Repro Misc Flashcards by Joe McAuley

What level does ART in HIV aim to keep CD4+ count at?

> 350

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WHO advice on the duration of breastfeeding and transition off of it?

Exclusively breastfeed for 6 months

Then a combination of foods and breastfeeding up until 2 years of age

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Post partum haemorrhage after placental delivery, exam reveals a hard, contracted uterus?

Likely perineal trauma

Hard contracted uterus normal - rules out atonic uterus

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Woman suddenly collapses after delivering placenta and is in a state of shock, fundus is difficult to elicit on abdo exam?

Uterine inversion

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Woman collapses suddenly before she was due to be discharged 5 days after delivery by c-section?

PE likely - always suspect in unexplained collapse after surgery or in peurperium

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Woman has constant abdo pain then collapses whilst in labour. Foetal bradycardia on CTG. This is 2nd pregnancy, previous child delivered by C-section?

Uterine rupture

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How is induction of labour performed?

If Bishops <6 - vaginal PGE2 then reassess 6hr later

Then if Bishops still <7 another vaginal PGE2 and reassess 6hr later

If this fails then artificial ROM and syntocinon

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When is artificial ROM most commonly performed?

When a woman is in active labour but her waters have not broken

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When is a membrane sweep performed?

To try and kick-start active labour at 40 and 41 weeks in nulliparous, and 41 weeks if multiparous

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3 enzymes that HIV contains?

Reverse transcriptase
Protease
Integrase

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How does HIV establish persistence?

By constantly mutating through a process called antigenic variation

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What happens once HIV infects a cell?

It is a retrovirus, therefore, carries 2 copies of RNA. Once a cell is infected, the RNA is transcribed into DNA and is integrated into the host cell genome

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Diagnosis of gestational diabetes?

Fasting glucose 5.6 or more; OR

2-hour OGTT 7.8 or more

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Management of gestational diabetes?

If fasting glucose <7 then lifestyle advice and reassess in 2 weeks. If still 5.6-7 then metformin

If fasting glucose >7 at diagnosis then start insulin immediately

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What clinical finding is typical of pneumocystis jirovicii?

Exercise desaturation

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What is a progesterone challenge test?

Give medroxyprogesterone acetate for 5 days and it should stimulate a withdrawal bleed

Proves normal functioning endometrium and intact outflow tract

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17 y/o girl with developed secondary sex characteristics has primary amenorrhoea. All endocrine tests are normal, but she fails a progesterone challenge test?

Absent uterus

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Woman due for elective ankle surgery in 4 weeks on COCP where she will be immobilised for a minimum of 10 days after?

Stop the pill 4 weeks before surgery and restart 2 weeks after - switching to POP would be a suitable alternative

UKMEC 4 - major surgery with prolonged immobilisation - does not apply to minor surgical procedures or laparoscopic procedures

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First line investigations for a couple presenting with infertility for 1 year?

Female - day 21 progesterone

Male - semen analysis

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Is previous ectopic pregnancy a contraindication for contraception?

No, copper coil only increases the risk of it occurring

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A couple are infertile for 1 year and testing reveals the woman has endometriosis. What is the management?

Continue trying to conceive naturally for another year.

The guidance for patients with mild male factor infertility, mild endometriosis or unexplained infertility –> try conceiving naturally for 2 years before offering IVF/ICSI

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What 5 female factors for infertility warrant early referral to infertility clinic (i.e. before 1 year)?

>35y/o
Amenorrhoea
Previous pelvic surgery
Previous STI
Abnormal genital exam

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What 5 male factors for infertility warrant early referral to infertility clinic (i.e. before 12 months)?

Previous surgery on genitalia
Previous STI
Varicocele
Significant systemic illness
Abnormal genital exam

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Is emergency contraception affected by BMI?

If BMI>26, a double dose of Levonelle is required

EllaOne and Cu IUD are fine

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Which contraceptive is associated with weight gain?

Depo-Provera (2-3kg in the first year)

Which cancer would have the greatest PERCENTAGE reduction if it was possible to remove the effect of obesity?

Oesophagus

Is there increased contractility of the heart during pregnancy?

Yes - to allow greater CO

Is uterine fibroids a cause of large for dates pregnancy?

Yes

What does the vas deferens develop from embryologically?

Mesonephric duct

What does the fornix of the vagina develop from embryologically?

Paramesonephric duct

Is IVF a cause of IUGR?

Yes

Is maternal anaemia a cause of IUGR?

Is maternal BMI <18 a cause of IUGR?

Yes

When can nuchal thickness be tested in screening for Down Syndrome?

11-14 weeks

When is the uterine fundus normally palpable in a singleton pregnancy?

12 weeks

A woman in labour suite requires forceps delivery. 4 options for analgesia?

Epidural Spinal anaesthesia Pudendal nerve block Perinial block

When can the sex of the foetus be determined by USS?

18 weeks

How is pain from female repro tract carried to CNS?

Bladder, uterus, ovary, adnexae (endocervix?) - all the bits touching the peritoneum basically --> T11-L2 via visceral afferents Below this but above levator ani --> S2-S4 via parasympathetic fibres (referred to back of legs/buttocks) Below levator ani --> S2-S4 via somatic sensory (localised pain in perineum)

83 y/o lady is having falls. She takes Oxybutynin for urge incontinence. What can this be replaced by?

Mirabegron (beta3 agonist therefore no anticholinergic SE)

For women experiencing hot flushes in menopause, apart from HRT what can be offered?

Fluoxetine - can be used for vasomotor symptoms of menopause | citalopram and venlafaxine also licensed for this

How are medical deliveries of miscarriages carried out?

Vaginal misoprostol alone | no need for PO mifepristone

At booking appointment woman reveals Hx of 2 previous DVT's, management?

LMWH starting immediately, until 6 weeks post-partum

Is aminophylline CI during breast feeding?

Is amiodarone CI during breastfeeding?

Yes

Most common cause of infection in a newborn <7 days old?

group B strep

Most common cause of haemorrhage in a newborn?

Prolonged ventouse delivery

Can mothers with HepB breastfeed?

Yes

Difference in presentation between acute fatty liver of pregnancy and cholestasis of pregnancy?

Cholestasis - pruritis, nausea, lethargy, jaundice, obstructive pattern LFT's AFLP - non-specific e.g. malaise fatigue, nausea

Which infections are screened for at booking appt?

HIV HepB Rubella Syphilis

What placental abnormality is higher with assisted conception?

Placenta praevia

Management of suspected PE in pregnancy?

Confirm DVT by doppler USS, if present give LMWH before CTPA/VQ-scan

What can be given to suppress lactation if wishing to cease breastfeeding?

Cabergoline (dopamine agonist)

If a 52y/o woman who still has a uterus opts for oestrogen-only HRT, what else can be given?

Mirena IUS for 4 years

What is a normal symphyseal fundal height?

Within +2/-2 of the gestational age

Woman presents at 9 weeks gestation with vaginal bleeding. US confirms viable intrauterine pregnancy, however high vaginal swab isolates Group B strep, management?

Intrapartum IV Benzylpenicillin (or Clindamycin) It is likely group B strep is her natural flora so treating with Erythromycin will not reduce the chance of colonisation at birth.

Where do ectopic pregnancies most commonly occur? | Where are they most likely to cause rupture?

Most commonly in Ampulla | Rupture in Isthmus

A pregnant woman has an episode of urinary incontinence. 3 weeks later, at 37 weeks gestation, she appears with fever, tachycardia and feeling generally unwell. Foetal tachycardia also present. Likely cause?

Chorioamnionitis Likely that 'incontinence' was rupture of membranes

What triad of signs should make you consider chorioamnionitis?

Maternal fever Maternal tachycardia Foetal tachycardia Hx of premature ROM

Woman presents with menorrhagia. What are the full management steps starting with investigations?

Start with FBC. If structural/histological abnormality suggested, refer for TVUS If no contraception required, prescribe Tranexamic acid or Mefanamic acid (if there's pain) If contraception required, offer Mirena 1st line, or COCP/POP 2nd line

33 y/o woman presents with sudden onset LIF pain that has been getting worse for 5 hours. It started just after sexual intercourse. Lower abdo tender on exam, no guarding, bimanual exam unremarkable. USS shows free fluid in pelvic cavity. Urine hCG test negative?

Ruptured ovarian cyst

How to differentiate ovarian torsion from ruptured ovarian cyst?

Cyst: Sudden onset unilateral pain Preceded by intercourse/strenuous activity Abdo exam tender but no guarding/peritonism Bimanual exam may be uncomfortable but generally unremarkable ``` Torsion: Quick onset unilateral pain Assoc w nausea and vomiting May be guarding on exam Bimanual exam - tender adnexal mass USS shoes enlarged, oedematous ovary with impaired blood flow ```

How to differentiate fibroids and adenomyosis by bimanual exam?

Both have Hx of abdo pain and menorrhagia: Fibroids - uterus feels bulky Adenomyosis - uterus feels boggy

Man and woman both taking methotrexate for rheumatological problems, wish to get pregnant. What is the management?

BOTH man + woman must stop methotrexate for 3 months before trying to conceive

Couple having fertility problems, semen analysis normal, TVUS of woman reveals 3 submucosal fibroids - management?

Myomectomy

What is 2nd line to Labetalol for pregnancy-induced hypertension/pre-eclampsia if asthmatic?

Nifedipine

How can USS be used to predict risk of pre-eclampsia?

At 20 weeks, USS may show bilateral maternal uterine artery doppler waveform abnormalities - high risk of developing pre-eclampsia

Woman is 6 days post-natal with uncomplicated pregnancy and no PMHx. She isn't sleeping and yesterday seemed confused. Today she is full of ideas about activities for the coming day. She is very confident about caring for her baby and reports being extremely happy. Diagnosis?

Puerperal psychosis

Which of the following is NOT part of foetal alcohol syndrome spectrum: - Dysplastic kidneys - Ventricular septal defect - Micrognathia and smooth philtrum - Anencephaly - Microcephaly

Anencephaly

Where does fluid in the foetal lung come from?

It is mostly produced in the foetal lungs

What % oxygen should be used initially in newborn resuscitation? Ratio of compressions:breaths?

21-30% 3:1

For a preterm infant, what should be taken into account when measuring growth& development? For how long?

Corrected gestational age Until 12 months

What normal finding can some newborns have on their trunk?

Dry, cracked skin

Is short time between pregnancies a risk factor for developing pelvic girdle pain in pregnancy?

What is first line management for pre-menstrual syndrome? | If this doesn't work what medication can be offered?

Lifestyle - diet, exercise, sleep hygiene, reduce stress Meds - if not planning pregnancy COCP, if planning pregnancy SSRI Complementary therapy may work e.g. Vit B6 (pyroxidine supplements) may work

Woman presents 20 weeks gestation in her 2nd pregnancy with lower backache, fever and vaginal loss of a cloudy white, viscous substance. Temp 38.2C, HR 98, suprapubic tenderness on palpation. Os slightly open with fluid draining. Diagnosis?

Chorioamnionitis

Which hormonal medication is assoc w development of endometrial hyperplasia?

Tamoxifen

What cells secrete hCG? | How long after fertilisation can it be detected in maternal bloodstream?

Syncytiotrophoblasts 8 days

Which screening tool can be used to screen for post-natal depression?

Edinburgh Scale

Investigation for placenta praevia?

TVUS

A 42 y/o woman has been in stage 3 labour for 64 mins and lost 2800ml of blood. She has 1 previous child who was delivered by C-section. PMHx = PID. An antenatal USS clocked a problem, which was not picked up by the delivery team. What is the underlying problem, and what is the management?

Placenta accreta Emergency hysterectomy

Investigation for post-menopausal bleeding?

1st - TVUS | If endometrial wall thickened --> hysterescopy + biposy

In LCSC, after skin and superficial + deep fascia, what are the the layers you must go through to reach uterus?

``` Anterior rectus sheath Rectus abdominis muscle Transversalis fascia Extraperitoneal connective tissue Peritoneum Uterus ```

How long can lochia persist for? | What Ix is warranted if it persists for longer?

6 weeks TVUS

A 24y/o lady with T1DM is 25+3 weeks pregnant. She has thin, watery discharge from her vagina. Speculum exam normal. Foetal fibronectin level 300 (+ve). Management?

Admit 2 doses of Dexamethasone 12 hours apart Monitor blood glucose carefully and adjust insulin pump accordingly - steroids can cause hyperglycaemia (foetal fibronectin is a protein released from gestational sac - high levels gives a high chance of premature labour)

How can the COCP mask PCOS?

By causing normal periods (may even be heavy) and decreasing acne, hirsutism etc. Weight gain will still be present, and once stopping the pill patients will become oligo-/a-amenorrhoeic

A 30 y/o woman presents 10 weeks gestation with 2 episodes of foul-smelling red discharge PV. There is assoc lower back pain, temp 39, BP 85/65. Cervical os is open and US confirms products of conception in uterus. What is going on?

Inevitable miscarriage which has become septic --> surgical management pronto

Management of miscarriage?

Usually expectant If risk of haemorrhage, maternal request or evidence of infection then intervention warranted - If septic, surgical removal required - If no increased risk, vaginal misoprostol can be used to augment excretion

Management of post-natal depression assuming good support network, no suicide risk etc and no Hx of depression?

1st - CBT | 2nd - SSRI or TCA

A 43 y/o woman is 27 weeks gestation and is having regular, weak contractions. Her cervix is 3cm dilated and membranes are intact. Management?

Admit | Give tocolytics + steroids

Common complications after hysterectomy with antero-posterior repair? (1 acute, 2 chronic)

Acute - urinary retention Chronic - enterocele and vaginal vault prolapse

Which lymph nodes would malignancy from these locations spread to: - Ovary - Uterus - Cervix

Ovary - para-aortic Uterus - para-aortic Cervix - internal iliac

Woman in 3rd trimester has lower back pain worse at night, why does this happen?

Pelvic muscles and ligaments start to relax in preparation for labour

When are foetal movements usually first felt?

Around 20 weeks if primigravida | 16-18 weeks if multiparous

When should nipples enlarge and darken during pregnancy?

Nipples enlarge in first few weeks due to high circulating oestrogen and human placental lactogen They darken at 12 weeks due to high circulating melanocyte stimulating hormone

1st and 2nd line analgesia in pregnancy?

1st - paracetamol | 2nd - low dose codeine

How long after chancre does it take for secondary syphilis to present?

2-8 weeks

Presentation of lymphogranuloma venerum abscess?

Initially painles groin ulcer Then a couple of weeks later painful inguinal lymphadenopathy If left untreated, can develop into large perianal or vulval abscess Rx: doxcycline or erythromycin

If a pregnant woman is exposed to chicken pox and is not immune, within how long should she receive varicella Ig?

10 days

Best treatment for Bartholin's Cyst abscess?

Marsupialisation process Cut open the abscess and suture the edges to leave it open so it can drain freely

What is the first line investigation in any elderly lady presenting with urinary incontinence? Why?

Urinalysis To ensure there is no underlying UTI/diabetes causing or precipitating the incontinence

In an uncomplicated pregnancy, if baby not born at 40 weeks, when should IOL be offered?

Between 41-42 weeks to decrease risk of complications assoc w prolonged pregnancy

How long after TOP can pregnancy test still be positive for?

4 weeks After this indicates potential incomplete abortion or persistent trophoblast

What to give as prophylaxis for group B strep?

Erythromycin OR If temp >38C then Benzylpenicillin

Who is offered HepB screening? When should babies receive HepB vaccine? What is given and when? Can it be passed via breastfeeding?

Everyone If high risk, e.g. mother chronically infected, IVDU, has acute HepB during pregnancy etc HepB Ig + vaccine within 12 hours of birth, then vaccine again at 1-2 and 6 months No (HIV can though)

What is McRobert's position?

Supine with both hips fully flexed and abducted (increases space in SI joint)

PCOS increases the long-term risk of which disease?

Endometrial carcinoma

Is Hx of PID a CI for IUD?

If it was <3 months ago yes

Repro Misc Flashcards

(107 cards)