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Reproductive > Repro PassQuess > Flashcards

Repro PassQuess Flashcards

1
Q

Vaginal thrush in a non-pregnant woman. Prescribe what medication?

A

Oral fluconazole

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2
Q

Who should receive high dose (5mg - as opposed to 400mcg) folic acid from before conception?

A

Anyone at risk of producing a child with neural tube defects:

  • either partner has a NTD, they have had a previous pregnancy affected by a NTD, or they have a family history of a NTD
  • taking antiepileptic drugs, has coeliac disease, diabetes, or thalassaemia trait.
  • obese (BMI >30)
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3
Q

Gestational diabetes - fasting blood glucose is >7 (high)

Management = ?

A

Start insulin

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4
Q

Gestational diabetes - fasting blood glucose is <7 (lower)

Management = ?

A

2 weeks diet and exercise
Then metformin
Then insulin

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5
Q

Bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy e.g. hyperemesis.

The uterus is large for dates and serum hCG is very high

A

Hydatidiform mole

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6
Q

First-line option for managing infertility in polycystic ovarian syndrome ?

A

Clomifene

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7
Q

Fitz-Hugh-Curtis a.k.a. ____________ ?

A

Perihepatitis

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8
Q

Painless bleeding after 24 weeks of gestation - what does this show ?

A

Placenta praevia

(placenta is attached to the lower part of the uterus)

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9
Q

How long after childbirth can the intrauterine device be inserted?

A

Within 48 hours or after 4 weeks

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10
Q

Levonorgestrel intrauterine device/system vs Copper intrauterine device

A

Levonorgestrel prevents heavy menstrual bleeding
Copper often causes heavy menstrual bleeding

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11
Q

Absolute contraindications to vaginal birth

A

Previous vertical (classical) caesarean scars (approx 1% of C-sections)
Previous episodes of uterine rupture

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12
Q

Pre-eclampsia management

(Remember L, N, S)

A

Labetalol → Largely Used
Nifedipine → Narrow airways (asthma) friendly
Magnesium Sulfate → Seizure Prevention and neuroprotection

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13
Q

Nausea and vomiting due to hyperemesis gravidarum

What to prescribe ?

A

IV saline + potassium chloride

(dehydrated + hypokalaemic)

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14
Q

Rokitansky’s protuberance = what condition ?

A

Teratoma (dermoid cyst)

  • may contain skin/hair/teeth
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15
Q

How long post-termination does pregnancy test remain positive?

A

4 weeks

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16
Q

2nd repeat cervical smear is positive, what do you do ?

A

Refer for colposcopy

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17
Q

First line investigation for suspected preterm prelabour rupture of the membranes = ?

A

Speculum examination - to look for pooling

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18
Q

Bleeding in first trimester - first line investigation = ?

A

Transvaginal ultrasound

  • assess foetal heartbeat
  • intrauterine/ectopic pregnancies
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19
Q

First-line option for pregnant women with previous hypertension?

A

Oral labetalol

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20
Q

Most common complication of myomectomy (operation to remove uterine fibroids) ?

A

Adhesions

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21
Q

In gestational diabetes, if blood glucose targets are not met with diet/metformin then what should be added?

A

Insulin

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22
Q

Most common site of ectopic pregnancy ?

A

Ampulla

(AMPLE babies)

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23
Q

Heavy periods (menorrhagia) but does not want contraception

A

Mefenamic acid / tranexamic acid

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24
Q

1st line surgical intervention for PPH

A

Intrauterine balloon tamponade

(used after pharmacological measures fail

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25
Q

Bloating, frequency, urgency in a woman who’s been on HRT for over 5 years

A

Ovarian cancer

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26
Q

Rhesus -ve Primigravida - management?

A

Give anti-D at 28 weeks

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27
Q

Foetal renal agenesis causes …

A

Less foetal urine production

therefore less amniotic fluid

therefore foetus feels abnormally prominent

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28
Q

Down syndrome screening 11-13 weeks

A

Combined test
- Nuchal translucency (ultrasound)
- reduced PAPP-A
- increased beta-HCG

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29
Q

Down syndrome screening at 15 weeks gestation?

A

Quadruple test
- Serum oestriol
- hCG
- alpha-fetoprotein (AFP)
- inhibin A

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30
Q

What is the Kleihauer test?

A

Quantifies the dose of anti-D required following a sensitising event (when the Rhesus antigen enters the mother’s Rh -ve blood)

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31
Q

Long, closed, firm cervix prior to birth. Management?

A

Vaginal prostaglandin E2 pessary

(primes the cervix)

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32
Q

Most common cell type in ovarian tumours

A

Epithelial cells (90%)

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33
Q

Premature ovarian insufficiency - signs + investigations

A

Typical menopausal symptoms in under 40 (eg. vaginal dryness, hot flushes and secondary amenorrhoea)

plus two elevated FSH levels taken 4-6 weeks apart

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34
Q

Fitz-Hugh-Curtis = inflamed liver capsule causing adhesions in the peritoneum

What condition is this associated with?

A

Pelvic inflammatory disease

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35
Q

Sudden onset right/left iliac fossa pain in girls

Stabbing pain can be so severe it causes vomiting

A

Ovarian torsion

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36
Q

Most common risk of induction of labour?

A

Failure to induce labour, requiring caesarean section

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37
Q

Absolute contraindication to induction of labour ?

A

Previous C-section

if the patient is ‘induced’, contractions will spread along the weakened scarred uterus, subsequently leading to uterine rupture

38
Q

Staging criteria for endometrial cancer

A

FIGO staging

39
Q

90% of vulval cancers are _________ cell carcinomas

A

Squamous cell carcinoma

40
Q

Sumitriptan cannot be co-prescribed with ________.

Why?

A

COCP

Because both increase risk of STROKE.

41
Q

Urinary vs serum b-hCG

A

Urinary = diagnose pregnancy
Serum = monitor pregnancy

42
Q

Woman under 40. Periods stopped.
FSH > 25

Diagnosis?

A

Premature ovarian insufficiency

Treatment = HRT

43
Q

Chandelier sign?

A

a.k.a. cervical excitation
Shows PID (and sometimes ectopic pregnancy)

44
Q

Pre-menstrual syndrome treatment ?

A

COCP with no pill-free interval

45
Q

Emergency contraception method up to 5 days ?

A

Copper IUD (then leave in to provide ongoing contraception)

46
Q

Gold standard investigation for definitive diagnosis of most forms of endometriosis

A

Laparoscopy

47
Q

PID treatment

A

Intramuscular ceftriaxone, oral doxycycline and oral metronidazole

Ceftriaxone = gonorrhoea
Doxycycline = chlamydia
Metronidazole = anaerobes

48
Q

Endometriosis management

A

1st: Paracetamol + NSAIDs
2nd: COCP
3rd/when endometriosis is causing infertility: Surgical management*

**
- Diathermy of lesions
- Ovarian cystectomy (for endometriomas)
- Adhesiolysis
- Bilateral oophorectomy (sometimes with a hysterectomy)

48
Q

Cause of atrophic vaginitis in post-menopausal women?

A

Low circulating oestrogen levels

49
Q

Treatment for cervical cancer to preserve fertility?

A

Radical trachelectomy
(removal of cervix)

50
Q

What is a cervical ectropion?

A

Adolescents, during pregnancy + women taking combined hormonal contraception

High levels of oestrogen trigger an enlargement of the cervix, causing eversion of the endocervical canal, which appears as a red ring

51
Q

Shoulder tip pain =

A

Irritation of the diaphragm

Happens in ectopic pregnancy

52
Q

Foetal complications in rubella infection

A

Sensorineural deafness, congenital cataracts, ‘blueberry muffin’ rash and salt-and-pepper chorioretinitis

53
Q

Induction of labour

A

1st line: Membrane sweep (inserting a gloved finger into the external os and separating the membranes from the cervix)

Vaginal prostaglandins (PGE2): These are used to ripen the cervix and induce contractions

Amniotomy: Artificial rupture of membranes

Balloon catheter: This is inserted into the cervix to mechanically dilate it.

54
Q

Imperforate hymen =

A

Cause of primary amenorrhoea

Symptoms = cyclical abdominal pain, back pain, urinary and bowel symptoms

55
Q

Acute unilateral pelvic pain + localised peritonism

CRP not raised + b-hCG negative

A

Ruptured ovarian cyst

(diagnosed by transvaginal ultrasound)

56
Q

Which type of twins are associated with the greatest risk of complications?

A

Monochorionic-Monoamniotic twins

57
Q

Perimenopausal vs postmenopausal HRT type

A

Perimenopausal = Monthly cyclical HRT (simulates monthly menstruation)

Postmenopausal = Continuous combined HRT

58
Q

Placenta praevia investigation =

A

Transvaginal ultrasound

59
Q

Child has chickenpox. Pregnant woman is exposed (she has no VZV antibodies)

A

Administer varicella zoster immunoglobulin

60
Q

Complication of PID which causes liver capsule to be inflamed

  • leads to shoulder tip pain due to irritation of diaphragm
A

Fitz-Hugh-Curtis syndrome

61
Q

Sex hormone levels in PCOS =

A

Raised testosterone
Low sex hormone binding globulin (due to SHBG binding to testosterone)
Raised LH, normal FSH

62
Q

What is a cystocele?

A

A cystocele is prolapse of the bladder backwards into the vagina due to a defect in the anterior vaginal wall

63
Q

NSAIDs in pregnancy?

A

NO!

64
Q

Hyperemesis gravidarum early signs

A

Ketonuria (due to starvation)
>5% loss of pre-pregnancy body weight

65
Q

Lactational amenorrhoea as a contraceptive method?

A

The woman has complete amenorrhoea.
The woman is fully, or nearly fully (>85% of feeds are breast milk) breastfeeding.
It has been six months or less since the birth of the baby

66
Q

When should external cephalic version be offered?

A

Nulliparous women = 36 weeks
Multiparous women = 37 weeks (term)

67
Q

Joint pains, new diabetes, liver fibrosis =

A

Haemochromatosis

Investigation = iron studies (high serum iron, high ferritin, high transferrin)

68
Q

HELLP stands for …

A

Haemolysis, Elevated Liver enzymes and Low Platelets

69
Q

Acute fatty liver of pregnancy management =

A

Immediate delivery

70
Q

Obstetric cholestasis - what treatment soothes itching?

A

Ursodeoxycholic acid

  • reduces serum bile acid
71
Q

Which class of drugs (+ examples) can improve success rate of external cephalic version?

A

Tocolytic with a beta-mimetic effect (beta-2 receptor agonists)

  • terbutaline
  • ritodrine
  • salbutamol
72
Q

When is Kleihauer test used?

A

To guide dose of anti-D prophylaxis

(assesses number of foetal cells in maternal circulation)

73
Q

Treatment for pneumocystis pneumonia?

A

Co-trimoxazole

74
Q

Migraines with aura contraindicate which contraception?

A

COCP

(use POP instead)

75
Q

Medication used to suppress lactation

A

Cabergoline

76
Q

Single ulcer + lymphadenopathy

Differentials = ?

A

Chancroid –> PAINFUL ulcer + PAINFUL lymphadenopathy

LGV –> painless ulcer + PAINFUL lymphadenopathy

Syphilis –> painless ulcer + painless lymphadenopathy

77
Q

Multiple small round pearly lesions on the genitals with a central area of umbilication

No pain, no other symptoms

A

Molluscum contagiosum

(Genital warts are irregular in shape and have no central umbilication)

78
Q

MOA of fluconazole (treatment for vulvovaginal candidiasis)

A

Inhibits synthesis of ergosterol
(ergosterol = an essential component of fungal cell membranes)

79
Q

Treatment for chancroid

A

Ceftriaxone or azithromycin

80
Q

Uterine fibroids - what contraceptive method ?

A

Intra uterine system

( can lead to a reduction in bleeding 6 months after insertion, thus alleviating symptoms of heavy periods)

81
Q

HSV 1 vs 2

Which is mouth and which is genitals?

A

1 mouth to feed (cold sores on mouth)
2 lips to purse (genital lesions)

82
Q

Chlamydia microscopy?

A

Chlamydia not visible on microscopy

83
Q

Gonorrhoea microscopy?

A

Gram-negative diplococci

84
Q

Trichomoniasis wet mount microscopy/NAAT results

A

Motile organisms

85
Q

Bilateral nodularity in breasts of a younger patient which worsens in relation to their menstrual cycle

A

Fibrocystic disease

(treatment = analgesia)

86
Q

HER2 positive breast cancer - treatment?

A

Herceptin (a.k.a. Trastuzumab)

87
Q

Benign breast lesion that grows within the mammary ducts of the breast

  • blood-tinged nipple discharge
  • no skin changes or palpable lumps
A

Intraductal papilloma

88
Q

Bilateral, thick, sticky green or yellow nipple discharge + nipple inversion in a perimenopausal patient

A

Mammary duct ectasia

(dilation and thickening of the lactiferous ducts of the breast)

89
Q
A

Reproductive (14 decks)

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