Reproduction Flashcards
(204 cards)
1
Q
What are the high risk malignant breast features that warrant an urgent hospital referral?
A
changes of contour
suspicious lump
blood stained nipple discharge
2
Q
Basic structure of the breast?
A
15-25 lobes each containing tubuloacinar glands that each drain into their own lactiferous duct through lactiferous sinus and out the nipple
surrounded by fibrocoleginous and adipose tissue
3
Q
main changes in the breast during pregnancy and stimulating factors?
A
oestrogen and progesterone
increase in secretory tissue
decrease in fibro fatty tissue
4
Q
what are the ABs in breast milk?
A
secretory IgA
5
Q
What is apocrine secretion and what uses it?
A
apical portion of the secretory cell/epithelial cell pinches off and loses part of cytoplasm releasing a membrane bound vesicle
Lipids
6
Q
What is merocrine secretion and what uses it?
A
secretions enter lumen by exocytosis
proteins
7
Q
common bacteria in acute mastitis?
A
staph aureus
strep pyogenes
8
Q
Abx for staph aurea?
A
flucoxacillin
9
Q
anti eostrogen therapy
A
tamoxifen
helps reduces swelling and pain
10
Q
anti HER2 therapy
A
trastuzamab
11
Q
Common metastatic cancers to the breast
A
bronchial
clear cell kidney
serous ovarian
12
Q
type 1 endometrial Ca histological features?
A
microsatelite instability
13
Q
type 2 endometrial ca histological features?
A
papillary and glandualr architecture with diffuse marked nuclear pleomorphism
14
Q
what is meigs syndrome?
A
triad of bengin ovarian tumour
ascites
pleural effusion
15
Q
HPV ass with cervical Ca?
A
16 & 18
16
Q
chemotherapy drug used in cervical Ca?
A
cisplatin
17
Q
Pagets disease of the nipple?
A
ductal carcinoma in situ progresses up to the nipple
common eczematic rash
underlying Ca in breast
18
Q
in situ meaning?
A
no invasion of BM
19
Q
Symptoms of DCIS?
A
usually asymptomatic- no mass
seen on US as calcification (no blood supply to the internal malignant cells so they die and calcify)
20
Q
Bengin calcification lesions of the breast?
A
fat necrosis
sclerosing adenosis
21
Q
cyproterone acetate uses?
A
acne and hirsutism
(anti androgen and progesterone)
prostate cancer
22
Q
When is the COCP contraindicated?
A
migraine with aura
breast feeding women <6 weeks postpartum
23
Q
Best contraception post partum?
A
mother protected to day 21
exclusively breast feed for 6months & ammenhoreic
POP after 21 days for breast feeding or not (additional contraception for first 2 days)
24
Q
POP contraindications?
A
breast cancer in last 5 years
25
cottage cheese discharge
thrush
26
When is downs syndrome combined screening test?
10-14 weeks
27
What does downs screening test involve?
US- neural translucency
| Blood test BHCG, PAPP-A (high and low in ds)
28
What screening test for downs is done if >14 weeks?
```
quadruple test
(BhCG and inhibin A raised, AFP and unconjugated oestriol low)
```
29
menorrhagia treatment?
tranexamic acid
30
dysmenorrhoea treatment?
mefanamic acid
31
Contraception for menorrhagia?
IUS
| COCP
32
What are the basic investigations for infertility?
semen analysis
| day 21 progesterone
33
What are the values for day 21 progesterone?
<16 repeat and if low refer
<30 repeat
>30 ovulating
34
What are the high risk HPV subtypes?
16 & 18
35
What warrants urgent (2weeks) coloscopy referral?
```
severe dyskariosis (CINIII)
suspected invasive Ca
```
36
What is placenta praevia?
placenta lying in the lower uterus. covers the internal OS completely partially or marginally
37
What is placental abruption?
separation of placenta from uterine wall causing maternal haemorrhage in the intervening space
38
What are the symptoms of placental praevia?
painless bright red vaginal bleeding after 20 weeks gestation
39
What is placental accreta?
placenta invades myometrium ad becomes inseperable from uterine wall
40
treatment of hyperthyroid in pregnancy?
PTU 1st trimester
| carbimazole 2nd/3rd trimester
41
Why does hyperthyroidism get worse in first trimester?
HCG increase
42
How do you treat hypothyroid in pregnancy?
increase levothyroxine by 25-50 in 1st trimester
43
Treatment of gestational diabetes?
insulin
44
What is polyhydromnios and how it is diagnosed?
excess amniotic fluid
| USS
45
What is threatened miscarriage?
painless bleeding before 24 weeks cervical OS closed
46
What can be used to screen for postnatal depression?
edinburgh scale
47
baby blues features and management?
3-7 days
tearful, anxious
reassurance and support
48
Postnatal depression features and management?
1-3 months
typical depression signs and effects on bonding
mod-sev: CBT and paraoxetine
49
peurperal psychosis features and management?
onset 2-3 weeks
severe mood swings
delusions, hallucinations
emergency hospital referral
50
pathophysiology of gestational diabetes?
placental products such as HCG and TNF alpha increase insulin resistance and cause a decrease in functioning B cells
51
is metformin safe in pregnancy?
yes
52
what is a chroinic haematoma?
pooling of blood between chorion and endometrium
53
Common presentation of chrionic haematoma and diagnosis?
bleeding in early pregnancy
threatened misscarraige
USS (crescent adjacent to the sac)
54
What are molar pregnancies?
chromosomally abnormal/non viable fertilised egg leading to abonormal placental overgrowth and swollen chorionic villie (grape like cluster) has the potential to become malignant
type of gestational trophoblastic disease
55
snow storm appearance?
molar pregnancy
56
What are the typical signs and symptoms of molar pregnancy?
bleeding
exagerated symptoms of preganacy
very high serum hCG
57
What is the difference between complete and partial moles?
complete mole - no maternal DNA. Haploid paternal egg duplicates after fertilisation
partial mole- maternal and paternal DNA. fertilised by two sperm or duplicating paternal DNA. Fetal reminents present
58
What is adenomyosis?
endometriosis in the myometrium
| 'spongy'
59
What is a uterine/vaginal vault prolapse and when does it commonly occur?
upper portion of vagina drops down into vaginal canal or outside
post hysterectomy
60
What is a urthrocele?
urethra pressing into vagina wall
61
What is a cystocele?
anterior prolapse
| bladder herniates into the vagina
62
What is a rectocele?
posterior prolapse
| rectum pushes against wall of vagina
63
What is an enterocele?
pouch of douglas with small bowel herniates into vagina
64
what is listeria and where is it commonly found?
gram positive bacillus
| pate, butter, soft cheeses, cooked sliced meat
65
Why listeria infection dangerous in pregnancy?
can lead to misscarraige
66
What is the treatment for listeria infection?
amoxicillin
67
What may CSF show in listeria meningitis?
pleocytosis (increased lymphocytes) and tumbling motility
68
How do you treat listeria meningitis?
IV amoxicillian and gentamicin
69
What is a second degree vaginal tear?
tear into subcutaneous tissue
70
What is a 1st degree vaginal tear?
tear into mucosa only
71
What is a 3rd degree vaginal tear?
tear into external anal sphincter
72
What is a 4th degree vaginal tear?
tear into ractal mucosa
73
What is obstetric cholestasis and the cause?
reduced flow of bile down the bile ducts to the liver and some leaks out into blood stream
unknown cause but proposed increase in oestrogen and progesterone slow down bile movement
74
What are the typical symptoms of obstetric cholestasis?
severe itch after 24 weeks
75
Management of fibroids?
IUS
Symptoms- tranexamic acid, COCP
GnRH- to reduce size but only short term as grows back rapidly
surgery- myomectomy
uterine artery embolisation- reduces blood flow thus oestrogen supply to the uterus
76
What is tranexamic acid?
antifibrinolytic- prevents plasmin from breaking down fibrin clots
77
What is hyperemesis and when is it most common?
excess vomiting due to increased hCG
| most common weeks 8-12
78
treatment of BV?
metronidazole
79
musty frothy green discharge. strawberry cervix?
trichomonas vaginalis
80
treatment of trichomonas vaginalis?
metronidazole
81
gonorrhoea treatment?
im ceftriaxone and oral azithromycin
82
cottage cheese discharge?
candida
83
What is used to facilitate placental delivery and reduce risk of PPH?
oxytocin/ergometrine
84
What is used to initiate labour?
prostaglandin E2
85
How do you treat primary PPH (within 24hrs)?
IV syntocinon/oxytocin or IV ergometrine
| IM carboprost
86
What is ashermans syndrome and what is it commonly associated with?
adhesions and fibrosis of the endometrium commonly after dilation and curettage
87
What are the main signs of ashermans?
amenorrhoea
infertility
menstrual pain
recurrent misscarraige
88
How do you diagnose ashermans?
hysteroscopy
89
Why should women avoid eating liver in pregnancy?
high levels of vit A
90
How can you calculate risk of malignancy index (RMI) in women?
serum CA 125
| USS findings and menopausal status
91
What should women high risk of pre-eclampsia take?
aspirin 75mg from week 12
92
Who are high risk for pre-eclampsia?
exsiting hypertension or in previous pregnancy
CKD
autoimmune disorders- SLE, antiphospholipid syndrome
diabetes
93
What happens to blood pressure in normal pregnancy?
falls in 1st trimester then raises 2nd trimester
94
What is definition of pregnancy induced hypertension?
>150/90
| or an increase in >30/15 after week 20
95
What is definition of pre-eclampsia?
pregnancy induced hypertension with proteinuria
96
What is the treatment for gestational hypertension?
oral labetalol
97
What is pre-exsisting hypertension in pregnancy?
history before pregnancy or >140/90 <20 weeks
98
What happens in pre-eclampsia?
kidney function declines causing salt and water retention- oedema
renal blood flow and GFR decreases
99
What is the management of pre-eclampsia?
1st labetalol
2nd methyldopa
3rd nefidipine
100
What is pre-eclampsia?
multi sytem disorder with diffuse vascular endothelial dysfunction and widespread circulatory disturbance
101
What is the cure for pre-eclampsia?
delivery
102
when do you give steroids for promotion of fetal lung surfactant?
up to 36 weeks
103
What is eclampsia seizure treatment and prophylaxis?
magnesium sulphate
if fails consider benzodiazepines
IV labetalol and hydralazine for BP
104
What is premature ovarian failure?
menopausal symptoms and elvevated gonadotrophin level <40 yrs
105
chlamydia treatment?
azithromycin single dose or doxycycline 7 days
106
classic history of placenta praevia?
painless bright red bleeding after 24 weeks
| previous c sections
107
what is neuropathic pain?
pain arising from damage or disruption to nervous system
108
Give some examples of neuropathic pain?
diabetic neuropathy
post herpetic neuralgia
trigeminal neuralgia
prolapsed intervetebral disc
109
What is treatment of neuropathic pain?
1- amitriptyline, duloxetine, gabapentin or pregabalin
110
When is tramadol useful?
rescue therapy for exacerbations of neuropathic pain
111
When is topical capsaicin useful?
localised neuropathic pain eg post herpetic neuralgia
112
Trigeminal neuralgia first line?
carbazepine
113
What is clomiphene used for?
induce ovulation i npatients with anovulatory ovulation
114
What antibiotic is safe in pregnancy?
trimethoprim
115
What do smear tests show?
dyskaryosis
| change in squamous epithelial cells
116
CIN classification shows what?
cervical intraepithelial neoplasia-coverage/spread of the abnormal cells identifies on coposcopy
117
What are the treatments for CIN?
cryotherapy
laser
cold coagulation
large loop incision of the transformation zone
118
What is vulvular intraepithelial neoplasia?
dysplasia of squamous epithelium of the vulva with invasive/cancerous potential
119
What is extramammary pagets disease and how does it present?
red itchy ulcerated skin
| malignant epithelial cell in the epidermis of the vulva
120
What is a defining feature of HPV infection?
koilocytic change- raisin like nucleus
121
postmenopausal women with leukoplakia and parchment like vulvar skin?
lichen sclerosis
122
what is lichen sclerosis and what does it increase risk of?
benign thinning and atrophy of epidermis
fibrosis of dermis
slight increased risk of squamous carcinoma
123
what is lichen simplex chronicus?
thickening of the skin/hyperplasia of the squamous epithelium
leukoplakia with thick leathery vulvar skin
completely benign]ass with chronic irritation and scratching
124
what is common presentation of vulvar squamous carcinoma?
leukoplakia
| biopsy
125
What are the main causes of vulvar carcinoma?
HPV related- infection of high risk HPV causing vulvar interepithelial neoplasia and leading to cancer
non HPV- long standing lichen sclerosis
126
What is lynch syndrome?
cancer predisposition syndrome
AD
increases risk of endometrial, ovarian and colorectal cancer
127
what causes the increased risk for cancer in lynch syndromes?
inherited mutations of the DNA mismatch repair system
128
what is overflow incontinence?
involuntary release of urine from a permanently overfilled bladder
129
What are the main causes of overflow incontinence?
bladder outflow obstruction
weakened/ loss of detruser muscle contraction- cant expel enough urine
side effect of anticholinergic side effects
autonomic neuropathy
130
What are the signs of overflow incontinence?
huge palpable bladder, chronic retention, wet at night
131
How do you treat overflow incontinence?
catheter
132
How do you diagnose incontinence?
urodynamic studies
133
What is stress incontinence and the cause?
urine leaks out of the bladder during increased intra-abdominal pressure and no detruser contraction due to insufficient closure of the bladder (damage of the pelvic floor or urethral function commonly in childbirth)
134
What are the classic signs in stress incontinence?
involuntary leakage on exertion or when sneezing or coughing
135
What is the treatment for stress incontinence?
pelvic floor exercises
weight loss
stop smoking
surgical correction
136
What causes urge incontinence?
```
detruser over activity:
afferent over stimulation due to irritant in bladder
excess central facilitation
loss of central inhibition
parasympathetic nerve damage
```
137
What are the classic symptoms of urge incontinence?
feeling of constantly needing to pee
increased frequency
small voided volumes
nocturia
138
What are the treatments of urge incontinence?
avoid caffeine
bladder retraining
oxybutynin- anticholinergic
139
What are some key biochemical findings in PCOS?
elevated androgens
| hyperinsulinemia, insulin resistance, raised LH
140
PCOS triad?
hyperandrogenism
oligoovulation/anovulation
>12 enlarged follicles
141
What is acanthosis nigricans?
darkened skin usually in neck or armpit
| due to hyper insulinaemia
142
What are the treatments in PCOS?
lifestyle
metformin
COCP
laproscopic ovarian drilling (destroys the tissue in the ovary that is producing the androgen)
143
Typical presentation of PID?
```
history of infection
bilateral abdo pain
abnormal bleeding or discharge
fever
cervical excitation
```
144
treatment of PID?
Im ceftriaxone
| 2 week course of doxycyline and metronidazole
145
How much does PID increase your risk of infertility?
10-20% after single episode
146
what is a leiomyoma?
uterine fibroid
147
What are uterine fibroids and what causes them?
benign smooth muscle tumours
| oestrogen dependant
148
What is the typical presentation of uterine fibrods?
menorrhagia- anemia
infertility
olderwomenwith longer exposure to oestrogen
149
What is a complication of fibroids in pregnancy?
red degeneration
150
What is red degeneration?
fibroids grow quicker due to increased oestrogen in pregnancy
haemorrhage in the middle of the fibroid
151
What are the symptoms of red degeneration?
abdominal pain
vomitting
low grade fever
in middle trimester
152
What are the treatments for larger fibroids?
mirenia coil/IUS
| GnRH analogues to reduce bulk before surgery or induce menopausal state
153
What part of the pituitary releases LH and FSH?
anterior
154
Surgery options for fibroids?
hysterectomy
| preserve fertility- myomectomy, embolisation
155
Leiomyosarcoma cell morphology?
spindle cell
156
what is adenomyosis?
endometriosis in the myometrium
157
What are the classic symptoms and signs of endometriosis?
```
asymtomatic
pelvic pain prior to period
heavy periods
dyspareunia
fixed retroverted uterus
enlarged boggy tender uterus (adenomyosis)
```
158
What is a chocolate cyst?
endometriosis in the ovaries
159
What is the management of endometriosis?
if asymptomatic no treatment
COCP
surgery
160
What is endometritis and what are the features of each type?
inflammation of the endometrium
acute- neutrophils
chronic- plasma cells
161
What are the common symptoms of endometritis?
lower abdo pain, uterine tenderness
162
What is treatment for endometritis
doxycycline and metronidazole
163
What is the main cause of endometritis and what threat does this pose?
infection
| risk of pID
164
What is dysfunctional uterine bleeding?
abnormal bleeding patterns with no organic cause
| usually due to hormone disturbances
165
What are the 2 types of dysfunctional uterine bleeding?
anovulatory- irregular cycle
| ovulatory- regular with cycle
166
NSAIDs in menorhagia?
Pain management
mefanamic acid, naproxen
inhibits COX and reduces prostaglandin synthesis (linked to heavy periods)
167
antifibrinolytic in menorrhagia?
stops the break down of fibrin clots
| tranexamic acid
168
progesterones in menorrhagia?
prevent the endometrium growing too quickly
169
GnRHa in menorrhagia?
can reduce bleeding but cause symptoms of menopause
170
classic presentation of placenta previa?
painless red bleeding in third trimester uterus soft and non tender
171
What is an antepartum haemorrhage?
bleeding from the genital tract after 24 weeks pregnancy
172
What are the main causes of APH?
placenta previa
placental abruption
vasa previa
173
Why should a vaginal exam not be conducted for suspected APH?
placenta previa can easily rupture
174
What is placenta previa?
placenta lies in lower uterine segment has big risk of haemorrhage
175
Key differences between placenta previa and placental abruption?
preva- no pain, no tenderness, shock proportional to blood loss
abruption- pain, tense, swollen and tender uterus shoch outwith blood loss. fetal heart absent/destressed
176
What is placenta accreda and the main risks?
placenta is attaches to the myometrium as isnt restricted by the decidua basalis
difficult detachment at birth causing PPH
177
what are the key risk factors for placenta accreda?
c section
| placenta previa
178
what is placental abruption?
placenta separates from endometrium prior to delivery causing maternal haemorrhage
179
What are some causes of placental abruption?
pre-eclampsia/HTN
trauma
increased maternal age
multiparity
180
what are the signs of placental abruption?
CTG fetal heart absent or distressed
181
treatment of placental abruption?
emergency admission
resus
steroids
delivery
182
When is the best window to give steroids to reduce fds?
24-48 hrs before birth
183
when should the placenta normally be expelled?
5-10mins
184
What is meant by a retained placenta?
failure to deliver>30mins
185
what is the risk with a retained placenta?
PPH
186
How do you manage a retained placenta?
syntocinon and breast feeding
| >hr surgical removal
187
what is a post partum haemorrhage?
>500ml blood loss
188
what is meant by priamry and secondary pph?
primary <24hrs since birth
| secondary >24hrs
189
What are the 4 ts of post partum haemorrhage?
tone
trauma
tissue
thrombin
190
What are the treatments for primary PPH?
uterine massage
IV syntocinon or ergometrine
IM carbopost
if severe surgical ligation or hysterectomy
191
What does ergometrine do?
causes contraction of the uterus to reduce blood flow
192
What is carboprost?
synthetic prostaglandin induces contraction and can be used for abortion or to treat PPH
193
What is a moderate and major PPH?
500-1500ml
| >15000ml
194
What is a choriocarcinoma?
trophoblastic malignancy can arise from molar pregnancies
195
What are trophoblast?
outer cells of the blastocyst that provide nutrients for embryo and develop into a large part of the placenta
196
What is cervical incompetence?
cervix begins to dilate and efface before term
197
treatment of cervical incompetence?
treated if threatened pregnancy
| suture shut and removed at 36 weeks
198
what is the genetics of androgen insensitivy sydrome?
X linked recessive
199
what is another name for candida infection?
thrush
200
What are the typical symptoms of thrush?
itchy white discharge
201
What is candida balatitis?
thrus on tip of penis
202
Most individuals are colonised with small numbers of candida what are the risks for becoming infected?
abx
immunocompromised
poor diabetes control
high oestrogen
203
diagnosis of thrush?
high vaginal swab/vulvovaginal swab
culture- c.albicans
budding (yeast) on gram stain
204
treatment of thrush?
topical clortimazole
| oral flucanazole
