laparoscopic ablation
33
Give the antibiotic of choice for chlamydia infection?
Doxycycline
34
Define primary and secondary amenorrhea?
Primary: Absence of menses at 14 (without secondary sexual characteristics) OR Absence of menses at 16 Secondary: Absence of menses for 6 months after period of regular menses
35
Name 5 causes of amenorrhea?
``` Pregnancy Menopause Head injury, Tumour Weightloss Hypopituitarism PCOS ```
36
State 5 clinical features of PCOS?
``` Oligo/Amenorrhea Infertility Hirtuism Obesity Acanthosis nigricans on flexural surfaces ```
37
Give 5 ways you can manage PCOS?
``` Lifestlye changes (lose weight, stop smoking, exercise etc.) Supportive ``` Metformin - increase insulin sensitivity Clomifene - induce ovulation for infertility COCP - increase sex hormone binding globulin Cosmetic - hair removal
38
State 4 ways fibroids can be managed?
Medical: IUCD GnRH analogues Surgery: Hysterectomy (definitive) Myomectomy
39
Give 4 risk factors for developing endometrial cancer?
``` Unopposed oestrogen therapy Obesity Nulliparity Late menopause FHx Tamoxifen ```
40
If a patient is experiencing post menopausal bleeding, what differentials come to mind?
``` Endometrial/cervical carcinoma Vaginitis Polyps Oestrogen withdrawal (stopping HRT) Foreign body ```
41
State 6 immediate complications of menopause?
Vasomotor: Hot flushes, Night sweats End organ atrophy: Vaginal dryness, dyspareunia, dysuria Psychological: Depression, loss of libido
42
Give 2 long term complications of menopause?
Osteoporosis | Cardiovascular disease
43
State 4 possible complications of HRT?
Unopposed oestrogens: increased risk of endometrial/ovarian cancer Increased risk of breast cancer Increased risk of IHD and CVA Increased risk of venous thromboembolism
44
How can you estimate the date of delivery?
EDD=LMP+1year-3months+7days
45
What are the 3 stages of labour?
Creation of birthing canal Expulsion of foetus Expulsion of placenta
46
What drug is given in the 3rd stage of labour and whats its action?
Syntometrine (oxytocin and ergometrine) Stimulation of uterine contraction and smooth muscles in blood vessels to contract Expulsion of placenta and reduces risk of PPH
47
How is Premature rupture of membranes managed?
Administration of: Prostaglandinds and oxytocin to induce labour
48
If there is meconium in the liquor, what 2 steps must be taken?
Fetal blood sampling Scalp electronic monitoring (CTG) ?C-section (thick meconium or low foetal pH)
49
Name 4 ways pain relief can be achieved during labour?
Simple: breathing exercises, relaxation techniques, water immersion Narcotic injections (pethidine) IM Nitrous oxide (entonox) Spinal block Epidural anesthesia Transcutaneous electrical nerve stimulation (TENS)
50
How can a breech presentation be managed?
External cephalic version (ECV) | C-Section
51
Give 3 indications for induction of labour?
``` Prolonged pregancy Hypertension Pre-eclampsia Rhesus disease PROM ```
52
Give 6 causes of dystocia?
Difficulty in labour Passage: Abnormal bony pelvis, Cervical dystocia (fail to dilate) Passenger: Large (macrosomia, hydrocephalus), Malpresentation Powers: Insufficient activity, hypotonic contractions, Uncoordinated contractions
53
How might a problem with contractions be managed during labour?
Hydration Analgesia (pain & fear produces catecholamines which can inhibit uterine activity) Amniotomy Oxytocin infusion
54
What are 4 indications for forceps delivery?
Delay in the second stage of labour (failure of maternal effort e.g. exhaustion, epidural analgesia or malposition of fetal head) Complications in the second stage (fetal distress, prolapsed cord, ecalmpsia) Prevent undue maternal effort (cardiac disease, respiratory disease, pre-eclampsia) Breech delivery
55
What are 3 possible complications of forceps deliever?
Maternal trauma Foetal bruising Foetal facial nerve paralysis (usually resolves) Foetal brachial plexus injury
56
Give 6 indications for emergency C-Section?
``` Severe pre-eclampsia Placental abruption Foetal distress Failure to progress Prolapsed cord Failed induction of labour ```
57
What are the TORCH infections?
Infections passed from mother to foetus which can have severe consequences? ``` Toxoplasmosis Others: syphillis, VZV, HIV, Parvovirus Rubella Cytomegalovirus Herpes simplex ```
58
How are the TORCH infections managed?
High dose aciclovir
59
What 4 pieces of advice will you give to a woman at her first antenatal clinic appointment?
Folic acid supplements Lifestyle advice (smoking and alcohol cesation) Food hygiene Antenatal screening tests available (anomalies, downs syndrome, haemoglobinopathies)
60
What 2 tests can be done to screen for downs syndrome and when?
1st trimester: Combined test (nuchal translucency, bHCG, pregnancy assosciated plasma protein, womans age) 2nd trimester: Quadruple test (bHCG, Alpha fetoprotein, Inhibin A, unconjugated estriol)
61
How is gestational diabetes and pre-eclampsia screened?
Oral glucose tolerance test & Blood pressure and protein in urine
62
State 4 causes of a large for gestational age foetus?
Constitutionally large Maternal diabetes Intrauterine infections Hyperinsulinaemia
63
State 4 possible complications of intrauterine growth restriction?
``` Hypoxia Hypothermia Jaundice Hypoglycaemia Infection ```
64
Give 4 possible causes of intra uterine growth restriction?
Maternal: poor nutrition, smoking/alcohol Foetal: abnormality, infection Placental: failure of trophoblast invasion
65
Give 5 possible complications of pre-eclampsia?
``` Eclampsia Cardiac/pulmonary oedema Acute renal failure HELP syndrome (haemolytic anaemia, elevated liver enzymes, low platelet count) Placental abruption Foetal death ```
66
How can pre-eclampsia be managed?
Primary prevention: calcium supplements/aspirin Medical: magnesium sulphate prevents seizures, antihypertensives (labetalol), steroids for foetal lungs, induction of labour Surgery: C-Section Delivery is the only cure!
67
Give 4 risk factors for developing pre-eclampsia?
``` FHx of pre-eclampsia Primigravida Past Hx of pre-eclampsia Multiple pregnancy Extremes of maternal age ```
68
Give 4 problems associated with twin pregnancies?
``` Malpresentation Polyhydramnios Conjoined twins IUGR Low birth weights ```
69
Give 5 possible complications to the foetus from gestational diabetes?
``` Macrosomia Shoulder dystocia Hypoglycaemia Hypoxia Intrauterine death/Miscarriage ```
70
State 4 conditions which are suggested by presence of hyperemesis gravidarum?
Multiple pregnancy Thyrotoxicosis in pregnancy Molar pregnancy UTI in pregnancy
71
Give 4 things you look for on vaginal examination during labour?
``` Cervix (consistency, effacement and dilatation) Intact membranes Colour of amniotic fluid Presenting part Size of pelvic outlet ```
72
Give 4 signs on a CTG that might indicate foetal distress?
Absence accelerations Presence decelerations Decreased baseline activity Baseline tachycardia/bradycardia
73
What is the difference between an epidural and a spinal anaesthetic?
Epidural anaesthetic is inserted in the potential space between dura mater and periosteum inside the vertebral column Spinal anaesthetic is inserted into CSF fluid after piercing the dura mater
74
State 4 risk factors for prematurity?
``` Extremes of maternal age Smoking PROM Prev. preterm labour Drug abuse ```
75
How can you prolong labour?
``` Tocolytics: Beta agonists (Terbutaline) Calcium channel blockers (Nifedipine) ```
76
State 3 risk factors of developing cervical cancer?
Multiple sexual partners Smoking Early onset of sexual activity
77
Give 4 ways you can manage prolapse in women?
``` Lifestyle: Lose weight, stop smoking Topical oestrogens Pessary Pelvic floor physiotherapy Surgery ```
78
What are the advantages and disadvantages of breast feeding? Give 3 each
``` Advantages for the baby: Reduced diarrhoea Reduced risk of infections Advantages for the mother: Reduced risk of breast CA+ ovarian CA Bonding with the baby ``` Disadvantages: Volume of intake is uncertain Transmission of drugs Insufficient vit K/vit D
79
Give 3 differences of amniocentesis and chorionic villius sampling?
Time to test Chorionic villus sampling = 10wks-20wks Amniocentesis = 16wks+ Foetal death Chorionic villus sampling = 4% Amniocentesis = 1% Neural tube defects Chorionic villus sampling = Not detected Amniocentesis = Detected
80
State 3 ways you can manage menorrhagia?
Progesterone containing IUCDs (Mirena) Antifibrinolytics (Tranexamic acid) Antiprostaglandins (Mefenamic acid) Endometrial resection
81
Give 4 clinical features of fibroids?
Menorrhagia Fertility problems Pain Palpable mass
82
How might vaginal thrush present?
Red and sore Non offensive with white curds Around vagina and vulva
83
How can you treat vaginal thrush?
Topical Tx. Cotrimazole and cream | Oral fluconazole
84
How can you differentiate Trichomoniasis and Bacterial vaginosis?
Trichomoniasis produces vaginitis and sexually transmitted BV mostly asymptomatic BOTH produce fishy odour BOTH treated by Metronidazole

Medicine (17 decks)

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