repro Flashcards
(309 cards)
1
Q
what is the folic acid dose for a healthy mother?
A
400 micrograms per day
2
Q
what is the folic acid dose for women w/ underlying health conditions?
A
5mg per day
3
Q
what is chorioamnionitis?
A
infections of the membranes in the uterus
4
Q
what is the recommended first line pain killer in pregnancy?
A
paracetamol - crosses the placental membrane but is not teratogenic
5
Q
can codeine phosphate be taken in pregnancy?
A
yes at low doses if it is needed
6
Q
how does vasa praevia present?
A
rupture of membranes followed immediately by vaginal bleeding
7
Q
what is dysfunctional uterine bleeding?
A
menorrhagia w/ no underling pathology
8
Q
what is the most common cause of bleeding in post menopausal women?
A
atrophic vaginitis
9
Q
what is the first line for dysfunctional uterine bleeding?
A
merina coil
10
Q
does hyper or hypothyroidism cause menorrhagia?
A
hypothyroidism
11
Q
what is the advantage of skin patch HRT compared to oral tablet HRT?
A
reduced VTE risk
12
Q
what is premature ovarian failure?
A
menopause before 40
13
Q
what are the blood results in premature ovarian failure?
A
low / no oestrogen
high FSH and LH (due to no -ve feedback to the pituitary)
14
Q
what is the treatment for CIN || and ||| and why?
A
large loop excision of the transformation zone (LLETZ) because they often progress to invasive cancer (unlike CIN | which often regresses)
15
Q
what is the whirlpool sign indicative of?
A
ovarian torsion
16
Q
what is a cystocele?
A
herniation of the bladder into the vagina
17
Q
what is the first line imaging modality to investigate ovarian pathology?
A
USS
18
Q
what condition causes difficulty palpating the foetal parts?
A
polyhydramnios
19
Q
what is a potential complication of polyhydramnios and why?
A
umbilical cord prolapse because the excess amniotic fluid can prevent engagement of the presenting part and leave room for the cord to get past (prolapsing)
20
Q
what is the time frame for the anomaly scan?
A
18-20+6 wks
21
Q
what is the management for a pregnant pt. w/ hyperemesis gravidarum and why?
A
thiamine supplements
because intractable vomiting can result in thiamine deficiency which can cause wernickies encephalopathy and result in foetal death
22
Q
what is the test used to investigate downs at 15 wks?
A
the quadruple test (used after 13 wks gestation)
23
Q
what is the test used to investigate downs at 12 wks?
A
the combined test (first test used and can be used between 11-13+6 wks)
combined test = nuchal translucency + hormone levels in the blood
24
Q
what is naegles rule used to calculate?
A
estimated date of delivery based on the date of the last menstrual period
25
how do you calculate the EDD using naegles rule?
add one year and 7 days to the last menstrual period and subtract 3 months
26
what is a membrane sweep and when is it offered?
a finger is inserted into the cervical opening and a sweeping movement is done to separate amniotic membranes from the cervix
done in post term pregnancy
27
what is the kleihauer test done for?
to quantify the dose of Rh D antigen in the maternal circulation
28
how does congenital toxoplasmosis present?
CNS problems
visual impairment
hearing loss
29
how is toxoplasmosis acquired?
exposure to cat faeces
30
what is the management of a pregnant pt who has hypothyroidism but is euthryoid on her current levothryoxine dose?
increase the levothyroxine dose by 25mcg and repeat thyroid function tests in 4 wks
31
what is frank breech?
legs are fully extended up to the shoulders and the presenting part is at the pelvic inlet
32
what kind of HRT is given to menopausal women w/ symptoms who still have regular periods?
monthly, cyclical HRT
33
what kind of HRT is given to postmenopausal women?
continuous combined HRT
34
what is the contraceptive used in a pt who is 3wks post partum and is breast feeding?
progesterone only pill
35
when can the IUD be fitted after delivery?
up to 48 hrs after or 4 wks post partum
36
what is the most common ovarian cancer?
epithelial ovarian cancer
37
what is the most likely ovarian cancer in pre menopausal women?
germ cell ovarian cancer
38
what is the treatment option for a woman w/ cervical cancer who wants to remain fertile?
radical trachelectomy (removal of the cervix, upper vagina and pelvic lymph nodes)
39
what is a choriocarcinoma?
a tumour that arises when the fertilised ovum forms abnormal trophoblastic tissue instead of a foetus
40
when should a choriocarcinoma be suspected?
after the evacuation of a hydatidiform mole if bHCG levels do not fall
41
at what bishops score should induction of labour be carried out?
8 or more
42
what does a tender woody uterus indicate?
placental abruption
43
what is a planned external cephalic version?
proceedure that aims to manually turn the baby
44
when is planned external cephalic version done?
if the baby is still breech at 36 wks
45
why is methotrexate contraindicated in pregnancy?
because it is a folic acid antagonist
46
what are the foetal defects seen in methotrexate use during pregnancy?
anencephaly
hydrocephalus
cleft lip / palate
skull defects
47
what type of previous C section is an absolute contraindication for a vaginal delivery
classic C section (vertical)
48
what is the first line treatment for hyperemesis gravidarum?
promethazine
49
what is primary amenorrhoea defined as?
failure to establish mensuration by 15 in girls w/ normal secondary sex characterisitics (e.g. breast bud development)
50
what is the most common type of ovarian cancer?
epithelial ovarian cancer
51
what is the most common subtype of epithelial ovarian cancer?
serous
52
what is the most common class of ovulation disorder?
normogonadotrophic normoestrogenic anovulaion
53
what is the reason for anovulatiton in PCOS?
there is normal gonadotrophin levels and normal oestrogen levels however in the follicular phase FSH can be low causing anovulation
54
division between day 4-8 after fertilisation results in what type of twins?
monozygotic twins w/ diamniotic and dichorionic placentation
55
division between day 8-12 after fertilisation results in what type of twins?
monozygotic twins w/ monoamniotic and monochorionic placentation
56
what is the typical finding on ABG in hyeremesis gravidarum?
metabolic alkalosis
57
fibroids causing difficulty conceiving are likely to be located where and why?
submucosal because here they lie in the uterine cavity and disrupt the process of embryo implantation
58
which feature is not assoc w/ hyperemesis gravidarum and may point to another pathology?
abdo pain
59
psammoma bodies are seen in which ovarian cancer?
serous cystadenocarcinoma
60
what are the 3 types of benign surface derived ovarian tumour?
serous cystadenoma
mucinous cystadenoma
brenner tumour
61
what are the 2 types of malignant surface derived ovarian tumour?
serous cystadenocarcinoma
| mucinous cystadenocarcinoma
62
germ cell ovarian tumours are more common in what age group?
adolescent girls
63
what is the most common germ cell ovarian tumour?
teratoma (90%)
64
what are the 2 types of teratoma?
mature teratoma aka dermoid cyst- benign
| immature teratoma - malignant
65
what are the 4 types of germ cell ovarian tumours?
teratoma
dysgerminoma
yolk sac tumour
choriocarcinoma
66
what kind of ovarian cancer is a granulosa cell tumour?
a malignant sex cord stromal tumour
67
what kind of ovarian tumour is a sertoli leydig cell tumour?
a benign sex cord stromal tumour
68
what kind of ovarian tumour is a fibroma?
a benign sex cord stromal tumour
69
smoking is a protective factor against which cancer?
endometrial
70
how does ellaone (ullipristal) work as emergency contraception?
selective progesterone receptor modulator and primary mechanism of action is inhibition of ovulation
71
what kind of epithelium lines the ectocervix?
stratified squamous non keratinised
72
what kind of epithelium lines the endocervix?
mucous secreting simple columnar epithelium
73
how does the cervical screening programme work?
all women are initially screening for high risk HPV between the ages of 25-64 and then if that is +ve the same sample is analysed for abnormal cytology
74
which vessel supplies the greatest contribution to the arterial supply of the breast?
the internal mammary artery
75
how should a pregnant woman w/ 3 risk factors for thromboprohylaxis be treated?
started on low molecular weight heparin from 28 wks until 6wks post natal
76
how should a pregnant woman w/ >3 risk factors for thromboprophylasix be treated?
started on low molecular weight heparin immediately until 6 wks post natal
77
what is adenomyosis?
the presence of endometrium in the myometrium
78
diabetes in pregnancy causes a risk of what 6 things?
```
macrosomia
polyhydramnios
shoulder dystocia
neonatal hypoglycaemia
congenital heart abnormalities
neural tube defects
```
79
what is the most common cause of pelvic inflammatory disease?
chlamydia
80
what findings on combined test screening are indicative of downs?
increased nuchal translucency on USS
increased HCG
decreased
81
how do sperm prevent polyspermy?
through the release of Ca ions
82
schiller duval bodies are pathognomonic of what ovarian tumour?
yolk sac tumour
83
what is the most common breast cancer?
invasive ductal carcinoma
84
what is the mechanism of action of tamoxifen?
selective oestrogen receptor modulator
85
which lymph nodes drain the medial part of the breast?
internal thoracic
86
which lymph nodes drain the lateral part of the breast?
axillary
87
what is the first line for the medical management for a miscarriage w/ retained products of conception?
vaginal misoprostol
88
what is the most common C section incision?
suprapubic incision
89
what volume of amniotic fluid is considered polyhydramnios?
2-3l
90
what is the first line antibiotic for a UTI in pregnancy?
nitrofurantoin
91
what are variable decelerations usually due to?
cord compression
92
which condition is gestational trophoblastic disease strongly assoc w/?
thyroid dysfunction
93
what is the advice regarding breast feeding in a mother who has HIV?
breast feeding should be avoided and the baby should have antiretroviral therapy for 4-6wks
94
what is the follow up for a woman who had gestational diabetes?
fasting plasma glucose test done at 6-13 wks post partum
95
what is the management of a woman w/ gestational diabetes and a fasting plasma glucose of >7mmol/l?
immediately start on insulin
96
what is the management of a woman w/ gestational diabetes and a fasting plasma glucose of <7mmol/l?
lifestyle advice and if this doesnt work then insulin
97
what is the first line treatment for menorrhagia?
the merina coil (aka levonorgesterel IUS)
98
what is primary dysmenorrhoea?
crampy lower abdo pain at the time of mesntruation
99
what is the most common type of incontience in women?
stress incontinence
100
what is the first line for the treatment of severe PMS?
fluoxetine (SSRI)
101
what is the first line in the treatment of moderate PMS?
COCP
102
how is trichomonas vaginalis diagnosed?
direct visualization, wet mount microscopy and high vaginal swab
103
what is the most common type of vulval cancer?
squamous cell carcinoma
104
where in relation to the uterine artery do the ureters run?
ureters run inferior to the uterine artery (water under the bridge)
105
what are the cortisol and aldosterone levels in sheehan syndrome?
cortisol low
aldosterone normal
106
which phase of the menstrual cycle is variable?
the follicular phase
107
what is the main function of LH?
cause ovulation
108
what is the effect of rising oestrogen levels on FSH and LH?
rising oestrogen levels cause a -ve feedback and stop the release of FHS and LH from the anterior pituitary and stop the release of GnRH from the hypothalamus which further decreases FSH and LH levels
109
how does the LH surge before ovulation occur?
there is a drop in oestrogen levels and so the -ve feedback is turned off, increasing LH levels
110
which hormone is released by the corpus luteum?
progesteroen
111
if fertilisation occurs what keeps the corpus luteum alive?
hCG
112
if fertilisation does not occur how does the cycle restart?
the corpus luteum degenerates and so progesterone and oestrogen levels fall and this turns off the -ve feedback to the hypothalamus and anterior pituitary and so levels of FSH and LH start to rise again
113
how does menstruation occur?
the corpus luteum degenerates and so progesterone and oestrogen levels fall and this causes the endometrium to break down, allowing menstruation to occur
114
explain the management of stress incontinence
first line - life style modification (weight loss) and pelvic floor exercises
second line - surgery
third line - duloxetine (only if not suitable for / doesnt want surgery)
115
explain the management of urge incontinence
first line - conservative (weight loss, reduce caffeine and bladder training)
second line - medical management w/ anti muscarininc
third line - surgical botox
116
what is pelvic inflammatory disease?
chronic inflammation of the pelvis as a consequence of infection (usually chlamydia)
117
what is the main risk factor for endometrial cancer?
oestrogen exposure (early menarche, late menopause, nulliparity, unopposed oestrogen)
118
what is the most common type of endometrial cancer?
adenocarcinoma
119
how do most endometrial adenocarcinomas arise?
from endometrial hyperplasia
120
what is the diagnosis of a woman w/ post menopausal bleeding until proven otherwise?
endometrial cancer
121
COCP is protective for which 2 cancers?
endometrial
| ovarian
122
what is the most common cervical cancer and what is it caused by?
squamous cell carcinoma caused by HPV
123
which cancer is smoking protective for?
endometrial
124
which 2 cancers are smoking a risk factor for?
ovarian and cervical
125
what is cervical intraepithelial neoplasia (CIN)?
a precursor lesion of invasive cervical carcinoma
126
what is the age group for cervical cancer?
25-44
127
what medication can be used pre surgery to reduce the size of fibroids?
GnRH agonists
128
what is red degeneration?
a pregnancy related complication of fibroids where they rapidly enlarge and outgrow their blood supply
129
what is the likely diagnosis of a pregnant woman w/ a history of fibroids who presents w/ severe abdo pain and low grade fever?
red degeneration
130
what is the gold standard investigation for a diagnosis of endometriosis?
explorative laparotomy
131
what is a contraindication for the COCP?
migraine w/ aura
132
where do ectopic pregnancies usually occur?
in the ampulla
133
an ectopic pregnancy in which site is most likely to rupture?
the isthmus (narrower)
134
what is the best way to check a females ovulatory status?
day 21 progesterone level
135
where is the most common site for referred pain from the ovaries and why?
the periumbilical region because the sympathetic nerve supply to the ovary originates at T10 (which is the level of the umbilicus)
136
what is the treatment for bacterial vaginosis?
metronidiazole 400mg twice a day for a week
137
how does BV present?
painless thin grey ish watery discharge w/ a fishy odour
138
when does PMS occur?
in the late luteal phase
139
what is complete androgen insensitivity syndrome (AIS)?
where the cells cannot respond to androgens at all
140
how does complete androgen insensitivity syndrome present?
secondary sex characteristics and external genitalia of a woman but do not have a uterus and have undescended testes in the abdo
141
what is partial androgen insensitivity syndrome (AIS)?
where the cells can partially respond to androgens
142
how does partial androgen insensitivity syndrome present?
phenotype can vary (due to partial response to androgens)
can present w/ normal female / male sex characteristics or the presence of both
143
what is mild androgen insensitivity syndrome (AIS)?
where the cells respond to androgens to some extent
144
how does mild androgen insensitivity syndrome present?
born w/ male sex characteristics but are infertile
145
what is the karyotype in androgen insensitivity syndrome?
46 XY
146
what is the most common cause of a clear, non itchy vaginal discharge?
ectropion
147
HRT increases the risk of which cancer?
breast
148
what are the classic features of turners syndrome?
short stature webbed neck
149
what is the karyotype for turners syndrome?
45 XO
150
what is the hormonal profile in turners syndrome?
hypergonadotrophic hypogonadism
low oestradiol despite high FSH and LH
151
what is syphilis caused by?
treponema pallidum
152
how does primary syphilis present?
as a painless genital ulcer known as a chancre
153
when do symptoms of secondary syphilis present?
2-8wks after the primary chancre
154
what are the symptoms of secondary syphilis?
maculopaupular rash on the hands and soles, generalised lymphadenopathy, flu like symptoms and condylomata (white infectious wart like thing)
155
slit like appearance of the nipple indicates what?
duct ectasia
156
what is the nipple discharge seen in duct ectasaia?
green brown discharge
157
what is the appropriate management of a symptomatic woman who had a failed medical management of miscarriage?
surgical evacuation of products of conception
158
what is the first line treatment for infertility in women w/ PCOS who wish to conceive?
clomifene citrate
159
how does clomifene citrate improve fertility in women w/ PCOS?
it binds to oestrogen receptors, preventing oestrogen from binding and so the -ve feedback of oestrogen on FSH and LH is lifted, allowing the conc of FSH and LH to increase and hence ovulation is triggered
160
what is the second line treatment for infertility in women w/ PCOS who wish to conceive and clomifene citrate didnt work?
clomifene citrate and metformin
161
ovid mobile parasites on wet saline mount indicates what?
trichomoniasis
162
clue cells on wet saline mount indicates what?
BV
163
what is a mammary duct fistula?
an epithelial lined connection between the periareolar skin and the underlying duct
164
how can you differentiate pagets from eczema?
pagets affects the nipple first rather than the areola and pagets is unilateral
165
what is aortocaval compression?
supine hypotensive syndrome
hypotension in the supine position (lying down) that occurs in pregnant women >20 wks gestation
166
when does amniotic fluid embolism occur?
during labour and / or up to 48 hrs after
167
what is an amniotic fluid embolism?
when amniotic fluid and / or foetal cells enter the maternal circulation and cause cardiopulmonary arrest
168
why does oesophageal atresia cause polyhydramnios?
because oesophageal atresia is a swallowing abnormality in the foetus and this impairs the circulation of the amniotic fluid causing polyhydramnios
169
why is menopause assoc w/ an increase in FSH?
because in menopause there is a decrease in oestrogen and so this switches off the -ve feedback loop on FSH and so there is an increase in FSH
170
what is the most accurate blood test to confirm menopause?
FSH (increased)
171
women w/ gestational diabetes should give birth no later than when?
40 + 6 wks
172
what is the ultrasonographic criteria for PCOS?
ovarian vol > 10ml
OR
at least 12 follicles in one ovary measuring 2-9mm in diameter
173
what are the recommendations regarding breast feeding?
exclusive breast feeding for 6 months then a combo of foods and breast feeding until 2 years or beyond
174
what is the only clinical diagnostic feature of adenomyosis?
enlarged uterus
175
what is adenomyosis?
endometriosis of the musculature
176
how is adenomyosis diagnosed?
based on cyclical pain w/ menses and enlarged uterus
177
what is the anticholinergic used in the management of urge incontinence?
oxybutinin
178
what is turtling of the babys head a sign of?
shoulder dystocia
179
what is the likely diagnosis of a woman who collapsed suddenly after the delivery of the placenta and the outline of the uterine fundus cannot be palpated?
uterine inversion
180
list 4 high risk factors for developing pre eclampsia?
previous pre eclampsia
type 1 or 2 diabetes
essential hypertension
CKD
181
list 5 moderate risk factors for developing pre eclampsia?
```
BMI > 35 at booking
FHx of pre eclampsia
maternal age > 40
first pregnancy
multiple pregnancy
```
182
what is the most common cause of DIC in pregnancy?
placental abruption
183
where is the main lymphatic drainage of the ovary?
para aortic lymph nodes
184
what is the AB used in asymptomatic bacterurima in the first and second trimesters of pregnancy?
nitrofurantoin
185
what is the AB used in asymptomatic bacterumia in the third trimester of pregnancy?
trimethoprim
186
what is the first line treatment in pts w/ menorrhagia and dysmenorrhoea who do not want the mirena coil?
mefenamic acid (NSAID)
187
what is a contraindication for the use of mefenamic acid in the management of menorrhagia and why?
IDB because NSAIDs increase GI bleeding
188
what is used in the treatment of pts w/ menorrhagia and dysmenorrhoea who do not want the mirena coil and who have IBD?
tranexamic acid (antifibrinolytic)
189
what is sheehans syndrome?
hypopituitarism secondary to pituitary infarction due to haemorrhagic shock in labour and post partum
190
explain the sites of blood formation in the developing foetus
blood products are first produced by the yolk sac
by 8 wks the yolk sac is replaced by the liver as the main site
by 20 wks (4 months) the bone marrow is the main site
191
what is the physiological explanation for dyspnoea in pregnancy?
there is an increased tidal vol resulting in increased minute ventilation and the increased resp workload results in the feeling of breathlessness
192
what is laparoscopy and dye and when is it done?
method if investigating tubal patency in women w/ known co morbidities such as endometriosis w/ normal blood tests etc
193
what is the first line and most effective management of women struggling to breast feed?
organising a one to one visit from the health visitor
194
what is the first line treatment for chlamydia?
doxycycline 100mg twice daily for 7 days
195
what is the treatment for chlamydia if doxycycline is contraindicated or not tolerated?
azithromycin 1g orally as a single dose and then 500mg orally for 2 days
196
what is the first line management of gonorrhoea?
ceftriaxone 1g IM
197
how is chalmydia diagnosed?
NAAT test
198
what is the treatment for BV?
oral metronidazole 400mg twice a day for 5 to 7 days
199
what is the treatment for BV in a woman who wont comply to treatment for a wk?
a single dose of metronidazole 2g
200
what is the treatment for trichomoniasis?
oral metronidazole 400mg twice a day for 5 to 7 days
201
what is the treatment for pelvic inflammatory disease?
ceftriaxone 1g as a single IM dose followed by oral doxycycline 100mg twice daily and oral metronidazole 400mg twice daily for 14 days
202
how is the diagnosis of HIV confirmed?
HIV PCR and p24 antigen tests
203
how is HIV managed?
start highly active anti retroviral therapy (HAART) as soon as diagnosis is made regardless of CD4 count
204
what are the rules regarding HIV and pregnancy delivery?
vaginal delivery possible if viral load undetectable at 36wks
C section necessary if viral load detectable
205
what is the PEP given to neonates whos mother has HIV?
if viral load is detectable - triple therapy
| if viral load is undetectable - mono-therapy
206
what is the broad ligament?
a double layer of peritoneum
207
what is the function of the broad ligament?
to help keep the uterus in its correct midline position
208
what is the round ligament?
an embryological remnant
209
what is the most common position of the uterus?
anteverted and anteflexed
210
how can the position of the uterus be determined?
by palpation on bimanual examination
211
what is the perineal body and why is it important?
bundle of collagen and elastic tissue into which the perineal muscles attach
important for pelvic floor strength
212
what is the function of bartholins glands?
secrete lubricating fluid
213
the internal mammary artery (main blood supply to breast) is a branch of which artery?
subclavian
214
what is a common position of the uterus (not anteverted anteflexed)?
retroverted retroflexed
215
which blood results are caused by teratomas?
raised hCG and aFP
216
what are the protective factors for ovarian cancer?
factors that stop ovulation or reduce the number of lifetime ovulations
pregnancy
COCP
breast feeding
217
women under 40 who are suspected to have ovarian cancer are likely to have what type of ovarian cancer?
germ cell tumours (teratoma)
218
why does tamoxifen increase the risk of breast cancer?
because even though it has an anti oestrogenic effect on breast tissue it has an oestrogenic effect on endometrial tissue and therefore increases the risk of endometrial cancer
219
what are the 2 most common cervical cancers?
1. squamous cell carcinoma
| 2. adenocarcinoma
220
what is the age bracket for cervical screening every 3 years?
25-49
221
what is the age bracket for cervical screening every 5 years?
50-64
222
what are the types of breech presentation?
complete breech
incomplete breech
frank breech aka extended breech
footling breech
223
how does complete breech present?
sitting cross legged
224
how does incomplete breech present?
sitting w/ one leg crossed and one leg up
225
how does frank breech present?
both legs up
226
how does footling breech present?
w/ one foot presenting though the cervix w/ foot extended
227
which structures on the foetal skull outline the vertex?
anterior and posterior fontanelles and the parietal eminences
228
what is the legal limit for a social termination of pregnancy?
23 wks + 6 days
229
what is the first line investigation for chlamydia in an asymptomatic female?
first void NAAT
230
COCP is protective against which cancer?
ovarian and endometrial
231
lymph from the gonads drain to which group of lymph nodes?
lumbar
232
when starting the progesterone only pill how many days of additional protection are needed?
if commended up to and including day 5 of the cycle it will provide immediate protection
if commenced after day 5 of the cycle additional methods of contraception should be used for 2 days
233
what is the management of placental abruption when the foetus us alive, <36 weeks old and not showing any signs of foetal distress?
admit and administer steroids
234
after using levonelle for emergency contraception when can hormonal contraception be started?
immediately
235
what is the safest form of contraception in personal / family history of breast cancer or confirmed BRAC1?
copper coil
236
what is the most appropriate management of a pt presenting with symptoms highly suggestive of thrush (white lumpy discharge with no smell and no other symptoms)?
first line treatment fluconazole 150mg oral capsule as a single dose
high vaginal swab not needed for diagnosis
237
what is the risk of using SSRIs during pregnancy?
there is a small risk of congenital heart defects
238
what is the bacterium that causes group B streptococcus disease?
streptococcus galacticae
239
what happens to blood pressure during pregnancy?
falls in the first half of pregnancy
240
what is the primary mode of action of the copper coil?
decreases sperm motility and survival
241
what is the primary mode of action of the combined pill?
inhibits ovulation
242
what is the primary mode of action of the progesterone only pill?
thickens cervical mucus
243
what is the mode of action of levonorgestrel (levonelle)?
suppresses ovulation
244
what is the prophylaxis given for group B strep?
benzylpenicillin
245
what is a myomectomy?
a surgical procedure to remove uterine fibroids
246
what is the criteria for a diagnosis of gestation diabetes?
fasting glucose >5.6mmol/l
OR
2 hour glucose level of 7.8mmol/l
remember 5678
247
what is the first line for infertility in PCOS?
clomifine
248
what are the 3 causes of increased nuchal translucency?
downs syndrome
congenital heart defects
abdominal wall defects
249
what is the first stage of labour defined as?
from the onset of true labour to full dilation of the cervix
| 10cm = fully dilated
250
what are the rules for methotrexate before conception in men and women?
stop methotrexate at least 6 months before conception in both men and women
251
when is anti D given to rhesus -ve pregnant women?
first dose at 28 weeks
second dose at 34 weeks
any sensitising events
252
what is the management of gestational diabetes if the fasting plasma glucose is <7mmol/l?
trial of diet and exercise for 1-2 weeks
253
what is the management of gestational diabetes if the fasting plasma glucose is >7mmol/l?
commence insulin
254
what is the treatment for mastitis?
flucloxacillin for 10-14 days and continue breast feeding
255
which 2 cancers is the COCP protective against?
ovarian and endometrial
256
which 2 cancers does COCP increase the risk of?
cervical and breast
257
what does a snowstorm appearance on USS indicate?
a complete mole
258
what is a complete molar pregnancy?
duplication of haploid sperm fertilising an empty ovum resulting in 46XX but no foetal tissue
259
after evacuation of a molar pregnancy what does it indicate if the HCG levels are not falling?
persistent trophoblastic disease
260
what is the most severe form of persistent trophoblastic disease?
choriocarcinoma
261
when is the progesterone only injection contraindicated and why?
women over the age of 50 because of the effect on bone mineral density
262
is it safe to breast feed with hep B?
yes because hep B cannot be transmitted via breast feeding (unlike HIV)
263
what is post party thyroiditis?
post partum thyroiditis = an autoimmune condition which presents as the body transitions from the immunosuppressed state of pregnancy back to normal immunity
264
how is post party thyroiditis treated?
beat blockers
265
what should be done if a woman w/ known placenta praaevia goes into labour (w/ or w/out bleeding)?
emergency c section (category 1 c section)
266
how is post party thyroiditis diagnosed?
based on clinical manifestations and thyroid function tests alone
267
what is the management of post partum haemorrhage caused by uterine atony?
syntocinon followed by ergometrine
268
what is the best way to assess ovulation?
day 21 progesterone
269
which HPV strains are most commonly responsible for cervical cancer?
HPV 16 and 18
270
how often are women aged 25 - 49 offered cervical screening?
every 3 years
271
how often are women aged 50-64 offered cervical screening?
every 5 years
272
what is the management ion cervical cancer ?
hysterectomy or radical chemoradiation
273
when can you restart hormonal contraception after taking ulipristal acetate?
5 days
274
how long is contraception needed after menopause?
<50 = 24 months after last period
>50 = 12 months after last period
275
what should be suspected in pts w/ continuous urianry dribbling after a prolonged labour?
vesicovaginal fistula
276
after giving birth when is contraception needed post partum?
21 days
277
what is the first step in possible endometrial cancer?
transvaginal ultrasound
278
what is the definition of pregnancy induced hypertension?
the onset of hypertension after 20 wks gestation in a women who was previously normotenisve
BP > 140/90 AND proteinurea OR other organ involvement
279
what is the first line for hypertension in pregnancy?
labetolol
nifedipine if asthmatic
280
when should magnesium be stopped when used for the treatment of eclampsia?
24 hrs after delivery or the last seizure
281
what is the classic triad of vasa praevia?
rupture of membranes
painless vaginal bleeding
foetal bradycardia
282
what are the guidelines for prescribing anti D to women having an abortion?
prescribe anti D for women having any abortion after 10 wks
do not prescribe anti D for women having a medical abortion before 10 wks
consider anti D for women having a surgical abortion before 10 wks
283
what is the medication of choice for suppressing lactation when breast feeding is being ceased?
cabergoline
284
what does a boggy uterus indicate?
adenomyosis
285
what is adenomyosis?
the presence of endometrial tissue w/ in the myometrium
286
which pt demographic is adenomyosis most common in?
multiparous women at the end of their reproductive years
287
what is the first line investigation for adenomyosis?
transvaginal ultrasound
288
what is mittelschmerz?
benign preovulatory lower abdo pain that occurs mid cycle
289
what is ashermans syndrome?
intrauterine adhesions
290
is aspirin safe in breast feeding?
no
291
what are the three features of Meigs syndrome?
a benign ovarian tumour
ascites
pleural effusion
292
what is the likely diagnosis of a woman > 30y/o w/ dysmenorrhoea, menorrhagia and an enlarged and boggy uterus?
adenomyosis
293
what is the mode of action of the COCP?
inhabits ovulation
294
what is the mode of action of the implantable contraceptive?
inhibits ovulation
295
what is the mode of action of the copper IUD?
decreases sperm motility and survival
296
how are vesicovaginal fstulae diagnosed?
urinary dye studies
297
what is the impact of smoking on hyperemesis gravidarium?
smoking decreases the risk
298
what is the first line investigation for per term pre labour rupture of membranes?
speculum exam to look for pooling of amniotic fluid in the posterior vaginal vault
299
what is the diagnosis when US shows crown rump length >7mm and there is no foetal heartbeat?
diagnostic of miscarriage
300
what is the first stage of labour?
from the onset of true labour until the cervix its fully dilated (10cm)
301
what is the second stage of labour?
from full dilation to delivery of the foetus
302
what is the third stage of labour?
from delivery of the foetus to complete delivery of the placenta and membranes
303
what is lochia?
the passage of blood and mucus etc post partum
304
how long is lochia normal for?
4-6 wks post partum
US needed if persists for longer than 6wks
305
how often should women who have had CIN be offered cervical screening?
every 6 months
306
what is the diagnostic triad for hyperemesis gravidarum?
5% pre pregnancy weight loss
dehydration
electrolyte imbalance
307
what is the management of syphilis?
single IM benzathine benzylpenicillin
308
at which point should fibroadenomas be removed?
>3cm
309
