Week 3 Flashcards Preview

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Flashcards in Week 3 Deck (245):
1

What are common surgical incision for for Obs&Gyn

Lower segment Caessarean section (LSCS)
Laparotomy
Abdominal (and vaginal) hysterectomy
:aparoscopy

2

What are the layers of the abdominal muscles from outer to inner

External oblique
Internal oblique
Transversus oblique

3

What direction do the external oblique run in

Inferio-anterior

4

Where does the external oblique attatch

Between lower ribs to Iliac crest, pubic tubercle and linea alba

5

What is the Linea alba

Midline blending of the aponeurosis

6

What direction do the internal oblique run in

superio-anterior

7

Where does the internal oblique attach

Lower ribs, thoracolumbar fascia, iliac crest and linea alba

8

What direction do the Transversus Abdominis run

Transverse

9

Where does the Transversus Abdominus attach

Lower ribs, thoracolumbar fascia, iliac crest and linea alba

10

What are the transverse dividing lines of the rectus abdominis called

Tendinous intersections

11

What is the rectus sheath

Combined aponeuroses of anterolateral abdominal wall muscles

12

How many Rectus sheats are there

2, Anterior and posterior

13

Nerve supply to the Anterolateral abdominal wall travel inbetween what

Between internal oblique and transversus abdominis

14

The 7th-11th intercostal nerves becomes

Thoracoabdominal nerves

15

In the anterolateral Abdominal wall, T12 is

Subcostal

16

In the anterolateral Abdominal wall, L1 is

Iliohypogastric AND
Ilioinguinal

17

What are the main blood supply to the Anterior abdominal wall

Superior epigastric artery (continuation of internal thoracic)
Inferior epigastric arteries (branch of the external iliac artery)

18

What are the main blood supply to the lateral abdominal wall

Intercostal and Subcostal arteries (continuations of posterior intercostal arteries)

19

Where does the Superior and Inferior epigastric arteries lie in terms of depth

Posterior to rectus abdominis

20

How do you minimize injury to a muscle when incising

Incise in same direction as muscle fibre
Avoid nerves
Avoid blood supply

21

What is a LSCS incision

Lower Segment Caesarean Section incision

22

Where is a LSCS incision done

In the Linea alba below umbilical button, seperating rectus abdominis

23

What layers is gone through during LSCS incision Caesarean section

Skin and fascia
Rectus sheath (anterior and posterior)
Rectus abdominis
Fascia and peritoneum
Uterine wall
Amniotic sac

24

What layers are stitched together after a LSCS Caesarean section

Uterine wall w/ visceral peritoneum
Rectus sheath
(Fascial layer if high BMI)
Skin

25

What is a Laparotomy

A surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy

26

What is Dehiscence

A surgical complication in which a wound ruptures along a surgical suture

27

Inferior Epigastric Artery is a branch of

External iliac artery

28

Where does the Inferior Epigastric artery travel

Emerges just medial to the deep inguinal ring (Halfway between ASIS and pubic tubercele) passes superiomedial direction posteriorly to the rectus abdominis

29

What is Hysterectomy

Removal of the uterus

30

What is the anatomical relation between the ureter and the uterine artery

Ureter passes inferior to the artery
Water under the bridge

31

What is the chromosomal abonormality in Down's syndrome

Trisomy 21

32

What are the objectives of Antenatal Care

Detect and manage pre existing maternal disorders
Prevent or detect and manage maternal complications
Prevent or detect and manage fetal complications of pregnancy
Plan delivery
Provide advise regarding lifestyle of pregnancy

33

Antenatal care: What blood tests are done at booking appointment

FBC
Antibodies (Rhesus)
Glucose
Syphilis
Rubella

34

When is the dating scan done

Week 11-14

35

When is Fetal anomaly scan done

Week 18-21

36

When is Anti-D given if Rhesus negative

Week 28 and week 34

37

What History is taken during The booking visit

Menstrual
Medical
Obstetric
Family
Social

38

What examinations are done at the Booking visit

Height and Weight
BP
CVS
Abdomen

39

What investigations are done at the Booking visit

FBC
Blood type and Rhesus
Syphilis, rubella, HIV, Hep B&C
Urinanalysis, MSSU C&S
May do Ultrasound to confirm viability and number of fetuses

40

What examinations are done at follow up visits for antenatal care

BP and urinalysis
Fundal height
Lie and presentation
Fetal heart auscultation

41

What are the objectives of Fetal anomaly scan

Reduction in perinatal mortality and morbidity
Potential for in utero treatment
Identification of conditions amendable to neonatal surgery

42

What is assessed in Down's Syndrome Risk assessment on Ultrasound

Measured of skin thickness behind fetal neck using ultrasound (Nuchal Thickness, NT)

43

When is Nuchal Thickness measured

11-13+6 weeks

44

How is Down's risk assessment carried out in week 15-20

Blood test
Assay of HCG and AFP
Human Chorionic Gonadotropin and Alpha-fetoprotein

45

Which one of the HCG and AFP plays a role in increasing the risk for Down's syndrome

Human Chorionic Gonadotropin

46

In assessing Down's syndrome risk, what plays a big role

Maternal age

47

What are specific diagnostic tests used to find Down's syndrome

Amniocentesis
Chorionic villus sampling

48

When is Amniocentesis done

After 15 weeks gestation

49

When is Chorionic villus sampling done

After 12 weeks

50

What is the risk of miscarriage of Amniocentesis

1%

51

What is the risk of miscarriage of Chorionic villus sampling

2%

52

What is Amniocentesis

Sampling of the amniotic fluid through the abdomen under Ultrasound

53

What is the chorion

One of the membranes around the developing fetus. Together with the amnion it forms the amniotic sac

54

What is the Chorionic villi

Villi of the chorion where fetus and maternal blood can exchange material and oxygen

55

What is chorionic villi sampling

Sampling the Chorionic villi of the placenta, can be done transabdominally or transvaginally

56

What are Trophoblasts

Cells forming the outer layer of the blastocyst, provides nutrients to the embryo and develp into a large part of the placenta

57

Where does fertilization occur

Ampulla of the Fallopian tube

58

When does the blastocyst attach to the lining of the uterus

Day 5-8

59

What does the placenta produce

Several hormones to maintain pregnancy

60

When is implantation finished

By day 12 wen Blastocyst is buried in uterine lining

61

What cells form the placenta

Trophoblast and Decidual tissue

62

When is the placenta functional

by 5th week of pregnancy

63

What is the role of progesterone on decidual cells

Stimulates them to concentrate glycogen, proteins and lipids

64

How does the placenta work as a physiological arteriovenus shunt

Maternal blood is pumped into the Intravillus space to exchange nutrients with fetal blood inside the villus

65

What are the three factors that increase fetal oxygen uptake

1. Fetal Hemoglobin
2. Higher hemoglobin conc.
3. Bohr effect. Fetal blood can carry more oxygen in low pCO2 than in high pCO2

66

What electrolytes only go from mother to child

Iron and Ca2+

67

What does Human chorionic gonadotropin do

Prevents involution of the Corpus luteum
Effect on testes of male fetus

68

What is the effect of Human Chorionic Somatomammotropin

GH like effects
Decrease insulin sensitivity in mother
involved in breast development

69

When is Human Chorionic Somatomammotropin produced

from week 5 of pregnancy

70

When is Human Chorionic Gonadotropin produced

Increase from fertilization to about week 10 and then decrease, never cease.

71

What produced progesterone

Corpus Luteum

72

What is the action of progesterone

Development of Decidual cells
Decreases uterus contractility
Preperation for lactation

73

Which hormone is used as an indicator of vitality of fetus

Estriol

74

What is the effect of Estrogens

Enlargement of uterus
Breast development
Relaxation of ligaments

75

What hormone, released by the placenta, increases ACTH release

Corticotropin-
releasing hormone
CRH

76

CRH, released by the placenta, causes what changes in the mother

Increase aldosterone --> BP increase
Increase cortisol --> Edema and insulin resistance --> Gestational diabetes

77

What is the axis, from placenta to effecting hormone, causing hypertension in mother

CRH --> ACTH --> Aldosterone --> Hypertension

78

What hormone, released by the placenta, may cause Hyperthyroidism

HCG
Human chorionic gonadotropin

79

Why may a mother experience hyperparathyroidsism

Because the Calcium demand increases

80

What is the change in Cardiac output during pregnancy

30-50% increase

81

Why is the Cardiac output increased during pregancy

placental circulation
Increased metabolism
Skin- thermoregulation
Renal circulation

82

What are some physiological changes seen in the heart during pregancy

ECG changes
Functional murmurs
Heart sounds

83

When and why does the cardiac output change in later pregnacny

Decreased in last 8 weeks
Uterus compresses vena cava

84

What are the changes seen in Heart rate during pregancy

HR increases up to 90/min to increase Cardiac output

85

What are the changes seen in Blood pressure during the 2nd trimester and why

Drops due to Uteroplacental circulation expands and peripheral resistance decreases

86

What are the physiological changes when there are twins

Cardiac output increases more and blood pressure drops more

87

What is the change in plasma volume during pregancy

Increases proportionally with Cardiac output (50%)

88

What is the change in Erythropoesis (RBC) during pregnancy

Increase with 25%

89

What is the change in hemoglobin concentration during pregancy

Decreased by dilution

90

What is the change in Iron requirements during pregnancy

Increases significantly
6-7mg/day in 2nd half of pregancy

91

What is the effect of progesterone on CO2 levels

Progesterone signals the brain to lower CO2 levels

92

How is CO2 levels decreased

RR increase
Tidal and minute volume increase
pCO2 decrease slightly

93

What is the change in O2 consumption during pregnancy

Increases to meet metabolic need of fetus, placenta, and mother

94

What is the change of Glomerulate filtration rate and renal plasma flow during pregancy

Increases
Up to 30-50% peaks at 16-24 weeks

95

What is the change of Urine formation during pregnacy

Slight increase

96

What postural changes affect renal function during pregnancy

Upright position (decrease)
Supine position (increase)
Lateral position during sleep (Big increase)

97

What is pre-eclampsia

Pregnancy induced hypertension + proteinuria

98

What is the single most significant risk factor for pre-eclampsia

Having had pre-eclampsia previous pregnancy

99

What are the features of pre-eclampsia

Hypertension
Edema formation (swelling)
GFR decreases

100

What are risk factors for pre-eclampsia

Pre-existing hypertension, diabetes, autoimmune disease (lupus) renal disease. FH, obesity and multiple gestation

101

What is Eclampsia

Extreme pre-eclampsia
Vascular spasm, extreme hypertension, chronic seizures and coma
LETHAL without treatment

102

What is the treatment for Eclampisa

Vasodilators and cesarean section

103

What is average weight gain during pregnancy

24lbs

104

What is the weigh gain distribution during pregancy

Fetus - 7lbs
Extra-embryonic fluid/tissue - 4lbs
Uterus - 2lbs
Breasts - 2lbs
Body fluid -6lbs
Fat accumulation -3lbs

105

What is the recommended extra calorie intake during pregancy

250-300 kcal/day increase

106

What is the recommended extra protein intake during pregnancy

increase 30g/day

107

What are the 2 phases of metabolism during pregancy

1-20 weeks - Mother's anabolic phase
21-40 week - Accelerated starvation of hte mother to supplement high metabolic demand of fetus

108

What hormones cause insulin resistance in the mother

Human placental lactogen
Cortisol
Growth hormone

109

Special nutrional need in pregnancy

High protein diet
Iron supplement - 300mg
B-vitamins - erythropoesis
Folic acid
Vitamin D3 +Ca2+ supplement
K vitamin prior to labor

110

What is the action of Progesterone and Estrogen on contractility of uterus

Progesterone inhibits contractility
Estrogen increases contractility

111

Where is Oxytocin from

Maternal posterior pituitary gland

112

What is Oxytocin effect on uterus

Increases Contractions and Excitability

113

What are Braxton Hicks contractions

Sporadic uterine contractions that happens during pregnancy, keep the uterine muscles ready for labor

114

Explain the positive feedback of contractions during labor

Cervix stretch by fetal head increase contractions and increase oxytocin release which increase contractions
Contractions and pain cause neurogenic reflexes from spinal cord induces intense abdominal muscle contractions

115

What are the stages of labor

1st - Cervial dilation (8-24h)
2nd - Passage through birth canal (few-30 min)
3rd - Expulsion of placenta

116

What is the effect of Estrogen on lactation

Growth of ductile system
Inhibit milk production

117

What is the effect of Progesterone on lactation

Development of lobule-alveolar system
Inhibit milk production

118

What is the effect of Prolactin on lactation

Stimulates milk production
Stimulates colostrum

119

What is colostrum

Low volume, protein rich and low fat form of milk.
Aids newborns digestive system

120

What is the newborns first stool called

Meconium

121

What is the effect of Oxytocin on lactation

Increased due to sucking stimulus
Increases milk release

122

Where is Prolactin released from

Anterior pituitary

123

Reproductive organs are developed from which embryological layer

intermediate mesoderm

124

Male reproductive system is developed from which ducts

Wolffian ducts
also called Mesonephric ducts

125

Female reproductive system is developed from which ducsts

Mullerian ducts
aslo called Paramesonephric ducts

126

What controls the testes to descend to the scrotum

The Gubernaculum

127

What is the Gubernaculum

a fibrous cord that connects the fetal testis with the bottom of the scrotum and by failing to elongate in proportion to the rest of the fetus causes the descent of the testis.

128

What are some common abnormalities of the uterus

Double uterus - Double vagina
Double uterus
Bicornate or Unicornate uterus
Septated uterus
Cervical atresia

129

What is the Broad ligament formed from

When the Paramesonephric Ducts fuse

130

What form of Investigation do you use to test Fetal Placenta

Chorionic Villus Biopsy

131

How do you test fetal Skin/Urine cells

Amniocentesis

132

What type of tests are available for blood test of fetus

Fetal blood sampling

133

When is Chorionic Villus Sampling done

Earlier in pregnancy, around week 10-13

134

When is Amniocentesis done

15 weeks and more

135

When is Fetal blood sampling done

18weeks and later

136

When can Fetal DNA from Maternal Blood test be done

8 weeks and up

137

What is the miscarriage risk with Chorionic Villus Biopsy

1-2%

138

What is the viability of tissue in Chorionic Villus Biopsy and Amniocentesis

Chorionic Villus Biopsy - Good
Amniocentesis - Poor

139

Why is Fetal DNA from Maternal Blood test not done more

At this time, only limited analyses available

140

What carries a higher miscarriage risk, Chorionic Villus Biopsy or Amniocentesis

Chorionic Villus Biopsy - 1-2%
Amniocentesis - 0.5-1%

141

What is confined Placental mosaicism

A discrepancy between the chromosomal makeup of the cells in the placenta and the cells in the baby

142

What is FISH genetic testing

Fluoresence In Sity Hybridization
To test for a missing bit of chromosome that is too small to see

143

What are the fetal abnormalities on scanning that indicate aCGH or chromosome analysis

Small size, especially if symmetrical growth failure
Increased nuchal thickness
Structural malformation - ex brain or heart

144

What are the indications for aCGH or chromosome analysis

High risk of chromosomal trisomy on screening
Fetal abnormalities on scanning
Parent has balanced chromosomal rearrangement

145

What is the prenatal screening program in Scotland

Dating ultrasound scan with serum biochemistry - week 12
Serum screening of mom at 16weeks
20 week detailed scan

146

What is Fetal DNA in maternal blood test able to test for at the moment

Sex determination
Trisomy testing

147

What is Duchenne Muscular Dystrophy

rare recessive X-linked form of muscular dystrophy. Dystrophin is disabled. Muscle dystrophy and premature death.

148

What does NIPT stand for in genetic testing

Non-invasive Prenatal testing

149

What is DiGeorge syndrome

22q11 deletion
Hearth defects, learning difficulties, cleft palate and potenitally many other problems

150

_____ is the presence of an abnormal number of chromosomes in a cell, for example when having 45 or 47 chromosomes when 46 is expected in a human cell.

Aneuploidy

151

What is Clinodactyly

Curvature of a digit in the plane of the palm towards the adjacent finger. Commonly fifth finger towards fourth finger.

152

What is the genetic abnormality in Patau Syndrome

Trisomy 13

153

What is turner's syndrome

Missing one X chromosome
45,X
Other variants and mosaicism is possible

154

What is it called when tow acrocentric chromosomes stick to each other

Robersonian Translocation

155

What is it called when there is a balanced translocation

Reciprocal translocation

156

What would aCGH look like in the parent with a balanced translocation

Normal - aCGH only detects imbalance

157

What is reproductive risk in reciprocal translocation in one parent

Most translocations, ~50% normal or balanced
Unbalanced products commonly miscarriage and in some cases causes live birth with abnormalities

158

What is the definition of pre-term birth

Delivery between 24 and 36+6 weeks

159

What are the survival rates in pre-term birth (24,27,32)

24weeks - 20-30%
27weeks - 80%
32weeks - >95%

160

What is the Aetiology of pre-term birth

Infection
Over distention
Placental abrubtion
Intercurrent illness (UTI, pneumonia, appendicitis)
Cervical incompetence
Idiopathic

161

Risk factors for pre-term birth

Previous Pre-term birth
Multiple, twins, (50% risk)
Uterine anomalies
Parity (=0 or >5)
Poor socio-economic status, smoking, drugs (esp cocaine)
Low BMI (

162

What is the definition for Small for Gestational Age (SGA)

Infant with a birth weight that is less than 10th percentile for gestation corrected for maternal height, weight, fetal sex and birth order

163

Causes of Intra Uterine Growth Restriciton (IUGR)

Maternal
Fetal
Placental

164

Fetal factors in poor growth

Infection - Rubella, CMV, Toxoplasma
Congential anomalies - eg absent kidneys
Chromosomal abnormalities - eg Down's

165

Placental factors for Poor growth

Infarcts
Abruption
Often secondary to hypertension

166

What are the two types of Intra Uterine Growth Restriciton (IUGR)

Symmetrical (Everything is small)
Asymmetrical (Only one part is small, head or body)

167

Clinical features of Poor growth

Predisposing factors
Less than expected fundal height
Reduced liquor (amniotic fluid)
Reduced fetal movements

168

When should a fetal heart acceleration occur

At the start of a uterine contraction, returning to baseline rate before or sometimes after the contraction

169

What is looked at during assessment of fetal wellbeing with the biophysical profiles

Ultrasound assessment
Considers
Movement, tone, fetal breathing movements, liquor volume.
Score out of 10. 8-10 satisfactory, 4-6 repeat, 0-2 deliver

170

What is the difference between IUGR and SGA

Intrauterine growth restriction (IUGR) refers to a condition in which a fetus is unable to achieve its genetically determined potential size. SGA is

171

Aetiology of Large for Dates Pregnancy

Wrong dates
Multiple pregnancy
Diabetes
Polyhydramnios

172

What is the definition of Polyhydraminos

Excess amniotic fluid

173

What does Chorionicity refer to in Multiple pregnancy

membrane pattern of the twins

174

What are the different Chorionicity in multiple pregnancy

Dichorionic Diamniotic (completley seperate)
Monochorionic Diamniotic (Share amniotic membrane)
Monochorionic Monoamniotic (Share All membranes)

175

Where is Alpha-Fetoprotein produced

Liver of the fetus

176

How is Multiple pregnancy managed in terms of antenatal visits

More frequent antenatal visits
Detailed anomaly scan at 18weeks
Regular scans from 28 weeks
Routine iron supplementation

177

What is the definition of Gestational Diabetes

Carbohydrate intolerance resulting in hyperglycemia of variable severity with onset or first recognition during pregnancy

178

Blood glucose to diagnose Gestational Diabetes

Fasting => 5.1 mmol/L
2 hour => 8.5 mmol/L

179

What is Freinkels hypothesis

Freinkels hypothesis: abnormal maternal mixture of metabolites gain access to developing fetus modifying phenotypic gene expression in developing cells may lead to short and long term effects

180

Fetal hyperinsulinemia leads to

Decreased levels of arterial O2 and increased EPO

181

First line treatment in Gestational Diabetes

Lifestyle changes
Diet, Weight control and exercise

182

When is pharmacologicial intervention considered in Gestational Diabetes

When lifestyle changes fail
Macrosomia on ultrasound

183

Additional management in pregnancy if maternal Diabetes (1or2)

Pre pregnancy counseling
Fetal anomal scan at 18 weeks
Regular eye checks for retinopathy

184

______ is the portion of the cervix which is touchable and visible through the vaginal canal

Ectocervix

185

What types of cells are in the Ectocervix

Squamous epithelial cells

186

What type of cells are in the Endocervix

Columnar epithelial cells

187

What is the area between Ectocervix and the Endocervix

Transformation zone

188

Where is the postition of the Transformation zone

Position changes during life as physiological response to
Menarche
Pregnancy
Menopause

189

What happens when Endocervical epithelium is exposed to acid environment of vagina

Cervial erosions
Leads to physiological squamous metaplasia

190

What is a mucus-filled cyst on the surface of the cervix called

Nabothian cyst/follicle

191

What types of Inflammatory pathology of the cervix is there

Cervicitis
Cervical polyp

192

What types of neoplastic pathology of the cervix

Cervical Intraepithelial Neoplasia (CIN)
Cervical cancer (Squamous carcinoma, Adenocarcinoma

193

Which HPV type increase risk of Cervical cancer

HPV 16 and 18

194

What percentage of HPV infections leads to cancer

0.8%

195

Risk factors for Cervical neoplasia

HPV
Vulnerability of SC junction in early reproductive life (age at first intercourse, long term OCP, non-use of barrier contraception)
Smoking (3x risk)
Immunosupression

196

Which HPV causes Gential warts

Type 6 and 11

197

What is a Koilocyte

A squamous cell that has undergone a number of structural changes due to HPV infection

198

What changes are seen in a Koilocyte

Nuclear enlargement
Irregular nuclear ccontour
Darker stained nucleus
Clear area around nucleus, perinuclear halo

199

What cancer does HPV cause

Invasive Squamous carcinoma

200

How long does it take from HPV infection-->High grade CIN --> Invasive cancer

HPV infection --6months-3years-->>High grade CIN --5-20years-->>Invasive cancer

201

What is CIN

Cervical Intraepithelial Neoplasia
Dysplasia of Squamous cells
Pre-invasive stage of cervical cancer

202

How is Cervical Intraepithelial Neoplasia diagnosed

On smear test
Non visible and asymptomatic

203

Where does Cervical Intraepithelial Neoplasia occur

At the transformation zone

204

What is the difference between the degrees of Cervical Intraepithelial Neoplasia

Amount of Epithelium from basement membrane and up is involved.
CIN1 - Basal 1/3 abnormal
CIN2 - Basal 2/3 abnormal
CIN3 - Full epithelium thickness involved

205

What is the relation between CIN degree and invasive cancer

CIN1 - only 1% progress to invasion
CIN2 - 5% progress
CIN3 - >12% progress

206

How common is Invasive Squamous Carcinoma

75-95% of malignant cervical tumours
2nd most common female cancer worldwide
12th commonenst in Scotland
1.9% of all cancers in Scotland

207

Where does Invasive Squamous carcinoma develop from

Pre-existing CIN

208

Stages of Invasive Squamous Carcinoma

Stage 1 - In cervix
Stage 2 - Spread to adjacent organs
Stage 3 - Spread to pelvic wall
Stage 4 - Distant metastases or involvement of rectum or bladder

209

Sub staging of Stage 1 in Invasive Squamous Carcinoma

1A1 - depth

210

Symptoms of Invasive Cervical Carcinoma

Abnormal bleeding (post coital, post menopaus, brownish/blood vaginal discharge)
Pelvic pain
Hematuria/urinary infections
Ureteric ovstruction/renal failure

211

What is the local spread of Sqaumous carcinoma of the cervix

Uterine body, vagina, bladder, ureters, rectum

212

What is the Lymphatic spread of Squamous Carcinoma of the cervix

Happens early
To Pelvic and Para-aortic nodes

213

What is the hematogenous spread of Sqamous Carcinoma of the cervix

Happens late
Liver, lungs and bone

214

How is a sqamous carcinoma graded

Well / Moderately / Poorly differentiated
Undifferentiated / anaplastic

215

What is the preinvasive phase of endocervical adenocarcinoma called

Cervical Glandular Intraepithelial Neoplasia (CGIN)

216

Is Cervical Glandular Intraepithelial Neoplasia screened for on cervical smears

Possible but difficult to diagnose
Screening is less effective

217

Which has the best prognosis, Endocervical Adenocarcinoma or Squamous carcinoma

Endocervical Adenocarcinoma

218

Which HPV is related to Endocervical Adenocarcinoma

HPV 18

219

Other HPV driven diseases

Vulvar Intraepithelial Neoplasia (VIN)
Vaginal Intraepithelial Neoplasia (VaIN)
Anal Intraepithelial Neoplasia (AIN)

220

Vulvar Invasive Squamous Carcinoma spread to which lymph nodes

Inguinal Lymph nodes

221

Treatment of Vulvar Invasive Squamous Carcinoma

Radical Vulvectomy and inguinal lymphadenectomy

222

What is Vulvar Paget's disease

noninvasive intraepithelial adenocarcinoma in the Vulva. Crusting rash, arise from sweat glands in the skin

223

What are the gland duct posteriolateral to the vagina called

Bartholin's gland

224

Difference between Screening and Diagnostic testing

Symptoms require diagnostic testing
Screening testing is for asymptomatic patients

225

What is dyspareunia?

Difficult or painful sexual intercourse

226

What is the Cervical Screening programme in Scotland currently

Women aged 20-60
Every 3 years
Speculum examination, brush sample send for cytology

227

What is the Cervical Screening programme in Scotland after April 2016

25-64years
Every 3 years until 49, then every 5 years

228

Screening testing, what is Coverage

Screened population/Eligible population
% people getting screened of all people

229

Screening testing, what is Uptake

Screened population/Invited population
% people who accept the invitation to become screened

230

Age of HPV vaccination

Girls aged 11-13

231

After treatment of CIN, what is the follow up and what is done then

at 6 months
Another smear test + HPV testing

232

What kind of drug is Labetaolol and can it be given in pregnancy

a and b blocker (Lowers BP)
Given troughout pregnancy

233

What kind of drug is Betamethasone and can it be given in pregnancy

Corticosteroid which crosses placenta
Given below 36 weeks gestation to prevent neonatal complications of premature delivery (incl. Respiratory neonatal distress syndrome)

234

What kind of drug is Hydralazine and can it be given in pregnancy

Direct acting vasodilator (lowers BP)
Given during labor

235

What kind of drug is Magnesium sulphate and can it be given in pregnancy

Decrease calcium uptake by smooth muscle, prevents fits and lowers blood pressure

236

How much and when is Folic acid given

Before pregnancy and up until week 12 of pregnancy
400 micrograms of folic acid each day

237

Why is folic acid given in pregnancy

it can help to prevent birth defects known as neural tube defects, including spina bifida

238

How much of Vitamin D should be taken during pregnancy

10 micrograms/day

239

Why is Vitamin D taken in pregnancy

Prevent soften bones and Rickets.

240

What is the definition of anemia in pregnancy

Hb

241

What are the guidelines on Iron supplement

It is not routinely prescribed
If iron levels are low, iron supplements are prescribed

242

What is used to prevent heartburn in pregnancy

Lifestyle changes
Anti-acid (Rennie, Gaviscon)

243

Which antibiotics should be avoided in pregnancy

Cephaloporins - May be safe but best avoided
Aminoglycosides - only if life-threatning
Tetracyclines - only if absolutely necessary
Macroglides - none except Erythomycin
Fluoroquinoles

244

Which antihypertensive drugs are used in pregnancy

Labetalol
Nifedipine and Methyldopa may be used

245

Which anticonvulsant drug is used in severe preeclampsia

Magnesium sulfate IV