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Obs & Gyne Flashcards

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1
Q

What is the name of the axis, controlling the menstrual cycle?

A

Hypothalamic-pituitary-gonadal axis (HPG)

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2
Q

What are the 3 types of hormone involved in the control of the menstrual cycle?

A

Gonadotrophs (LH, FSH, hCG), steroids (Oestrogen, Progesterone), cytokines (activins, Inhibins)

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3
Q

What cells are sensitive to luteinising hormone?

A

Theca cells

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4
Q

What cells are sensitive to follicular stimulating hormone?

A

Granulosa Cells

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5
Q

What is the function of Theca cells?

A

Sensitive to LH, convert cholesterol precursor to testosterone and progesterone

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6
Q

What is the function of granulosa cells

A

Sensitive to FSH, Contain aromatase, and convert testosterone to oestrogen. Induce LH receptors one dominant follicle.

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7
Q

What hormone causes increased LH receptors on dominant follicle?

A

FSH, Granulosa cells cause increased receptors.

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8
Q

Which part of the menstrual cycle is variable in length.

A

Follicular stage (1-14 days)

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9
Q

What part of the menstrual cycle is constant in length?

A

Luteal Phase (15-28 days)

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10
Q

Explain implantation of the blastocyst.

A

2 way communication between the blastocyst and endometrium.

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11
Q

What is the function of hCG?

A

Signals to the corpus luteum to continue to produce progesterone, until the placenta is formed.

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12
Q

When does the fertilised egg start producing hCG?

A

6-7 days.

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13
Q

What is the name of the drug which competitively inhibits progesterone?

A

Mifepristone

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14
Q

What is mifepristone used for?

A

Medical abortion

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15
Q

What is the function of progesterone?

A

Proliferation, vascularisation and differentiation fo endometrium. Th1 regression and Th2 formation.

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16
Q

What does a decline in oestrogen during pregnancy indicate?

A

Fetal distress

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17
Q

What is the process of placenta formation called in humans?

A

Haemochorial placentation.

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18
Q

What are the cells called which invade the endometrium to aid implantation?

A

Extra-villus trophoblast.

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19
Q

What is the process of EVT invading spiral arteries called?

A

Endovascular invasion.

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20
Q

What diseases can failed endovascular invasion cause?

A 
Prematurity
Preeclampsia
Miscarriage
Abruption
Fetal growth restriction
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21
Q

What is the definition of ectopic pregnancy?

A

Pregnancy anywhere outside the uterus

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22
Q

Where is the Fallopian tube is the most common site for ectopic pregnancy?

A

Ampulla (50%)

Isthums (20%)

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23
Q

What term is given to a placenta which invades past Nitabuchs layer, into the superficial myometrium?

A

Placenta accreta (80%)

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24
Q

What term is given to a placenta which invades past Nitabuchs layer, into the deeper myometrium?

A

Placenta Increta (17%)

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25
What term is given to a placenta which invades past Nitabuchs layer, and penetrated into the uterine serosa?
Placenta Percreta (5%)
26
What is the risk of an abnormal placental connection?
Poor placental separation at parturition, leading to significant post part UK bleeding.
27
Do syncitiotrophoblast cells contain MHC?
No
28
Which Th cells have more of a role in pregnancy?
Th2
29
What diseases improve during pregnancy?
Auto immune diseases, Th1, Rheumatoid Arthritis
30
Which autoimmune diseases get worse during pregnancy?
SLE, Th2
31
What are the 3 stages of parturition?
Cervical dilatation, fetal expulsion, placental delivery and haemostasis
32
What is the Ferguson reflex?
Positive feedback of oxytocin on the hypothalamus, to sustain uterine contractions.
33
What are the reasons for using contraception?
Prevent unwanted birth, prevent teenage birth, prevent STI Transmission, control family sizes, reduce abortion rates.
34
What should be asked in the clinical assessment when prescribing contraception?
Obs: Previous pregnancy, Menstrual History, contraceptive need PMH: Previous STI, Heart disease, VTE. Breast cancer, migraine DHx: StJohns Wort Sx: Smoking, breast feeding
35
What should be included in the examination when prescribing contraception?
BP Measurements, BMI, Cervical smear, STI screen
36
What is the Fraser criteria?
A girl under 16 has capacity to contraception if they: Understand the doctors advise, The benefits outweigh the risks in giving contraception, The girl will continue having unprotected sex, Physical or mental health with suffer from pregnancy
37
What do you need to tell a patient starting contraception?
``` How to use Mode of action Efficacy Drug Interactions Side-effects/ benefits ```
38
What is the mechanism of the COCP?
Prevents ovulation, and alters cervical mucus to act as a plug. It also thins the lining of the womb.
39
What is the perfect use failure rate of the COCP?
0.1% to 2%
40
What is the typical use failure rate of the COCP?
8%
41
What are the advantages of the COCP?
``` Reversible, reliable, 12hr window Regular predictable cycle. Helps with acne. Low menorrhagia. Lower risk of PID Helps with PMS. Protective against ovarian, endometrium and colorectal cancer ```
42
What are the disadvantages of COCP?
Drug interactions (-epileptics, antibiotics, herbals) Doesn’t prevent STI D&V reduces efficacy Small risk of breast cancer and cervical cancer RISK OF VTE
43
What are the advantages of Contraceptive patches?
Even delivery of hormones (oestrogen and progesterone)
44
What are the disadvantages of contraceptive patches?
Skin irritation, expensive
45
How does the progesterone only pill work?
Thickens cervical mucus Thins endometrium Decreases tubular motility Stops ovulation (15-40%)
46
What is the perfect use failure rate of the POP?
0.5%
47
What is the typical use failure rate of the POP?
13%
48
What are the advantages of the POP?
Prevent oestrogenic side effects (breast tenderness, headache, nausea), Can be used in large BMI, Unused in individuals with migraines.
49
What are the disadvantages of POP?
``` Less effective than COCP, 3Hr window, Risk of ectopic Disrupt mistrial pattern, Ovarian cysts. ```
50
What is the perfect use failure rate of condoms?
2%
51
What is the typical use failure rate of condoms?
15%
52
What are the disadvantages of female condoms?
``` Loud, Intrusive, Easy for penis to miss Higher failure rate than male condoms, Careful insertion ```
53
What are the advantages of female condoms?
Protection from STI | Not affected by oils
54
What is the failure rate of diaphragms?
2-5%
55
Why would someone need their diaphragm size changing?
>3kg weight change
56
What are the disadvantages of diaphragms?
Correct insertion by trained staff, Spermicide can be messy, Must be in place 6hr after intercourse, Can become dislodged.
57
What are fertility awareness methods?
Planning of menstrual cycle to predict fertility in infertility periods.
58
What are the disadvantages of FAM?
Teacher required pregnancy/ prevent, 3-12 months data needed before start, Period of abstinence.
59
What is Lactational amenorrgea?
A postpartum period where a women is ammenorrhoeic if fully breast feeding
60
What is the effectiveness of LAM in normal breast feeding?
98%
61
What is the failure rate of LAM in pump breast milking?
5-6%
62
Give some examples of user dependant contraceptives.
``` COCP POP Contraceptive patch Condoms LAM FAM Diaphragms ```
63
Give examples of London acting contraceptives (LARC).
Injectable contraceptive Implant IUD IUS
64
Give examples of permanent contraceptives.
Male sterilisation | Female sterilisation
65
Give examples of emergency contraceptives.
Levonelle, elleOne
66
What is the name of the injectable contraceptive?
Deep-provera
67
What interval is depo-provers given?
12 week intervals
68
How does the injectable contraceptive work?
Inhibits ovulation by suppressing LH & FSH
69
How soon after abortion can depo-provers be given?
Immediately.
70
Should depo-provers be given to diabetic women?
Diabetic women can find altered blood sugar, so close regulation is needed.
71
What are the advantages of injectables?
Little user dependence, helps with PMS, heavy periods, amenorrhoic
72
What are the disadvantages of the injectables?
Irregular bleeding, amenorrhoea, increase appetite, increase weight gain, slow reversibility
73
What hormone do implants contain?
Progesterone
74
How long can I plants be fitted after abortion?
5 days
75
How is an implant identified on X-ray?
Barium sulphate
76
How do IUD’s work?
Foreign body reaction within uterus (copper), prevents implantation
77
How soon after abortion can IUD’s be fitted?
Immediately
78
How soon can IUD’s be fitted after delivery?
6 weeks
79
What are the advantages of IUD’s?
Long term, effective immediately, effective as immediate contraception
80
What are the disadvantages of IUD’s?
Menstrual irregularities, spotting, menorrhagia, increase risk of PID, Risk of ectopic
81
What hormone does mirena contain?
Progesterone
82
What are disadvantages of IUS?
Irregular bleeding, painful fitting, PID, Not emergency contraception
83
How does IUS work?
Endometrial atrophy
84
What are the advantages of IUS?
Effective, low risk of ectopic, low menstrual blood loss, low hormone levels
85
What hormone do levonella and Ella one contain?
Progesterone
86
What are the disadvantages of emergency contraception?
N&V, disrupt menstruation, doesn’t protect against STI
87
What are the advantages of emergency contraception?
Effective, easily available
88
What 2 medications are given to induce a miscarriage?
Mifepristone, and mesoprostol
89
What is the definition of Labour?
Spontaneous in onset, low-risk at start of labour and remaining throughout to delivery. The infant is born at 37-42 weeks of pregnancy. After birth mother and child are in good condition.
90
What is the latent phase?
Irregular contractions of uterus
91
How long does the latent phase last?
6hrs - 3 days
92
What is the management for the latent phase?
Stay at home, paracetamol
93
What is effacement?
Retraction of the cervix
94
What is dilation of the cervix?
Aperture of the cervix opening.
95
Labour: What is meant by ‘Presentation’?
The anatomical part of the foetus which presents itself first through the birth canal.
96
Labour: What is meant by ‘lie’?
The relationship between the long axis of the foetus and the long axis of the uterus.
97
Labour: What is meant by ‘attitude’?
Presenting part flexed or extended
98
Labour: What is meant by ‘engagement’?
The widest part of the presenting part has passed through the pelvic brim
99
Labour: What is meant by ‘station’?
Relationship between the lowest point of the presenting part and the ischial spines
100
What are the 3 P’s of active labour?
Power, passage, passenger
101
What is a side effect of Entonox?
N&V
102
What are fetal side effects of opiates?
Respiratory depression, diminished breast seeking behaviour
103
What are the maternal side effects of opiates?
N&V, euphoria, longer labour.
104
What is the most effective form of labour pain relief?
Epidural.
105
What are the maternal side effects of an epidural?
Longer labour (1&2 stage), Fetal malposition, increase instrumental use, Bladder incontinence, hypotension
106
What are fetal side effects of epidural?
Tachycardia, decreased breast feeding behaviour
107
How often is the fetal heart monitored at 1st stage & after a contraction?
Every 15 minutes, after 1 minute
108
What characterises 2nd stage labour?
Full dilation, Visible head, Descent.
109
What are the stages of the mechanism of labour?
``` Descent, Flexion, Internal rotation, Crowning, Extension, Restitution, Lateral flexion ```
110
What is the 3rd stage of labour?
Decrease blood loss, after birth delivery, cut cord, check placenta.
111
Why is cord clamping delayed?
Encourage drainage of blood into foetus, to reduce fetal anaemia.
112
What are risk factors for pelvic floor disorders?
Age, parity, obesity, smoking.
113
What is the definition of incontinence?
Involuntary leakage of urine
114
What are the 2 syndromes of incontinence?
Stress incontinence, overactive bladder
115
What is the pathophysiology of stress incontinence?
Sphincter weakness
116
What is the pathophysiology of an overactive bladder?
Involuntary bladder contractions.
117
What are the symptoms of an overactive bladder?
``` Urgency incontinence Frequency Nocturia Nocturnal enuresis ‘Key in door’/ handwash ```
118
What are the symptoms of stress incontinence?
Involuntary leakage
119
What are the simple assessments for incontinence?
Frequency volume chart Urinalysis Residual urine measurement Questionnaire
120
What information does a frequency volume chart provide?
``` Voided volume Frequency Fluid intake Diurnal variation Leakage frequency and quantity ```
121
What does nitrites on urinalysis indicate?
Infection
122
What can microscopic haematuria on urinalysis indicate?
Glomeruloneohritis, | Neoplasia, calculus, infection
123
What does protein on urinalysis indicate?
Nephrotic syndrome, cardiovascular disease
124
What does glucose on urinalysis indicate?
Diabetes, IGT
125
What are the e-PAQ dimensions?
``` Vaginal Bowel Urinary Coitus/ Sexual (V-bucks) ```
126
What is the treatment for stress incontinence?
Conservative- physiotherapy Surgical- sling
127
What is the treatment for overactive bladder?
``` Bladder drill, Botox Anticholinergics Augment Bypass ```
128
Give some examples of containment options for incontinence.
Pads, catheters, odour control, skin care
129
What lifestyle adaptations could you give to someone who is incontinent?
Weight loss, smoking cessation, reduce caffeine intake, avoid straining
130
What symptoms can local vaginal oestrogen help with incontinence?
Frequency, urgency, incontinence.
131
What parasympathetic nerve roots innervate the detrusor?
S2,3,4
132
What nerve roots innervate the detrusor for micturition?
T11-L2 (Sympathetic)
133
What can be used to treat an overactive bladder?
Atropine.
134
What nerve controls the external sphincter?
Pudendal (S2,3,4)
135
What receptors innvervate the detrusor?
M2, M3
136
Name an muscarinic antagonist.
Oxybutynin
137
What are the side effects of muscarinic antagonists?
Dry mouth, constipation, blurred vision, fast heart, memory loss
138
Name a beta-3 adrenergic agonist.
Mirabegron
139
Give some examples of physiotherapy for incontinence.
Pelvic floor exercises, Tens, vaginal cones
140
When should you repair a prolapse?
Symptomatic or severe
141
What is the procedure called for a prolapsed vagina?
Sacrifice spinous.
142
Give some examples of non-STI, genital infections.
Candidiasis, vestibulitis, balantis, bacterial vaginosis, lichen sclerosis, vulvodynia
143
What is the definition of the menopause?
Cessation of menstruation
144
What is the average age of the menopause?
51
145
How is the menopause diagnosed?
12 months amenorrhoea
146
What is the perimenopause?
Period leading up to menopause
147
What are symptoms of the perimenopause?
Irregular periods, hot flush, mood swings, atrophy of vagina
148
Give some short term impacts of the menopause.
``` Vasomotor symptoms (Sleep, mood, QoL) Generalised symptoms (Mood swings, hot flush, memory loss, headache, joint Pain) ```
149
Give some medium term impacts of the menopause.
Urogenital atrophy, UTI, Dyspareunia, incontinence (55-65 yrs)
150
Give some long term impacts of the menopause.
Osteoporosis, cardiovascular disease, dementia
151
What are the 3 options for menopause management.
Hormonal (HRT), non hormonal (Clonidine), non pharmaceutical (CBT)
152
What are the benefits of HRT?
Relief of menopausal symptoms, BMD protection
153
What are the risks of HRT?
Breast cancer, VTE, CVD, CVA
154
What is the risk increase of breast cancer with HRT (Oestrogen).
Little change
155
What is the increase risk of breast cancer with | HRT (Oestrogen and progesterone)?
Increased risk
156
What is the management of women with early, local breast cancer and menopausal symptoms?
Discontinue HRT, do not offer HRT
157
Women with BMI 32 is offered HRT? Transdermal or oral?
Transdermal, lower risk of VTE (Baseline population)
158
What age does CVD risk not increase when starting HRT?
<60 yrs
159
Who should have transdermal HRT?
Gastric upset, migraine, increased VTE, HTx, Choice
160
What is premature ovarian syndrome?
Menopause <40yrs, chromosomal abnormality, genetic
161
What is the advice in management of POS?
Hormonal replacement at least until the age of the menopause.
162
What are non hormonal methods to treat the menopause?
Clonidine, citalopram, fluoxetine.
163
What is endometriosis?
Endometrial tissue outside the uterus
164
What causes endometriosis?
Retrograde menstruation
165
What are 2 sites for endometriosis?
Umbilicus (Halbans), lungs (Meyers)
166
What is the usual presentation of endometriosis?
Pain, infertility
167
Describe the pain of endometriosis.
Cyclic Pain, dysmenorrhea, deep dyspareunia
168
What are the 2 methods of treatment of endometriosis?
Abolishing cyclicity, glandular atrophy
169
Give 2 examples of abolishing cyclicity methods to treat endometriosis.
OCP (long will cause glandular atrophy), GnRH agonists
170
Give examples of secondary care endometriosis care.
Surgery (ablation, excision, oooprectomy, pelvic clearance)
171
What are fibroids?
Benign uterine tumours, smooth muscle tumours, Oestrogen dependant
172
What are the symptoms of fibroids?
Asymptomatic, heavy periods, anaemia, infertility, miscariage
173
What is informed consent?
Informed consent is the process by which a fully informed patient can participate in choices about her health. Care.
174
What is the term for failing to obtain informed consent before performing a procedure?
Battery
175
What elements make up informed consent?
Nature of the procedure, Alternatives, risk and benefits, Has patient understood?! Acceptance by patient
176
What is amniocentesis?
Is usually done at 15-20 weeks, check for chromosomal abnormalities
177
What is choroid villus sampling?
Placental tissue is taken for analysis, 10-13 weeks.
178
What is the definition of a premature birth?
Born before 37 weeks
179
What is the definition of LBW infants?
<2.5kg
180
What can prematurity lead to?
Developmental delay, visual impairments, lung disease, cerebral palsy
181
What can be given to premature neonates to improve survival?
Steroids, surfactant, ventilation, nutrition, antibiotics.
182
What are related risk factors for PTB?
Vaginal bleeding, multiple pregnancy, race, infection (bacterial vaginosis, UTI, appendicitis)
183
What is the primary prevention of PTB?
Smoking and STD prevention, prevention of multiple pregnancy, planned pregnancy, cervical assessment at 26 weeks
184
What is the tertiary prevention for PTB?
Prompt treatments, steroids, antibiotics
185
What is the definition of preterm labour?
Persistent uterine acitivity and change in cervical dilation or effacement
186
What is the secondary treatment for preterm labour?
Trans vaginal cervical ultrasound, fetal fibronectin test
187
What is fetal fibronectin?
Extra cellular matrix protein found in choriodecidual inferface
188
What is the treatment for preterm labour?
Progesterone IM
189
What percentage of pregnancies are complicated by hypertension?
10%
190
What proportion of hypertensive pregnancies are Gestational hypertension?
70%, 30% are chronic HTx
191
What percentage of maturnal deaths are from hypertension?
20%
192
What are risk factors for hypertension in pregnancy?
Young females, black, multifetal pregnancy, renal disease,
193
What are the classifications of hypertension in pregnancy?
Gestational hypertension, preeclampsia, chronic hypertension, preeclampsia superimposed in chronic
194
What is the definition of gestational hypertension?
New HTx after 20 wks, 140/90, NO PROTEINURIA
195
What is the definition of preeclampsia?
New HTx after 20 wks, WITH PROTEINURIA
196
What is eclampsia?
Features of preeclampsia plus generalised tonic clinic seizures
197
What are the thresholds for PROTEINURIA?
>0.3g protein /24hrs, +2 urine dipstik
198
How should blood pressure be measured in pregnancy women?
Left lateral position, rest for 10 minutes, cuff at heart level
199
What is the classification of severe preeclampsia?
160/110, significant PROTEINURIA, oliguria, visual changes, headache, scotomata, pulmonary oedema, RUQ Pain
200
What is the clinical criteria for severe preeclampsia?
Impaired liver function tests, thrombocytopenia, IUGR, oligohyroaminos.
201
What physical findings are there in preeclampsia?
Brisk, hyperactive reflexes, ankle clonus
202
What are the differential diagnosis of preeclampsia?
TTP, HUS, FL of pregnancy
203
What blood tests are needed for preeclampsia?
Haemoglobin, Uris acid, LFT, platelets, creatinine, urine protein
204
What is the management for preeclampsia?
Hospilatalisation
205
What is the Antepartum management for preeclampsia?
Restricted activity.
206
What are the maternal indications for deliver in preeclampsia?
38 weeks, low platelets, deteriating liver, severe CNS symptoms
207
What a the the fetal indications for delivery in preeclampsia?
FGR, Oligohydramnios
208
What is the cure for preeclampsia?
Delivery
209
What medication is given to prevent CNS symptoms in preeclampsia?
Magnesium sulphate
210
What is the treatment of severe hypertention in pregnancy ?
Hydralyzine, labetalol
211
What is menstruation?
Monthly bleeding from the reproductive tract induced by hormonal changes of the menstrual cycle
212
How do you measure the menstrual cycle length
Start of day of bleeding to the start of the next day
213
What is the normal menstrual cycle lengths?
5/28
214
What is menorrhagia?
Heavy Bleeding that occurs at the expected intervals of the menstrual cycle
215
What is intermenstrual bleeding?
Bleeding that occurs between clearly defined menses
216
What is abnormal uterine bleeding?
Any bleeding from the uterus that is either abnormal in volume, regularity, timing, or is non menstrual
217
What is the definition of heavy menstrual bleeding?
Menstrual blood loss that is subjectively excessive by the the woman, and interferes with her emotion, social or material quality of life.
218
What are the pathological causes of AUB?
Uterine fibroids, polyps, adenomyosis, endometriosis
219
What are uterine fibroids?
Leiomyomas of the myometrium, 20% of women of reproductive age
220
What is most heavy menstrual bleeding due to a combination of?
Coagulopathy, ovulatory, endometrial dysfunction
221
What are uterine polyps?
Common benign localised growths of endometrium
222
What is adenomyosis?
Ectopic endometrial tissue within the myometrium.
223
What information should you get from a history of heavy menstrual bleeding?
Duration, cycle, heavy ness, clots, flooding
224
What are the differential diagnoses of HMB?
Thyroid disease, clotting disorder, drugs
225
What investigations should be done for menorrhagia?
FBCM TVS,endometrial biopsy
226
What are the treatments of HMB?
Reassurance, tranexamic acid, NSAIDs, progestagens, danazol, COCP, Mirena, ablation (infertility), hysterectomy
227
What is the definition of the puerperium
From the delivery of the placenta to six weeks following birth
228
What are the features of the puerperium?
Return to pre-pregnant state, transition to parenthood, initiation to suppression of lactation
229
Describe the physiology of endocrine changes in the puerperium.
Decrease in placental hormones (hCG, Oestrogen, progesterone, placental lactogen), increase in prolactin
230
Describe the physical changes in the puerperium.
Involution of the uterus and genital tract.
231
Puerperium: What is the Lochia rubra?
Day 0-4, blood discharge, decidua, fetal membrane, meconium
232
Puerperium: What is the Lochia serosa?
Day 4-10, cervical mucus, exudate, fetal membrane, WBC
233
Puerperium: What is the Lochia alba?
Day 10-28, cholesterol, epithelial cells, fat, mucus
234
What essential molecule is found in breast milk?
Lactoferrin.
235
What is a mnemonic for the classification of sepsis?
3T’s with white sugar
236
What is the definition of primary post partum haemorrhage?
>500ml blood loss after birth of baby
237
What is the definition of minor post partum haemorrhage?
Blood loss of <1500ml with no signs of shock
238
What is the definition of major post partum haemorrhage?
1500ml blood loss or clinical shock
239
What factors constitute 6 weeks postnatal LMWH?
Previous VTE, FHx, antenatal LMWH
240
What is a risk of epidural?
Post dural puncture headache.
241
What are the red flags of the puerperium?
Recent significant change in mental state, new thoughts of violent self harm, new expressions of incompetency as a mother, or estrangement from infant
242
What percentage of new mothers suffer from postnatal depression?
10%
243
What is the medical term for fibroids?
Leiomyomas
244
What is adenomyosis?
Endometrial tissue found in the myometrium of the womb.
245
What are the symptoms of fibroids?
``` Can be asymptomatic, Heavy periods, Painful periods, Lower back pain, Dyspareunia. ```
246
How many deaths are there from breast cancer per year?
12000
247
What are some reasons why the incidence of breast cancer is rising?
Western lifestyle, screening, life expectancy
248
What are some factors that predispose to breast cancer?
Late first child, alcohol, HRT, COCP, Obesity, lobular carcinoma in situ
249
What are some non modifiable factors for breast cancer?
Age of menarche, early parity and breast feeding, breast density, heredity
250
What are some modifiable factors for breast cancer
Weight, exercise, alcohol, exogenous oestrogen
251
What percentage reduction does 150 minutes of brisk exercise do to breast cancer risk?
9%
252
How often does breast cancer screening occur in the UK?
3 years
253
What is the age of breast cancer screening in the UK?
50-70 (47-73)
254
What are the disadvantages of screening?
Overdiagnosis, anxiety, costs, X-ray dose
255
What are the advantages of breast cancer screening?
Reduces breast cancer stage at diagnosis, diagnoses DCIS, which is rarely symptomatic
256
What are the clinical features of breast cancer?
Nipple inversion, lump, visible, blood discharge, visible skin changes
257
What are the signs of breast cancer?
Skin tethering, irregular lump
258
What do microcalcifications indicate on mammography?
DCIS, Cancer
259
What are the indications for a mastectomy?
Large tumour size, more than one cancer in same breast, patient choice, reconstruction
260
What factors indicate conservation and radiotherapy treatment?
Small tumour, no previous radiotherapy, pre operative chemotherapy, choice
261
What percentage of women with breast cancer have axillary involvement?
40%
262
What can unilateral lymph oedema indicate?
Axillary lymph blockage, due to breast cancer
263
What are the 2 categories of breast cancer?
Ducal and lobular
264
What is the name of the prognostic index which shows prognosis after surgery only for breast cancer?
Nottingham Prognostic Index
265
What is the common name for trastuzumab?
Herceptin
266
What adjuvant therapy is given to women with ER breast cancer?
Bisphosphonates
267
What are the complications of tamoxifen?
Hot flush, nausea, vaginal bleeding, thrombosis, endometrial cancer
268
What are the side effects of aromatase inhibitors?
Hot flushes, reduced bone density, joint Pain, DVT, endometrial cancer
269
FINISH BREAST LECTURE
.
270
What is the prevalence of infertility?
1 in 7
271
What is the definition of infertility?
Failure to conceive after 1 year of unprotected sex.
272
What is the single most important factor for fertility?
Maternal age
273
What is the relationship between miscarriage and age?
Increase
274
What are the 4 principles of care when carrying out a fertility clinic?
See both partners together, explanation and written advice, psychological effects of infertility, specialist team
275
What reproductive disorders are associated with obesity?
PCOS, Miscarriage, infertility, obstetric complications
276
What preconception advice is given to couples who are infertile?
Intercourse 2-3 times per week, folic acid, rubella, smoking, weight loss, smear,
277
What investigations should be done in patients who are infertile?
Ovulation function, semen quality, tubal patency
278
What investigations can be done to check ovulation?
Mid-luteal progesterone
279
What are the 3 parts of the ovarian reserve testing?
FSH, Antral follicle count, antimullarian hormone
280
What is the name of the criteria for polyciytic ovarian syndrome?
Rotterdam criteria
281
What are the contents of the Rotterdam criteria?
Anovulation, PCOS on USS, raised androgens (2 out of 3)
282
What is the treatment of PCOS?
Normalise weight, clomifiene(Oestrogen antagonist), metformin, gonadotrophins
283
What can cause blocked Fallopian tubes?
Infections, endometriosis, Previous surgeries
284
What are the treatment options for blocked Fallopian tubes?
Surgery, catheterisation, IVF
285
What are the treatments for endometriosis?
Laparoscopic ablation, cystectomy
286
What is the treatment of unexplained infertility?
IVF [2 years], THEN, Clomiphene, SIUI
287
What are the risks of IVF?
Multiple pregnancy, miscarriage, ectopic, abnormality, ovarian hyper stimulation syndrome,
288
What patient factors contribute to failed IVF?
Ahem cause of infertility, Previous pregancy, Previous attempts, environmental factors
289
What are the maternal risks of increased age and IVF?
HTx, GD, IUGR, instrumental delivery, VTE, death
290
What are the conditions of IVF?
Treatment after 12 months or 2 years of insemination
291
What is the treatment for fibroids?
Myomectomy, pregnancy rate higher after surgery
292
What are the differential diagnosis of a breast lump?
Benign breast change, fibroadenoma, cyst, sebaceous cyst, papilloma, fat necrosis, cancer, sarcoma, lymphoma
293
What are the characteristics of a malignant lump?
Hard, irregular margin, skin tethering, nodal swelling, older age
294
What are some indirect causes of maternal death in pregnancy?
CVD, Epilepsy, suicide, cancer, diabetes
295
What are direct causes of maternal death in pregnancy?
Pre-eclampsia, thrombosis, PPH
296
What are the cardiac changes in pregnancy?
Increase blood volume, increase oxygen demand, | Increase CO
297
What changes does pregnancy have on haematology?
Increase iron requirements (2-3 times), Dilutions anaemia, Folate anaemia and
298
What happens to tidal volume in pregancy?
Increases
299
What happens to residual capacity in pregnancy?
Decrease
300
Is pregnancy associated with respiratory acidosis or alkalosis?
Alkalosis
301
What is the incidence of asthma in pregancy?
4%
302
What is the age range for fibroadenomas?
25-30
303
What is the management for fibroadenoma?
Leave unless increasing in size
304
What are the characteristics for a fibroadenoma?
Smooth, mobile, non-tender
305
What is the age range for cysts?
35-55
306
What are the characteristics of breast cysts?
Hard, irregular
307
What is the management of breast cysts?
Aspirate
308
What age does fibrocystic change occur in?
Younger patients
309
What are the characteristics of fibrocystic change?
Tender, cyclical, rubbery
310
What is the management of fibrocystic change?
Reassurance
311
What are the risks with breast implants?
Capsule formation, rupture, migration, lymphoma
312
What are the symptoms of mastitis?
Red, swollen, tender, Pyrexia, Pain
313
What is a complication of mastitis?
Abscess formation
314
What is a complication of drainage of a breast abscess?
Lactational fistula
315
What organisms can cause acute peri-areole sepsis?
Staph Aureus, bacteroides, step, enterococci
316
What organisms can cause acute peripheral Lactational sepsis?
Staph aureus
317
What is duct ectasia?
Where the lactoferous ducks become blocked
318
What are the symptoms of duct ectasia?
Nipple discharge, pain, bloody discharge, nipple inversion
319
What are the symptoms of periodical mastitis?
Non cyclical pain, mass, nipple inversion
320
What are the symptoms of a breast abscess?
Periareolar abcess, fistula
321
What are the differential diagnosis of bloody nipple discharge?
Duct ectasia, papilloma, DCIS
322
What is the management of bloody discharge of the nipple?
Imaging
323
What are the differential diagnosis of single duct non bloody nipple discharge?
Duct ectasia or papilloma
324
What are papillomas of the breast?
Benign mass in a dilated ductal system
325
What is the name of the screening criteria?
Wilson and Junger Criteria
326
What is the definition of screening?
A process of identifying apparently healthy individuals who may be at an increased risk of a disease or condition
327
What diseases does the fetal anomaly screening programme look for?
Downs, Edwards, Patau’s
328
At what week does the fetal anomaly screening programme occur during pregnancy?
18 weeks to 20+6 weeks
329
What diseases does the infectious diseases screening program look for?
Toxoplasmosis, rubella, cytomegalovirus, hepatitis, herpes, syphilis
330
What are the 3 antenatal screening programme?
Fetal anomaly screening programme, Infectious diseases screening programme, Sickle cell and Thalassaemias screening program
331
What can the newborn screening programme detect?
Cystic fibrosis, congenital hypothyroidism, sickle cell disease, inherited mental IC diseases
332
What are the new born screening programmes?
New-born blood spot screening programme, New#born hearing programme, New-born physical examination screening programme
333
What is the incidence of Down’s syndrome
1 in 1000
334
What can be the complications of Down’s syndrome?
Heart defect, leukaemia, thyroid disease, epilepsy, alzheimers
335
What are the effects of Edwards syndrome?
Heart problems, facial and head deformities, brain abnormalities
336
What measurements are used in the combined test (first trimester) to screen for T21, T18, T13?
NT (If CR length is 45-84), b-HCG (Higher), PAPP-A (Lower)
337
What measurements are used in the quadruple test (second trimester) to screen for T21, T18, T13?
AFP, bHCG, Oestriol, inhibit A
338
When is the quadruple test offered to women?
Is women presents too late, if the foetus position means NT cannot be measured
339
What are dichorionic twins?
Two foetuses with 2 placentas
340
What diagnostic tests are offered to women who have a positive screening result?
Chorionic villus sampling, amniocentesis, Non-invasive prenatal testing
341
What is non-invasive prenatal testing?
Fetal Free DNA testing, from 10 weeks of pregnancy
342
How many fetal anomaly screening are women offered during pregnancy?
2
343
What is the Early ultrasound scan (10-14 weeks) used to detect?
Dating the pregancy and confirming viability, multiple pregnancy, NT
344
What is the ultrasound can atm 18 weeks to 20 weeks and 6 days used to detect?
Structural abnormalities
345
What screening test can be done in newborns?
Heel-prick screening test
346
What conditions does the heel-prick test detect?
Sickle cell disease, cystic fibrosis, congenital hypothyroidism, thalassaemia, inherited metabolic disease
347
What are some maternal obstetric emergencies?
Antepartum haemorrhage, Postpartum haemorrhage, Venous thromboembolism, Pre-eclampsia
348
What are fetal obstetric emergencies?
Fetal distress, cord prolapse, shoulder dystocia
349
What is the definition of antepartum haemorrhage?
Bleeding from anywhere in the genital tract after 24 weeks of pregnancy
350
What are the causes of antepartum haemorrhage?
Placenta praevia, placenta accreta, abruption, infection
351
How is a low lying placenta diagnosed?
20 week anomaly scan, painless bleed
352
What is the management of low lying placenta?
Education of symptoms, outpatient of management,anti D, elective Caesarian
353
What is the emergency management for a placenta praevia?
ABCDE, Examination (vaginal, USS, abdominal), fetal monitoring, steroids
354
What is the management for a placenta accreta?
20w scan, CS at 36 weeks, hysterectomy?, leave placenta in place, blood products available
355
What is vasa praevia?
Where the vessels of the placenta are covering the cervical os
356
What is the mortality of vas’s praevia?
60%
357
What must never be done in the examination of placenta praevia?
DIGITAL VAGINAL EXAMINATI9N
358
What is placental abruption?
Premature separation of the placenta from the uterine cavity,
359
What are the risks of a placental abruption?
Concealed haemorrhage, fetal distress, haemorrhage
360
What are the complications after antepartum haemorrhage?
Premature delivery, blood transfusion, ATN, DIC, PPH, ITU, ARDS, fetal hypoxia or death
361
What are the causes of post partum haemorrhage?
Tissue (placenta) Tone (No uterine contraction), Trauma (tears) Thrombin (clotting)
362
What are the risk factors for post partum haemorrhage?
Macrosomia, multiparty, long labour, pyrexia, instrumental delivery, shoulder dystocia
363
What is the most common direct cause for maternal death in the UK?
Sepsis
364
What is the pre management for sepsis in pregnant women ?
Flu vaccine
365
What are the risk factors for sepsis in pregancy?
Obesity, diabetes, anaemia, immunosuppressive, vawginal discharge, PID, GBS, amniocentesis, rupture of membranes prolonged,
366
What are the sings and symptoms of sepsis?
Pyrexia, hypothermia, tachycardia, tachypnoea, hypoxia, hypotension, oligouria, dizzy
367
What is the difference in presentation between placenta praevia and placenta abruption?
Placenta abruption is not as much blood and LOTS OF PAIN
368
What is the treatment of sepsis?
Oxygen, fluids, blood cultures, lactate, antibiotics, fluid chart
369
What is the definition of severe pre-eclampsia?
Hypertension +PROTEINURIA, plus one of pappiloedema, headache, visual change, clonus, liver tenderness, platelet or LFT dysfunction
370
What is the treatment for pre-eclampsia?
``` BP control (labetalol, methyldopa, Hydralazine) Magnesium sulphate, Fluids Coagulation factors, Delivery ```
371
What is given to induce uterine contraction?
Syntocin
372
What is the physiological cause of fetal morbidity in cord prolapse?
Vasospasm
373
What are risk factors for cord prolapse?
Premature membrane rupture, Polyhydramnios, long umbilical cord, multiparty,
374
What is shoulder dystocia?
Failure of the anterior shoulder to pass under the symphysis pubis after delivery of the fetal head
375
What are the risks of shoulder dystocia?
PPH, vaginal tear, cerebral palsy, brachial plexus injury
376
What are the risk factors for shoulder dystocia?
Macrosomia, Previous SD, maternal diabetes, post maturity, obesity, instrumental delivery
377
What are the 2 methods of fetal heart rate monitoring?
Intermittent monitoring, continuous monitoring
378
What are the advantages of intermittent auscultation of FHR?
Inexpensive, non-invasive, can be used at home
379
What are the disadvantages of intermittent auscultation?
Variability in accelerations and decelerations cannot be detected, long term monitoring not possible, quality of FHR can be affected by maternal heart rate and movement
380
What can be used for intermittent auscultation
Pinnard stethoscope, Doppler
381
What equipment is used for continuous monitoring in pregnancy?
Cardiotocography
382
What are the advantages of CTG?
Information about fetal heart and uterine activity, long term monitoring is possible, can determine variability
383
What are the disadvantages of CTG?
No I,provement in perinatal outcomes in low risk pregnancies, no morphological assessment of the heart, no true beat to beat FHR data, fetal exposure to ultrasound, ambulatory monitoring not possible.
384
What mnemonic is used for CTG interpretations?
``` DR C BRA V A D O (Define risk) (Contraction) (Baseline rate) (Variability) (Accelerations) (Decelerations, early, variable, late) (Overal ```
385
What is the normal baseline of a CTG?
110-160bpm
386
What is the normal variability in CTG heart rate in pregancy?
>5bpm
387
What are the advantages of fetal electrocardiograph?
Direct FHR monitoring, true beat-beat information
388
What are the disadvantages of fetal ecg?
Invasive, monitoring only if in labour, 2cm dilated and membranes not present, scalp injury and infection
389
What should the measurement be of the fundal height, compared to the gestational age?
+/-2cm from gestational age
390
What does low liquor volume mean?
Placental dysfunction
391
At what weeks are smokers babies scanned?
3 times! 26, 28, 32 weeks
392
What is the most common cause of Polyhydramnios?
Gestational diabetes, swallowing malfunction
393
What are tumour-suppressor genes?
Breaking signals during the G1 phase of the cell cycle, to stop progression to the S phase
394
Give 2 examples of tumour suppressor genes?
p53, Rb
395
What is the aetiology of endometrial cancer?
Obesity, diabetes, nulliparity, late menopause, ovarian tumour, HRT, Irradiation, tamoxifen, PCOS, HNPCC UNOPPOSED OESTROGEN
396
What is the medical name of endometrial cancer?
Adenocarcinoma, adenosquamous, | Papillary serous
397
What is the staging of endometrial cancer called?
FIGO I/II/III/IV
398
What are the treatments for endometrial cancer?
Hysterectomy, lymph node removal, radiotherapy, progesterone
399
What are the causes of cervical cancer?
HPV, early age intercourse, STD, cigarettes, OCP
400
What is a red flag of endometrial cancer?
Postmenopausal bleeding
401
What stains of HPV are common for cervical cancer
HPV16, HPV18
402
What percentage of the population will come into contact with HPV ?
75%
403
What does E6 in HPV block?
P53
404
What does E7 in HPV block?
Retinoblastoma suppressor
405
What is a persistent infection of HPV associated with?
High grade Cervical intraepithelial neoplasia
406
What is the 5 year survival rate of stage I cervical cancer
90%
407
What are the causes of vulval cancer?
HPV, Lichen sclerosis
408
What are the symptoms of vulval cancer?
Itching, soreness, lump, bleeding, dysuria
409
What are the treatments of vulval cancer?
Surgery, radiotherapy, adjuvant chemotherapy
410
What are the symptoms of ovarian cancer?
Bloating, abdomen pain, bowel habit change, urine frequency, obstruction,
411
What are the causes of ovarian cancer?
Ovulation (menarche, menopause, parity, OCP) | Genetic (BRCA, HNPCC)
412
What is the histological name for ovarian cancer?
Epithelial
413
What investigations can be done for ovarian cancer?
CA125, CEA, USS
414
What is the Risk of Malignancy Index?
CA125 x USS (3) x pre or post menopausal (3)
415
What is the definition of term?
37 completed weeks (37+7)
416
What is the definition of pre term?
Baby born at or before 37+6 weeks
417
What is the definition of post-term?
After 42 weeks
418
What ‘symptom’ questions should be asked in an obstetric history?
``` Nausea and Vomiting Visual change/ headache Swelling Itching PV bleeding/ loss Reduced fetal movements LUTS ```
419
What questions about ‘investigations should be asked in an obstetric history?
``` Had a scan? Had screening? Taking folic acid? Planned? Last menstrual period ```

Phase 3a (You) (2 decks)

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