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MSRA > Reproductive > Flashcards

Reproductive Flashcards

1
Q

Name some UKMEC 4 criteria

A

> 35 and smoking >15
Migraine with aura
History of thromboembolic disease
Uncontrolled hypertension
History of stroke of IHD
Major surgery with prolonged immobilisation
Breast feeding <6 weeks post partum
Breast Ca

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2
Q

What types of HPV cause cervical cancer?

A

16, 18 and 33

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3
Q

Name some causes of intermenstrual bleeding

A

Ectropion
Infection
Cervical polyps
Cervical Ca
Endometrial polyps
Endometrial Ca
Underdosing on COCP
Anovulatory uterine bleeding
IUD
POP
Contraceptive injection

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4
Q

What age can a child NEVER consent to sexual activity?

A

Under the sexual offences act 2003, the age is 13

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5
Q

By which day is HCG detectable in serum following conception?

A

Day 11 in 98% of women

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6
Q

When do serum levels of HCG peak?

A

Between 10 and 12 weeks

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7
Q

What is a molar pregnancy?

A

An abnormal pregnancy where a non viable fertilised egg implants in the uterus

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8
Q

What is the preferred form of emergency contraception?

A

Copper IUD

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9
Q

Within how many days of UPSI can you prescribe levonorgestrel?

A

Within 72 hours of UPSI

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10
Q

How does ulipristal acetate work?

A

Selective progesterone receptor modulator

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11
Q

Name some risk factors for endometrial Ca

A

Obesity
Nulliparity
Late menopause
FH of ovarian, breast or colon Ca
Tamoxifen
Unopposed oestrogen therapy
Pelvic irradiation
Diabetes
PCOS

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12
Q

Name some indications for anti-D in RhD negative mothers

A

Spontaneous miscarriage >12 weeks
Surgical or medical terminations of pregnancy
Situations where significant transplacental haemorrhage has occurred - i.e, ECV, antepartum haemorrhage, uterine procedures
Threatened miscarriage >12 weeks

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13
Q

How long can the Nexplanon stay in for?

A

3 years and can be replaced immediately

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14
Q

When in the cycle should Nexplanon be inserted for immediate effect?

A

Day 1-5
If inserted after, advise use of contraception for 7 days

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15
Q

How often is Depo-provera given?

A

Every 3 months

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16
Q

How do progesterone only injectable contraceptives work?

A

Mainly by inhibiting ovulation

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17
Q

What are “clue cells”?

A

Epithelial cells lined with bacilli, found in bacterial vaginosis

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18
Q

Describe the cervical cancer screening intervals

A

Available to all women aged 25-64
25-49: 3 yearly
50-64: 5 yearly
65+: only those who have not been screened before 50 or have had recent abnormal tests

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19
Q

What useful advice can you give to couples to increase the chances of conceiving?

A

Regular sexual intercourse (2-3x weekly) during natural cycle
84% of healthy couples will conceive within a year

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20
Q

What is the term given to reduced sperm motility?

A

Asenthozoospermia

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21
Q

What is the term given to abnormal sperm morphology?

A

Teratozoospermia

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22
Q

Name a useful test to check whether ovulation is occurring

A

Mid luteal cycle progesterone

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23
Q

Which antibiotics may interfere with contraceptive efficacy?

A

Enzyme inducers such as rifampicin

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24
Q

Name a key side effect of the copper IUCD

A

Irregular and heavy bleeding for up to 6 months post insertion

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25
Q

How early is B-hCG detectable in urine?

A

9 days post conception up to 20 weeks

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26
Q

What is the most sensitive imaging modality for detecting adenomyosis?

A

MRI

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27
Q

What is Asherman’s syndrome?

A

The occurrence of adhesions in the uterus such that the cavity becomes partially obliterated

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28
Q

What are the risks of smoking during pregnancy?

A

Preterm labour
Reduction in ovulation
Lighter for dates baby
Reduced reading ability
Abnormal sperm production

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29
Q

What is the advice for missing a POP?

A

Defined as >3hrs
Cerazette allows a 12 hour window
Take pill now and advise extra precautions for the next 48 hours

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30
Q

In which condition is an IUD deemed unsuitable?

A

History of PID

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31
Q

Name the treatment for toxoplasmosis

A

Spiramycin during pregnancy
Pyrimethamine and sulphadiazine if foetus is infected too

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32
Q

When is a pregnancy considered “term”?

A

37 to 42 weeks

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33
Q

What is anaemia in pregnancy as defined by the WHO?

A

Hb <110 g/l

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34
Q

What is a microprolactinoma?

A

<10mm in diameter

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35
Q

What may a prolactinoma present with?

A

Oligomenorrhoea
Infertility
Galactorrhoea

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36
Q

What are the features of a threatened miscarriage?

A

Minimal pain
Less bleeding compared to menstruation
Closed cervix
Uterus for dates
Foetal heart on ultrasound

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37
Q

What is the commonest presentation of endometriosis?

A

Secondary dysmenorrhoea

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38
Q

What may you see on laparoscopy with endometriosis?

A

Blood filled, chocolate cysts

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39
Q

What are the risks of Listeria infection during pregnancy?

A

Chorioamnionitis
Premature labour
Spontaneous abortion
Stillbirth

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40
Q

Which conditions are hyperemesis gravidarum more prevalent in?

A

Trophoblastic disease
Nulliparity
Non smokers
Age <30 years
Female foetus
Maternal obesity

41
Q

Which blood test should you do following confirmation of hyperemesis gravidarum?

A

Thyroid function test due to the fact that BhCG has TSH-like activity

42
Q

Which drug is 1st line for HG?

A

Promethazine

43
Q

How does the levonorgestrel morning after pill work?

A

Delays ovulation by preventing follicular rupture & causing luteal dysfunction

44
Q

Name some physiological respiratory changes during pregnancy

A
  1. Tidal volume increases by 40%
  2. Respiratory rate increases by 15%
  3. Increased O2 consumption
  4. Compensated respiratory alkalosis
45
Q

How does the COCP work?

A

Supresses LH, FSH, thus inhibiting ovulation

46
Q

Describe the pharmacological management of menorrhagia

A

1st line: Mirena
2nd line: TXA, NSAIDs, COCP
3rd line: Norethisterone (progestogen)

47
Q

Which drugs are used to treat hyperthyroidism in pregnancy?

A

1st trimester: PTU
2nd trimester: carbimazole

48
Q

What is defined as a ‘missed pill’ with regards to the COCP?

A

> 24 hours

49
Q

Name some risk factors for breech presentation

A

Uterine malformations, fibroids
Placenta praevia
Polyhydramnios or oligohydramnios
Fetal abnormality (e.g. CNS malformation, chromosomal disorders)
Prematurity (due to increased incidence earlier in gestation)

50
Q

What is the management for breech presentation?

A

If < 36 weeks: many fetuses will turn spontaneously
If still breech at 36 weeks NICE recommend external cephalic version (ECV)- this has a success rate of around 60%. The RCOG recommend ECV should be offered from 36 weeks in nulliparous women and from 37 weeks in multiparous women
If the baby is still breech then delivery options include planned caesarean section or vaginal delivery

51
Q

What are the RCOG absolute contraindications to ECV?

A

Where caesarean delivery is required
Antepartum haemorrhage within the last 7 days
Abnormal cardiotocography
Major uterine anomaly
Ruptured membranes
Multiple pregnancy

52
Q

When are women considered higher risk for neural tube defects in pregnancy?

A

Either partner has a NTD, they have had a previous pregnancy affected by a NTD, or They have a family history of a NTD
The woman is taking antiepileptic drugs or has coeliac disease, diabetes, or thalassaemia trait.
The woman is obese (defined as a body mass index [BMI] of 30 kg/m2 or more).

53
Q

Explain the management of chickenpox exposure during pregnancy

A

If there is any doubt about the mother previously having chickenpox maternal blood should be urgently checked for varicella antibodies
If the pregnant woman <= 20 weeks gestation is not immune to varicella she should be given varicella-zoster immunoglobulin (VZIG) as soon as possible
RCOG and Greenbook guidelines suggest VZIG is effective up to 10 days post exposure
if the pregnant woman > 20 weeks gestation is not immune to varicella then either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure

54
Q

What is the management for menorrhagia?

A

Does not require contraception:
either mefenamic acid 500 mg tds (particularly if there is dysmenorrhoea as well) or tranexamic acid 1 g tds. Both are started on the first day of the period
if no improvement then try other drug whilst awaiting referral

Requires contraception, options include:
intrauterine system (Mirena) should be considered first-line
combined oral contraceptive pill
long-acting progestogens

55
Q

When is surgical management indicated for ectopic pregnancies?

A

> 35mm adnexal mass
bhCG > 5000

56
Q

Name some indications for induction of labour

A

Prolonged pregnancy, e.g. 1-2 weeks after the Estimated date of delivery
Prelabour premature rupture of the membranes, where labour does not start
Diabetic mother > 38 weeks
Pre-eclampsia
Rhesus incompatibility

57
Q

Name some drugs that should be avoided in breastfeeding

A

antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

58
Q

Name some features of foetal varicella syndrome

A

Skin scarring, eye defects (microphthalmia), limb hypoplasia, microcephaly and learning disabilities

59
Q

What is the initial management of vaginal candidiasis?

A

oral fluconazole 150 mg as a single dose first-line
clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated
If there are vulval symptoms, consider adding a topical imidazole in addition to an oral or intravaginal antifungal
if pregnant then only local treatments (e.g. cream or pessaries) may be used - oral treatments are contraindicated

60
Q

Name some high risk groups for hypertension in pregnancy

A

hypertensive disease during previous pregnancies
chronic kidney disease
autoimmune disorders such as SLE or antiphospholipid syndrome
type 1 or 2 diabetes mellitus

61
Q

Name some features of congenital rubella syndrome

A

sensorineural deafness
congenital cataracts
congenital heart disease (e.g. patent ductus arteriosus)
growth retardation
hepatosplenomegaly
purpuric skin lesions
‘salt and pepper’ chorioretinitis
microphthalmia
cerebral palsy

62
Q

What is an important differential in the diagnosis of congenital rubella syndrome?

A

Parvovirus B19

63
Q

Name some risk factors for ovarian cancer

A

family history: mutations of the BRCA1 or the BRCA2 gene
many ovulations*: early menarche, late menopause, nulliparity

64
Q

Which cancers are at reduced risk of developing with the COCP?

A

Ovarian, endometrial

65
Q

Which form of contraceptive is associated with weight gain?

A

Injectable

66
Q

Name the diagnostic criteria for hyperemesis gravidarum

A

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

67
Q

In which instances should anti-D be given?

A

delivery of a Rh +ve infant, whether live or stillborn
any termination of pregnancy
miscarriage if gestation is > 12 weeks
ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required)
external cephalic version
antepartum haemorrhage
amniocentesis, chorionic villus sampling, fetal blood sampling
abdominal trauma

68
Q

Name some important tests for Rh -ve disease

A

all babies born to Rh -ve mother should have cord blood taken at delivery for FBC, blood group & direct Coombs test
Coombs test: direct antiglobulin, will demonstrate antibodies on RBCs of baby
Kleihauer test: add acid to maternal blood, fetal cells are resistant

69
Q

Name some contraindications to starting HRT

A

Current or past breast cancer
Any oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia

70
Q

How can you manage urogenital symptoms in menopause?

A

if suffering from urogenital atrophy vaginal oestrogen can be prescribed. This is appropriate if they are taking HRT or not
vaginal dryness can be treated with moisturisers and lubricants. These can be offered alongside vaginal oestrogens if required.

71
Q

Name some adverse effects of the injectable contraceptive

A

irregular bleeding
weight gain
may potentially increased risk of osteoporosis: should only be used in adolescents if no other method of contraception is suitable
not quickly reversible and fertility may return after a varying time

72
Q

Name some causes of primary amenorrhoea

A

gonadal dysgenesis (e.g. Turner’s syndrome) - the most common causes
testicular feminisation
congenital malformations of the genital tract
functional hypothalamic amenorrhoea (e.g. secondary to anorexia)
congenital adrenal hyperplasia
imperforate hymen

73
Q

Name some potential complications of pre-eclampsia

A

eclampsia
other neurological complications include altered mental status, blindness, stroke, clonus, severe headaches or persistent visual scotomata
fetal complications
intrauterine growth retardation
prematurity
liver involvement (elevated transaminases)
haemorrhage: placental abruption, intra-abdominal, intra-cerebral
cardiac failure

74
Q

What is the MOA of the progestogen only pill?

A

Thickens cervical mucous

75
Q

What is the MOA of the IUS?

A

Primary: Prevents endometrial proliferation
Also: Thickens cervical mucus

76
Q

Name some benign ovarian epithelial tumours

A

Serous cystadenoma
the most common benign epithelial tumour which bears a resemblance to the most common type of ovarian cancer (serous carcinoma)
bilateral in around 20%

Mucinous cystadenoma
second most common benign epithelial tumour
they are typically large and may become massive
if ruptures may cause pseudomyxoma peritonei

77
Q

Name some UKMEC3 criteria

A

more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease

78
Q

What is the first line management for dysmenorrhoea

A

NSAIDs

79
Q

What are the 4 Ts of PPH

A

Tone (uterine atony): the vast majority of cases
Trauma (e.g. perineal tear)
Tissue (retained placenta)
Thrombin (e.g. clotting/bleeding disorder)

80
Q

Name some risk factors for PPH

A

previous PPH
prolonged labour
pre-eclampsia
increased maternal age
polyhydramnios
emergency Caesarean section
placenta praevia, placenta accreta
macrosomia
the effect of parity on the risk of PPH is complicated. It was previously thought multiparity was a risk factor but more modern studies suggest nulliparity is actually a risk factor

81
Q

Name some features of severe pre eclampsia

A

hypertension: typically > 160/110 mmHg and proteinuria as above
proteinuria: dipstick ++/+++
headache
visual disturbance
papilloedema
RUQ/epigastric pain
hyperreflexia
platelet count < 100 * 106/l, abnormal liver enzymes or HELLP syndrome

82
Q

When is the first dose of anti-D given?

A

28 weeks

83
Q

When is the second dose of anti-D given?

A

34 weeks

84
Q

How quickly should a cat 2 LSCS be performed?

A

Within 75 minutes

85
Q

What is Meig’s syndrome?

A

A benign ovarian tumour (usually a fibroma) associated with ascites and pleural effusion

86
Q

Give some examples of antimuscarinic drugs

A

oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation)

87
Q

Give an example of a beta-3 agonist

A

Mirabegron

88
Q

What is the threshold for commencing insulin in GD

A

> 7mmol/l

89
Q

What tests are offered at 8-12 weeks?

A

Booking visit
general information e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
BP, urine dipstick, check BMI
Booking bloods/urine
FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
hepatitis B, syphilis
HIV test is offered to all women
urine culture to detect asymptomatic bacteriuria

90
Q

What does the quadruple test consist of?

A

alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin A

91
Q

What factors can reduce vertical transmission of HIV?

A

maternal antiretroviral therapy
mode of delivery (caesarean section)
neonatal antiretroviral therapy
infant feeding (bottle feeding)

92
Q

When is neonatal ART indicated?

A

zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml. Otherwise triple ART should be used. Therapy should be continued for 4-6 weeks.

93
Q

Explain the missed pill rules for COCP if 2 or more pills are missed

A

If 2 or more pills missed
take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day
the women should use condoms or abstain from sex until she has taken pills for 7 days in a row. FSRH: ‘This advice may be overcautious in the second and third weeks, but the advice is a backup in the event that further pills are missed’
if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

94
Q

Describe the phases of the menstrual cycle

A

Menstruation 1-4
Follicular phase (proliferative phase) 5-13
Ovulation 14
Luteal phase (secretory phase) 15-28

95
Q

How can you treat uterine fibroids?

A

Treatment to shrink/remove fibroids
medical
GnRH agonists may reduce the size of the fibroid but are typically used more for short-term treatment due to side-effects such as menopausal symptoms (hot flushes, vaginal dryness) and loss of bone mineral density
ulipristal acetate has been in the past but not currently due to concerns about rare but serious liver toxicity
surgical
myomectomy: this may be performed abdominally, laparoscopically or hysteroscopically
hysteroscopic endometrial ablation
hysterectomy
uterine artery embolization

96
Q

Describe some physiological ovarian cysts

A

Follicular cysts
commonest type of ovarian cyst
due to non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle
commonly regress after several menstrual cycles

Corpus luteum cyst
during the menstrual cycle if pregnancy doesn’t occur the corpus luteum usually breaks down and disappears. If this doesn’t occur the corpus luteum may fill with blood or fluid and form a corpus luteal cyst
more likely to present with intraperitoneal bleeding than follicular cysts

97
Q

Name some causes of oligohydramnios

A

premature rupture of membranes
Potter sequence
bilateral renal agenesis + pulmonary hypoplasia
intrauterine growth restriction
post-term gestation
pre-eclampsia

98
Q

What is the definition of oligohydramnios?

A

Definitions vary but include less than 500ml at 32-36 weeks and an amniotic fluid index (AFI) < 5th percentile

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