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Repro PassQuess Flashcards

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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
Bloating, frequency, urgency in a woman who's been on HRT for over 5 years
Ovarian cancer
26
Rhesus -ve Primigravida - management?
Give anti-D at 28 weeks
27
Foetal renal agenesis causes ...
Less foetal urine production therefore less amniotic fluid therefore foetus feels abnormally prominent
28
Down syndrome screening 11-13 weeks
Combined test - Nuchal translucency (ultrasound) - reduced PAPP-A - increased beta-HCG
29
Down syndrome screening at 15 weeks gestation?
Quadruple test - Serum oestriol - hCG - alpha-fetoprotein (AFP) - inhibin A
30
What is the Kleihauer test?
Quantifies the dose of anti-D required following a sensitising event (when the Rhesus antigen enters the mother's Rh -ve blood)
31
Long, closed, firm cervix prior to birth. Management?
Vaginal prostaglandin E2 pessary (primes the cervix)
32
Most common cell type in ovarian tumours
Epithelial cells (90%)
33
Premature ovarian insufficiency - signs + investigations
Typical menopausal symptoms in under 40 (eg. vaginal dryness, hot flushes and secondary amenorrhoea) plus two elevated FSH levels taken 4-6 weeks apart
34
Fitz-Hugh-Curtis = inflamed liver capsule causing adhesions in the peritoneum What condition is this associated with?
Pelvic inflammatory disease
35
Sudden onset right/left iliac fossa pain in girls Stabbing pain can be so severe it causes vomiting
Ovarian torsion
36
Most common risk of induction of labour?
Failure to induce labour, requiring caesarean section
37
Absolute contraindication to induction of labour ?
Previous C-section if the patient is 'induced', contractions will spread along the weakened scarred uterus, subsequently leading to uterine rupture
38
Staging criteria for endometrial cancer
FIGO staging
39
90% of vulval cancers are _________ cell carcinomas
Squamous cell carcinoma
40
Sumitriptan cannot be co-prescribed with ________. Why?
COCP Because both increase risk of STROKE.
41
Urinary vs serum b-hCG
Urinary = diagnose pregnancy Serum = monitor pregnancy
42
Woman under 40. Periods stopped. FSH > 25 Diagnosis?
Premature ovarian insufficiency Treatment = HRT
43
Chandelier sign?
a.k.a. cervical excitation Shows PID (and sometimes ectopic pregnancy)
44
Pre-menstrual syndrome treatment ?
COCP with no pill-free interval
45
Emergency contraception method up to 5 days ?
Copper IUD (then leave in to provide ongoing contraception)
46
Gold standard investigation for definitive diagnosis of most forms of endometriosis
Laparoscopy
47
PID treatment
Intramuscular ceftriaxone, oral doxycycline and oral metronidazole Ceftriaxone = gonorrhoea Doxycycline = chlamydia Metronidazole = anaerobes
48
Endometriosis management
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
Cause of atrophic vaginitis in post-menopausal women?
Low circulating oestrogen levels
49
Treatment for cervical cancer to preserve fertility?
Radical trachelectomy (removal of cervix)
50
What is a cervical ectropion?
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
Shoulder tip pain =
Irritation of the diaphragm Happens in ectopic pregnancy
52
Foetal complications in rubella infection
Sensorineural deafness, congenital cataracts, ‘blueberry muffin’ rash and salt-and-pepper chorioretinitis
53
Induction of labour
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
Imperforate hymen =
Cause of primary amenorrhoea Symptoms = cyclical abdominal pain, back pain, urinary and bowel symptoms
55
Acute unilateral pelvic pain + localised peritonism CRP not raised + b-hCG negative
Ruptured ovarian cyst (diagnosed by transvaginal ultrasound)
56
Which type of twins are associated with the greatest risk of complications?
Monochorionic-Monoamniotic twins
57
Perimenopausal vs postmenopausal HRT type
Perimenopausal = Monthly cyclical HRT (simulates monthly menstruation) Postmenopausal = Continuous combined HRT
58
Placenta praevia investigation =
Transvaginal ultrasound
59
Child has chickenpox. Pregnant woman is exposed (she has no VZV antibodies)
Administer varicella zoster immunoglobulin
60
Complication of PID which causes liver capsule to be inflamed - leads to shoulder tip pain due to irritation of diaphragm
Fitz-Hugh-Curtis syndrome
61
Sex hormone levels in PCOS =
Raised testosterone Low sex hormone binding globulin (due to SHBG binding to testosterone) Raised LH, normal FSH
62
What is a cystocele?
A cystocele is prolapse of the bladder backwards into the vagina due to a defect in the anterior vaginal wall
63
NSAIDs in pregnancy?
NO!
64
Hyperemesis gravidarum early signs
Ketonuria (due to starvation) >5% loss of pre-pregnancy body weight
65
Lactational amenorrhoea as a contraceptive method?
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
When should external cephalic version be offered?
Nulliparous women = 36 weeks Multiparous women = 37 weeks (term)
67
Joint pains, new diabetes, liver fibrosis =
Haemochromatosis Investigation = iron studies (high serum iron, high ferritin, high transferrin)
68
HELLP stands for ...
Haemolysis, Elevated Liver enzymes and Low Platelets
69
Acute fatty liver of pregnancy management =
Immediate delivery
70
Obstetric cholestasis - what treatment soothes itching?
Ursodeoxycholic acid - reduces serum bile acid
71
Which class of drugs (+ examples) can improve success rate of external cephalic version?
Tocolytic with a beta-mimetic effect (beta-2 receptor agonists) - terbutaline - ritodrine - salbutamol
72
When is Kleihauer test used?
To guide dose of anti-D prophylaxis (assesses number of foetal cells in maternal circulation)
73
Treatment for pneumocystis pneumonia?
Co-trimoxazole
74
Migraines with aura contraindicate which contraception?
COCP (use POP instead)
75
Medication used to suppress lactation
Cabergoline
76
Single ulcer + lymphadenopathy Differentials = ?
Chancroid --> PAINFUL ulcer + PAINFUL lymphadenopathy LGV --> painless ulcer + PAINFUL lymphadenopathy Syphilis --> painless ulcer + painless lymphadenopathy
77
Multiple small round pearly lesions on the genitals with a central area of umbilication No pain, no other symptoms
Molluscum contagiosum (Genital warts are irregular in shape and have no central umbilication)
78
MOA of fluconazole (treatment for vulvovaginal candidiasis)
Inhibits synthesis of ergosterol (ergosterol = an essential component of fungal cell membranes)
79
Treatment for chancroid
Ceftriaxone or azithromycin
80
Uterine fibroids - what contraceptive method ?
Intra uterine system ( can lead to a reduction in bleeding 6 months after insertion, thus alleviating symptoms of heavy periods)
81
HSV 1 vs 2 Which is mouth and which is genitals?
1 mouth to feed (cold sores on mouth) 2 lips to purse (genital lesions)
82
Chlamydia microscopy?
Chlamydia not visible on microscopy
83
Gonorrhoea microscopy?
Gram-negative diplococci
84
Trichomoniasis wet mount microscopy/NAAT results
Motile organisms
85
Bilateral nodularity in breasts of a younger patient which worsens in relation to their menstrual cycle
Fibrocystic disease (treatment = analgesia)
86
HER2 positive breast cancer - treatment?
Herceptin (a.k.a. Trastuzumab)
87
Benign breast lesion that grows within the mammary ducts of the breast - blood-tinged nipple discharge - no skin changes or palpable lumps
Intraductal papilloma
88
Bilateral, thick, sticky green or yellow nipple discharge + nipple inversion in a perimenopausal patient
Mammary duct ectasia (dilation and thickening of the lactiferous ducts of the breast)
89

Reproductive (14 decks)

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