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year 3. > Repro Ixs > Flashcards

Repro Ixs Flashcards

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1
Q

Miscarriage ixs

A

Fbc, blood group and rhesus status, serum hcg,

definitive diagnosis- transvaginal ultrasound

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2
Q

Gold standard ix for ectopic pregnancy

A

Trans vaginal ultrasound scan

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3
Q

Molar pregnancy ix and appearance

A

Uss diagnoses it- snowstorm appearance +/- fetus, theca lutein cysts

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4
Q

Infertility ixs woman

A

serum progesterone 7 days prior to expected next period. (28 day cycle= day 21): establish ovulation
Tsh
Rubella immunity
Chlamydia screeb
Ensure cervical smear test is up to date

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5
Q

Male infertility ix

A

Semen analysis
if abnormal repeat in 3 months

min. of 3 days and max of 5 days abstinence required for test

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6
Q

tests to check tubal patentcy
(first line and diagnostic)

A

Hsg (x-ray procedure to look at uterus and fallopian tubes)

Diagnostic: laproscopy and hyrdrotubation
^ indications: signific pelvic pain etc

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7
Q

When is hysteroscopy done

A

In cases where suspected endometrial pathology, ie: uterine septum, adhesions, polyp

(camera inserted in vagina and through cervix to view inside uters)

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8
Q

Pcos diagnostic criteria

A

the Rotterdam criteria state that a diagnosis of PCOS can be made if 2 of the following 3 are present:

  • infrequent or no ovulation (usually manifested as infrequent or no menstruation)
  • clinical and/or biochemical signs of hyperandrogenism (such as hirsutism, acne, or elevated levels of total or free testosterone)
  • polycystic ovaries on ultrasound scan (defined as the presence of ≥ 12 follicles (measuring 2-9 mm in diameter) in one or both ovaries and/or increased ovarian volume > 10 cm³)
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9
Q

ART eligibility

(8)

A

Stable relationship 2yrs
Female age <40 (<42)
Female bmi 18.5-30
Non smokers
No biological child
No illegal/abusive substances (inc methadone)
Neither partner can have been previously sterilised
Duration unexplained fertility for 2 yrs

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10
Q

Primary genital hsv ix

A

Swab lesion for hsv-1 and 2 pcr
Recommend full sti screen (chlamydia, gonnorhoea, syphillis, HIV)

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11
Q

Syphillis

A

non treponemal test + treponemal specific test

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12
Q

fibroids Ix

A

tv ultrasound

rarely MRI

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13
Q

premenopausal ovarian cysts Ix (1st line and other ixs)

A

1st: ultrasound scan

MRI, tumour markers CA125 and AFP (embryonal carcinoma),HCG (choriocarcinoma), LDH (dysgerminoma)

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14
Q

post menopausal masses Ix

A

CT and CA125

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15
Q

Gold standard ix for endometriosis

A

Laparoscopy

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16
Q

gestational diabetes Ixs
givecut off range for diagnosis

A

1st line: oral glucose tolerance test

fasting glucose: >=5.6
2 hour glucose: >= 7.8mmol

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17
Q

testing for chlamydia type II

A

NAAT

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18
Q

> = 55 presenting with post-menopausal bleeding
^what is this a red flag for and what should the management be

A

endometrial cancer
refer using cancer pathway :

  • transvaginal ultrasound scan and consideration of hysteroscopy with endometrial biopsy
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19
Q

when does ectopic pregnancy qualify for surgical management

A

> 35mm
if it is ruptured
pain
visible heartbeat
HCG>5000

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20
Q

Hypertension definition in pregnant women

A

> =140/90 on 2 occasions 4 hrs apart

> = 160 systolic once
=140 diastolic once

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21
Q

Proteinuria definition

A

UPCR>30mmol
(Urine protein creatinine ratio)

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22
Q

when should women with risk factors for gestational diabetes be offered screening test

A

oral-glucose tolerance test should be offered at 24-28 weeks

if woman has previously had gestational diabetes then offer it straight away and at 24-28 weeks

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23
Q

what score is used to determine if labour can commence

A

bishops score
<5 = labour is unlikely to start without induction
>/=8 indicates cervix is ripe

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24
Q

placenta praevia investigations

A

confirm by: TV ultrasound
MRI to exclude placenta accreta

do NOT do digital examination

check anomaly scan

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25
vasa praevia diagnostic test
ultrasound TA and TV with doppler
26
test to aid diagnosis of epidural abscess
MRI
27
rubella investigations
IgG specific to rubella and IgM within 10 days of exposure
28
when is amniocentesis offered
between weeks 15-20
29
test for persistent pulmonary hypertension of the newborn
measure pre and post ductal O2 sats= 10-20% difference (pre duct is right arm and head and neck)
30
hyperemesis gravidarum diagnostic criteria
5% pre-pregnancy weight loss dehydration electrolyte imbalance
31
pre-eclampsia diagnostic criteria
blood pressure of systolic 140 or diastolic 90 (or greater) and 1 or more of: proteinuria, organ dysfunction
32
when does pre-eclampsia occur
>20 weeks
33
down syndrome antenatal testing (SCREENING tests): when can test(s) be done which test is more accurate
combined test result: 11-13+6 weeks quadruple test: 15-20 weeks combined test more accurate
34
diagnostic test for downs
chorionic villus sampling or amniocentesis however women will be offered a second screening test called NIPT which is non invasive and has a very high sensitivity and specificity
35
what are the positive test results for downs syndrome (combined test)
high HCG, low PAPP-A, thickened nucheal translucency all low except Hcg, H for High
36
what are the positive test results from quadruple test for downs syndrome
high hcg, high inhibin A, low AFP, low oestriol
37
screening tool for postnatal depression
the edinburgh scale
38
scoring system if induction of labour is required
bishop score
39
cervical cancer screening- if the results are positive
positive hrHPV- refer to cytology. if cytology abnormal> colposcopy if cytology normal then the test is repeated at 12 monthss. if hrHPV -ve 12 months later> return to normal recall. if the repeat test is still hrHPV +ve and cytology still normal → further repeat test 12 months later: If hrHPV -ve at 24 months → return to normal recall if hrHPV +ve at 24 months → colposcopy
40
cervical cancer screening- what to do is results are inadquate
if inadequate- refer for another test in 3 months if inadequate again refer for colposcopy
41
how often is cervical screening offered in scotland
25-64 yrs every 5 years
42
preterm labour rupture of the membranes ix
1st line: sterile speculum examination (to look for pooling of the amniotic fluid in the posterior vaginal vault) & avoid digital examination -if pooling of fluid is not observed NICE recommend testing the fluid for placental alpha microglobulin-1 protein (PAMG-1) (e.g. AmniSure®) or insulin-like growth factor binding protein‑1 ultrasound may also be useful to show oligohydramnios
43
what can transvaginal ultrasound determine regarding pregnancy
whether pregnancy is intrauterine or ectopic, if there is a foetal heartbeat & the presence of any other abnormalities, such as a subchorionic haematoma
44
stereotypical PCOS results
raised LH:FSH ratio testosterone may be normal or mildly elevated SHBG is normal to low
45
diagnostic threshold for gestational diabetes
fasting glucose>= 5.6mmol/L 2 hour glucose is >= 7.8mmol/L
46
reduced fetal movements investigations for woman <24 weeks pregnant
handheld doppler if movements previously felt, otherwise refer to maternity
47
reduced feotal movements 24-28 weeks ix
handheld doppler
48
reduced foetal movements >28 weeks ix
1st handheld doppler, if no foetal heartbeat> immediate ultrasound if foetal heartbeat present- CTG
49
when is the anomaly scan performed and what is it for
18-20+6 weeks Anomaly scan evaluates anatomical structures of the foetus, placenta, and maternal pelvic organs. This allows for careful planning of the pregnancy as well delivery
50
what is baseline bradycardia feotus
hr <100bpm
51
baseline tachycardia foetus
hr> 160/min
52
what does early deceleration mean /indicate
early: deceleration of HR which commences w/ onset of a contraction and returns to normal on completion of contraction usually normal, can indicate head compression
53
Late deceleration (ctg) meaning/indication
pathological! Deceleration of the heart rate which lags the onset of a contraction and does not returns to normal until after 30 seconds following the end of the contraction Indicates fetal distress e.g. asphyxia or placental insufficiency
54
Variable decelerations: meaning/indications
Independent of contractions may indicate cord compression
55
reassuring CTG: baseline heart rate variability decelerations
Baseline heart rate: 110 to 160 bpm Baseline variability: 5 to 25 bpm Decelerations: None or early Variable decelerations with no concerning characteristics for less than 90 minutes
56
late deceleration foetus- ix
late decerelation- do foetal sampling. should be ph>7.2 if fetal acidosis consider urgent delivery
57
normal endometrial thickness
<4mm
58
how is low molecular weight heparin monitored in DVT (which blood test)
anti-xa activity
59
what is assessed in bishops score
cervical position cervical consistentcy cervical effacement cervical dilation fetal station
60
what should fundal height be
match gestational age from 20 weeks onward- within 1 or 2cm
61
what are the cut offs for recieving iron therapy in pregnancy
first trimester <110 2nd trimester <105 pospartum <100
62
how is menapause diagnosed
< 50 years of age AND amenorrhoeic for at least 2 years. > 50 years of age AND amenorrhoeic for at least 1 year.
63
chorioamniocentesis tx
IV antibiotics and immediate cesarean
64
premature ovarian insufficiency tx
hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of 51 years (for symptoms and to protect bones)
65
what should symphisis fundal height be after 16 weeks
same as gestational age +/- 2
66
when is a pregnancy test carried out after TOP
3 weeks after.
67
Most sensitive test for gonnorhoea
NAAT- requires urine or a swab to obtain the genetic materials
68
HIV Investigations
p24 antigen 1st line as it can detect HIV 1 -4 weeks after infection whereas HIV antibody test can take up to 3 months. HIV p24 antigen and HIV antibody tet are now standard for diagnosis and screening- reapeat test for confirmation
69
cervical cancer staging and how is it staged
FIGO staging Ia, Ib, II, III, IV Ia- microscopic, confined to cervix II- invades uterus/upper 2/3rds of vagina IV- extension of tumour beyond the pelvis or involvement of bladder or rectum
70
ovarian cancer ix
first CA125, if raised > abdo + pelvic us, if pos > urgently refer diagnosis usually involves laparotomy.
71
ovarian cancer staging
Stage 1 Tumour confined to ovary Stage 2 Tumour outside ovary but within pelvis Stage 3 Tumour outside pelvic but within abdomen Stage 4 Distant metastasis
72
endometritis ix
high vaginal swab, transvaginal ultrasound endometrial biopsy diagnostic but rarely used.
73
secondary post parum haemorrage ix
high vaginal swab for infection and tv us to look for retained products of pregnancy
74
abx tx for secondary pph and if penicillin allergic
- - Antibiotics - co-amoxiclav (co-trimoxazole + metronidazole if penicillin allergic)
75
when can chorionic villus sampling be carried out
11-14 weeks
76
when can amniocentesis be carried out
15-20

year 3. (33 decks)

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