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Finals Club (Dundee Medicine Master Summary Deck) > Year 3: Sexual Health and Reproduction > Flashcards

Year 3: Sexual Health and Reproduction Flashcards

Everything you need to know to pass for Sexual Health and Reproduction in Dundee Medical School (403 cards)

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1
Q

Presentation of Chlamydia

A

Female:

  • 70% Asymptomatic
  • Dyspareunia
  • Bleeding post sex
  • Watery clear discharge

Male:

  • 50% asymptomatic
  • Dysuria
  • Discharge
  • Epididymitis
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2
Q

Chlamydia trachomatis

A

Chlamydia

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3
Q

Serovers A-C for chlamydia

A

Eye trachomatis

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4
Q

Serovers D-K for chlamydia

A

Genital Chlamydia

“D-K for dick”

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5
Q

Serovers L1-L3 for chlamydia

A

LGV lymph: Lymphogranuloma venereum

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6
Q

Chlamydia typically affects ages

A

20-24

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7
Q

Test for chlamydia after

A

14 days since exposure

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8
Q

Investigations for chlamydia

A

Combined: Nucleic Acid Amplification Test (NAAT)/ PCR

  • Male: First pass urine
  • Female: Vaginal swab
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9
Q

Treatment for Chlamydia

A
  • Doxycycline (7 days) Twice per day

Pregnant: Azithromycin

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10
Q

Presentation for Gonorrhoea

A

Females:

  • 50% asymptomatic
  • Vaginal discharge (green pus)
  • Dysuria
  • Pelvic pain

Males:

  • Purluent discharge (green)
  • Dysuria
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11
Q

Neisseria Gonorrhea

Gram-negative (2 kidney beans facing eachother)

A

Gonorrhea

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12
Q

Investigations for Gonorrhea

A

Combined: Nucleic Acid Amplification Test (NAAT)/ PCR

Male: First pass urine

Female: Vaginal swab

MSM: Rectal swab

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13
Q

Treatment for Gonorrhea

A

Ceftriaxone IM

If refused: Cefixime

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14
Q

Primary Syphilis

A

Chancre (painless ulcer at site of infection)

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15
Q

Secondary Syphilis

A
  • Macules on hands and soles
  • Snail track ulcers
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16
Q

Latent Syphilis

A

No symptoms

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17
Q

Tertiary Syphilis

A

CVS and CNS effects “Neurosyphilis” etc

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18
Q

Treponema Pallidum

Spiral organism, 21 days incubation

A

Syphilis organism

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19
Q

Investigations for Syphilis

A
  • Swab of a lesion: PCR/ dark film microscopy
  • ELISA (IgM, IgG) + TPPA- to diagnose
  • VRDL + RPR- how active disease is
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20
Q

Treatment for Syphilis

A

Penicillin G (IM)

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21
Q

Herpes Simplex Virus (HSV) causes

Enveloped shaped virus, migrates to sacral root ganglion to hide

A

Herpes

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22
Q

Herpes presentation

A

Painful blisters and ulcers

Lymphadenopathy

Fever

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23
Q

Type 1 HSV causes

A

Cold sores

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24
Q

Type 2 HSV causes

A

Genital Herpes

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25
Investigations for Herpes
Swab and PCR
26
Treatment for Herpes
Aciclovir 5% topical lignocaine
27
Human Papilloma Virus (HPV) 1 and 2 cause
Palmer warts
28
Human Papilloma Virus (HPV) 6 and 11 cause
Anogenital warts - "thickened cauliflower epithelium"
29
Human Papilloma Virus (HPV) 16 and 18 cause
Cervical cancer
30
Vaccinations for HPV
**Gardasil: 6, 11, 16, 18** * Females 11-13 * MSM
31
Treatment for Genital warts
* Podophyllotoxin cream * Imiquimod cream * Cryotherapy
32
Trichomonas Vaginalis is a
protazoal parasite
33
Trichomonas vaginalis presentation
* Purulent green frothy vaginal discharge * Musty odour * Itchy * Strawberry spots "strawberry cervix"
34
Investigations for Trichomonas vaginalis
High vaginal swab for microscopy
35
Treatment for Trichomonas vaginalis
Metronidazole
36
Candida Albicans is a
fungal infection
37
Candida albicans presentation
* White discharge like "cottage cheese" * Intense itch * Common in immunocompromised or diabetics
38
Investigations for Candida albicans
HVS for culture
39
Treatment for candida albicans
Oral fluconazole Topical Cotrimazole
40
Phthirus Pubis are
pubic lice
41
Treatment for pubic lice
Malathion lotion
42
Investigations for HIV
* 3rd gen: IgM and IgG antibodies = sensitive after 3 months * 4th gen: p24 antigen = sensitive after 1 month * Rapid HIV fingerprick testing
43
Gardnerella vaginalis causes Coccobacilli
Bacterial vaginosis
44
Presentation of bacterial vaginosis
* Thin watery discharge * Stinks of fish (due to hydrogen peroxide) * pH of vagina is \> 4.5
45
Investigation for bacterial vaginosis
HVS for microscopy - Clue cells can be seen
46
Treatment for bacterial vaginosis
Metronidazole
47
Normal vaginal flora
Lactobacillus
48
Risks of contracting HIV
* Black * IVDU * MSM (anoreceptive especially) * Vaginal delivery (25%)
49
In pregnancy with HIV mothers should
* Opt for C-section if high viral load * Never breastfeed * Mothers should take HAART indefinitely * Infants should take PEP for 4 weeks
50
Acute HIV infection
13 weeks
51
Viral replication for HIV
6-12 hrs
52
HIV reduces
CD4+ T cells through CCRJ surface receptor, this makes the individual more susceptible to infection
53
Normal CD4+ count is
\>500 Anything \< 200 = infectinon risk
54
Treatment for HIV
HAART (Highly Active Antiretroviral Therapy) * **Tenofovir:** nucleoside reverse transcriptase inhibitors(NRTI) * **Emtricitabine**: nucleoside reverse transcriptase inhibitors(NRTI) * **Efavirenz:** non-nucleoside reverse transcriptase inhibitor (NNRTI)
55
Side effects of tenofovir
Nephrotoxic
56
Side effects of Efavirenz
* Sleep disturbance * Mood disorders
57
Post Exposure Prophylaxis should be taken
within 72hrs for 28 days
58
Cancers that AIDS (acquired immune deficiency syndrome) increases risk of
* NHL (EBV) * Cervical Cancer (HPV) * Kaposi's Sarcoma (HHV8 herpes)
59
Infections AIDS increased risk of
* Progressive Multifocal Lymphadenopathy (PML) * Pneumocystis Pneumonia * Cerebral toxoplasmosis- when \<150 CD4+ toxoplasma gondi * Cytomegalovirus- when \< 50 CD4+ * TB
60
PML is caused by
John Cunningham virus
61
Pneumocystis Pneumonia is caused by
Pneumocystis jiroveci
62
Treatment for Pneumocystis pneumonia
Cotrimoxazole
63
Cerebral toxoplasmosis is caused by
toxoplasma gondi
64
Treatment for Toxoplasmosis
Pyrimethamine and Sulfadiazine or cotrimoxazole
65
TB is caused by
Mycobacterium Tuberculosis
66
Menstruation lasts
28 days \<21 days = Polymenorrhea \>35 days = Oliomenorrhea
67
Normal volume of blood per period (cycle)
80ml Any more than this (and for an extended period of time) is considered menorrhagia
68
Peak bleeding occurs
1-2 Days in
69
No periods in \> 6 months is
amenorrhoea
70
Menometrorrhagia
Spotting between periods
71
Menstrual cycle is split into two phases divided by ovulation
* Follicular phase (starts at day 1) - Menstrual stage - Proliferative stage * Ovulation (day 14) * Luteal phase (ends at day 28) - Secretory phase
72
Oestrogen is responsible for
Follicular phase
73
Progesterone is responsible for
Luteal phase
74
At ovulation, there is a
LH spike
75
Progesterone is secreted by
the corpus luteum
76
Progesterone peaks
7 days after ovulation 7 days before day 28
77
Fertility testing tests
Progesterone 7 days before end of period
78
Hypothalamus produces
GnRH
79
GnRH then stimulates
Anterior pituitary to produce LH and FSH
80
LH stimulates
Theca cells to produce androgens
81
FSH stimulates
granulosa cells to convert androgens to oestrogen (by aromatase)
82
Oestrogen then goes on to
proliferate endometrial growth
83
A women is most fertile on
days 12, 13, 14
84
In males LH stimulates
Leydig cells to produce testosterone
85
In males FSH stimulates
sertoli cells to enhace spermatogenesis
86
Anti-mullerian hormone is used to measure
Ovarian reserve (levels of oocytes)
87
B-hCG (Human chorionic gonadotrophin)
* Secreted by syncytiotrophoblasts (early placenta structure) * Is used as a pregnancy test * Can also be very high in molar pregnancies, and ectopic pregnancies
88
Oestrogen increases
Breast development
89
Progesterone increases
breast tissue growth
90
Prolactin increases
mammary gland growth in breasts
91
Prolactin is inhibited by
dopamine
92
45 XO- missing an X * Only effects females * No pubic hair * Small breasts * Amenorrhea * Short stature * Webbed neck
Turner's syndrome
93
47 XXY- extra X * Only males * Wide hips * Tall * Reduced facial hair * Female pubic hair * Testicular atrophy * Gynecomastia
Kleinfelter's Syndrome
94
47 XXX * Tall * Low IQ * Reduced motor and speech development
Triple X
95
Menopause happens around
51 ## Footnote \< 40 = premature \< 45 = early \> 54 = late
96
What can cause premature menopause
* Past chemotherapy * Mumps * No oocytes (taken out in surgery etc)
97
Symptoms of Menopause
* Hot flush * Mood swings * DUB * Decreased collagen = vaginal dryness * Weight gain * Osteoporosis * Increased LH and FSH
98
Treatment for menopause
* 1st: **HRT (oestrogen and progesterone)** = COC - Can take just oestrogen if you have had a hysterectomy * Clonidine (Alpha agonist) for hot flushes
99
Oestrogen and desogestrel (type of progesterone)
Inhibit ovulation
100
All other progesterones
thicken cervical mucus
101
Combined Oral Contraceptive contains
Oestrogen and desogestrel (type of progesterone)
102
Method of COC
Inhibits ovulation
103
COC is useful for
* Controlling acne * Controlling heavy bleeding
104
COC increases the risk of
* Venous thromboembolism * Cervical cancer * Breast Cancer
105
COC is protective for
* Ovarian cancer * Endometrial cancer
106
COC is contraindicated in
* BMI \> 35 * Patients on PPIs (effects drugs) * Patients on Carbamazepine (effects drugs) * Migraines with Aura * 6 weeks post pregnancy * Thrombophilias * Immobile people * Smoking \> 15/day * Past VTE * PHx of Breast cancer
107
Starting COC
Day 1-5: no need for additional contraception Day 5+: Additional contraception for 7 days
108
Missed COC and no UPSI
1 pill: take ASAP 2 pills: take ASAP + additional contraception for 7 days
109
Missed pills and UPSI
* Week 1: EC required * Week 2: EC required * Week 3-4: omit pill-free interval
110
Progesterone Only Pills
Old: Progesterones New: Desogestrel
111
Old POPs method of action
Thicken cervical mucus
112
New POP
Inhibits ovulation
113
POP increases risk of
Breast cancer
114
If you miss a POP then
* EC is required * Additional contraception for 2/7 days
115
Depo-Provera
IM Progesterone given every 12 weeks
116
Method of Depo-Provera
* Inhibits ovulation * Thickens cervical mucus * Thins endometrium
117
Side effects of depo-provera
* Weight gain * Decreased fertility for 3 months after stopping
118
Starting depo-provera
First 5 days 5 days + = additional contraception for 7 days
119
Intra-Uterine System (IUS) "Mirena"
Hormonal coil containing progesterone
120
Method of IUS
Thins endometrium
121
IUS is used for
5 years
122
Starting IUS
Within first 7 days 7 days + = additional contraception for 7 days * Can start post pregnancy either \<48hrs or after 4 weeks * Can start immediately after TOP
123
IUS is often used to give women
Lighter and less frequent periods
124
Implant "Nexplanon"
Subdermal rod that contains progesterone
125
Method of implant
Inhibits ovulation
126
implant is used for
3 years
127
Start implant
First 5 days First 5 days + = additional contraception * 5 days post TOP * \< 21 days post-partum
128
Most effective contraceptive
Implant
129
Intra-Uterine Device (IUD)
Copper coil
130
Method of IUD
Toxic to sperm and egg
131
Start IUD
First 7 days * Can be used up to 120hrs post UPSI * \<48hrs or after 4 weeks post pregnancy * Immediately after TOP
132
IUD lasts for
5 years (sometimes 10)
133
What is required in a vasectomy
* Contraception for 8 weeks * Post-procedure semen analysis to confirm
134
3 types of emergency contraceptives
* Levonelle (oral) * EllaOne (oral) * IUD
135
Levonelle
Contains levonorgestrel (Increases progesterone) Used up to 72 hours post-UPSI
136
EllaOne
Contains ulipristal acetate (blocks progesterone) Used up to 120 hours post-UPSI
137
When taking Emergency contraception you must
* Repeat dose if you vomit (for orals) * Follow up pregnancy test in 3 weeks
138
Termination of pregnancy can happen
* 23+6 weeks for social TOP * Any time for an anomaly/ emergency
139
Medical TOP
* Early (\< 9 weeks) **Mifepristone + Misoprostol** * Late (9-12 weeks) **Mifepristone + Prostaglandins** (3 hourly) No more than 5 in 24hrs * Mid-trimester (12-24 weeks) Mifepristone + Prostaglandins (3 hourly)​ No more than 5 in 24hrs
140
Mifepristone
Used to terminate pregnancy
141
Misoprostol (synthetic prostaglandin) + prostaglandins
Push foetus out
142
Surgical TOP
* 6-12 weeks = Vacuum aspiration * 12-24 = Dilatation and Excavation
143
During Surgical TOP
* Fit with IUD/IUS * If woman is rhesus negative then give Anti-D within 72hrs
144
After TOP
follow up with pregnancy test 2-3 weeks later
145
Due to testosterone and Mullerian inhibiting factor in males
**Wolffian ducts will become the reproductive tract** Mullerian ducts will degenerate "Wolffian = male alpha like wolf"
146
In females
**Mullerian tracts will become the reproductive tract** Wolffian ducts will degenerate
147
a condition in which one or both of the testes fail to descend from the abdomen into the scrotum
Cryptorchidism
148
Cryptorchidism increases your risk of
testicular cancer
149
Treatment for Cryptorchidism
Orchidopexy (Moving testicles from abdomen into scrotum)
150
Androgen Insensitivity syndrome
Genetically male (XY) but is resistant to male hormones * Symptoms don't appear until puberty * Phenotypically is female * Undescended testes * X-linked recessive
151
Imperforate hymen can cause
* Amennorrhea * Abdominal pain * Usually presents around time of menarche * Normal breast development
152
Normal testicular size
12-25ml
153
* Primary amenorrhea * Undefined sexual characteristics * Small testicle volume Low LH and FSH No sense of smell (anosmia)
Kallman's syndrome (hypogonadotropic hypogonadism) * Failure to produce GnRH * Failure to start puberty
154
High GnRH Low FSH/ LH Low oestrogen
Pituitary dysfunction
155
* Non-functioning pituitary * Post-partum haemorrhage
Sheehan's Syndrome
156
Reasons for infertility in men
* CF * Hypogonadism (Kleinfelters etc) * Cryptorchidism * Testicular tumour * Due to previous chemo/radio therapy * Vasectomy * Drugs
157
Reasons for infertility in women
* PID * PCOS * Structural damage etc
158
For a couple to try IVF they need to have been trying for a baby for
2 years
159
Drug treatments in IVF
* GnRH agonist (buserelin) used to down regulate cycle * FSH and LH given 36 hours prior to implantation
160
* Rapid weight gain (15kg in 10 days) * Decreased urine output * Abdominal pain * Shortness of breath * Vomiting/ nausea * Tight abdomen
Ovarian Hyperstimulation Syndrome (Increased GnRH (from IVF medication) causes extensive luteinization ant release of VEGF, causing leaky vessels and hypovolaemia)
161
Small white mucus-filled cyst on the cervix
Nabolthian cyst
162
Cervical polyps
* Benign tumours * Usually asymptomatic * Tx: - take them out
163
Clear, non-smelling vaginal discharge
Cervial ectropion | (completely normal)
164
Cervical cancer screening
* Starts age 25 * Every 3 years until 50 * Then every 5 years until 64
165
Inside the cervix is
columnar (secretory tissue)
166
Outside the cervix is
Squamous
167
In cervical cancer HPV 16, 18
block p53 (tumour suppressor)
168
Risk factors for Cervical cancer
* Early reproductive age * Many partners
169
Koilocytes
Cells infected by HPV | (peri-nuclear halos)
170
CIN1
1/3 (basal)
171
CIN2
(2/3)
172
CIN3
Full thickness
173
If smear is inadequate then
repeat
174
If smear is inadequate 3 times then
Colposcopy
175
Low-grade dyskaryosis
repeat smear (6 months)
176
If smear is abnormal or HPV positive
colposcopy and biopsy
177
High grade dyskaryosis
Urgent colposcopy and biopsy
178
CIN 1
repeat biopsy in 6 months
179
CIN 2/ CIN3
LLETZ Laser ablation Cryotherapy
180
Test for cure
Smear and HPV test
181
* Middle aged * Bleeding post sex, during cycle * Brown/ blood discharge * Pelvic pain
Cervical Cancer * Squamous cell carcinoma (majority) * Adenocarcinoma (glandular) - minority
182
Staging for Cervical Cancer
1. Confined to cervix (a= microscopic, b= visible) 2. Local extension to adjacent organs 3. Involves pelvic wall 4. Distant mets/bladder
183
Stage 1a cervical cancer Treatment
Biopsy
184
Stage 1b cervical cancer treatment
Radical hysterectomy
185
Stage 2+ cervical cancer treatment
Radiotherapy Chemotherapy (Cisplatin)
186
Vulvar intraepithelial neoplasia (cancerous warts on/in vagina)
Found in old woman most commonly
187
* Ivory-white plaques * Patches with glistening surface on vulva * Redness * Itching
Lichen scelrosus of vulva
188
* Glandular cancer (slow growing) * Crusting rash * Red, velvety area with white islands of tissue on the vulva * Post menopausal * To do with apocrine glands
Vulvar Paget's Disease
189
Uterine prolapse Descent of uterus into the vagina
* 1st degree: Cervix remains in vagina * 2nd degree: Cervix at vaginal orifice * 3rd degree: Cervix is outside the vagina * Uterine procidentia: Entirely outside the vagina
190
Vaginal prolapse Herniations of other pelvic organs through vagina wall
* Cystocele (anterior)- bladder * Enterocele (middle/apical)- intestines * Rectocele (posterior)- rectum
191
* Pelvic lump * Dragging sensation * Incontinence
Prolapse
192
Prolapsed uterus/vagina management
* Weight loss / stop smoking * Pessaries * Sacrospinus fixation surgery
193
* Increased B-hCG * Grape-like clusters * Chorionic villi * Nausea and vomiting * Large mass in uterus
Molar pregnancy
194
Snowstorm appearance on abdominal USS
Molar pregnancy
195
Partial mole
1 egg and 2 sperm
196
Egg with no DNA and 1 or 2 sperm
Complete mole
197
Endometrial hyperplasia
* \>4mm post menopause * \>16mm pre menopause
198
Treatment for endometrial hyperplasia
IUS Severe: Dilation and curettage
199
Investigations for AUB bleeding
TVUS
200
Endometritis
* Abnormal bleeding * Fever * Abdo pain
201
Uterine fibroids
Benign smooth muscle tumour in uterus Leiomyoma
202
Uterine fibroids presentation
* Afrocarribean woman * Menorrhagia * Uterine mass * Pain * Infertility * Red degeneration pain of fibroid dying
203
Treatment for uterine fibroids
* Mirena * Hysterectomy bed rest and analgesia for Red degeneration pain
204
Adenomyosis
Endometrium is in the myometrium
205
Risk factors for endometrial carcinoma
* Oestrogen * PCOS * Lynch Syndrome
206
Endometrial carcinoma staging
1. Confined to uterus 2. Cervical involvement 3. Ovaries/tubes involvement 4. Other organs invovled
207
2 types of endometrial carcinomas
* Endometrioid * Serous
208
Endometrioid Carcinoma
* Oestrogen driven * Endometrial hyperplasia is precursor * good prognosis
209
Serous carcinoma
* p53 driven * Worse prognosis
210
Post menopause bleeding
Endometrioid cancer
211
Treatment for Endometrioid and Serous Carcinomas
Hysterectomy and bilateral salpingo-oophrectomy + Radio/ chemo if needed
212
Treatment for endometriosis
* 1st: COC / Mirena * 2nd: GnRH agonist * Laparoscoptic ablation
213
* Dysmennorrhoea * Menorrhagia * Dyspareunia * Painful defecation * Pelvic pain is CYCLICAL
Endometriosis Endometrial glands occur anywhere outside uterus, free blood causes irritation and fibrosis
214
Treatment for painful periods
Mefenamic acid and ibuprofen
215
Treatment for heavy period bleeding
Tranexamic acid
216
Ovarian cysts
* Follicular * Luteal * Endometriotic
217
Chocolate cysts
Endometriotic cysts
218
* Amenorrhea * Obese * Insulin resistance- Diabetics * Hyperandrogenism- hirtuism, acne * Increased testosterone * Increased LH:FSH ratio (LH is massive, FSH normal) * Enlarged follicular cysts (\>10ml) on USS
Polycystic ovarian syndrome
219
Treatment for PCOS
* **Weight loss** * Not wanting family: **COC + metformin** (to increase insulin resistance ) * Wanting family: **Clomifene citrate** (ovarian stimulant) + metformin
220
Risk factors of Ovarian cancers
* BRCA 1/2 * HNPCC gene (Lynch Syndrome) * Age * Late Menopause * Nulliparous
221
3 subtypes of ovarian cancers
* Epithelium: Serous, endometrioid, mucinous, clear cell * Germ cell: Teratoma (dermoid cyst) * Stroma: Granulosa cell, theca/leydig cell, fibroma
222
Symptoms of ovarian cancer
* Mass/swelling bloating * Decreased appetite * Urinary incontinence * Fatigue, malaise * Leg oedema * Similar presentation to IBS
223
Yellow cyst means
benign
224
Most common ovarian cancer
Serous
225
* Most common cancer \<25 * Produces T3 sometimes * Contains bones, teeth, fat etc
Teratoma (dermoid cyst)
226
Oestrogen producing ovarian tumour
Granulosa
227
Androgen producing ovarian tumour
Theca/leydig cell
228
* Ovarian tumour * Ascites * Pleural effusion
Meig's syndrome
229
Lynch syndrome
* Colorectal cancer * Endometrial cancer * Ovarian cancer * More cancers
230
Lynch Syndrome gene
HNPCC
231
CA-125
Indicates ovarian cancer (serous)
232
Treatment for Ovarian cancer
Surgery to remove + chemotherapy
233
Ovarian cancers drain towards
Para-aortic lymph nodes
234
Ovarian Cancer Staging
1. a) 1 ovary b) 2 ovaries 2. Invaded close by structures 3. Invaded lymph nodes 4. Distant
235
Uterine cancers (fundus) drain to
Para-aortic lymph nodes
236
Cervical cancer drains to
internal iliac nodes
237
Levator ani is supplied by
* Pudendal nerve (S2, 3, 4, 5) * Nerve to levator ani (S3, 4, 5)
238
Pelvic pain line
Levator ani
239
Supply to above the pelvic pain line
* Visceral (Superior)- touching peritoneum - Sympathetics (T11-L2) * Visceral (Inferior)- not touching peritoneum - Parasympathetics (S2,3,4)
240
Supply to below the pelvic pain line
Somatic: Pudendal nerve (S2, 3, 4)
241
Spinal anaesthesia blocks
All 3 areas that supply the pelvis
242
Pudendal nerve block is administered at
Ischial spine (4 or 8 o'clock)
243
Spinal anaesthesia and Epidural are administered at
L3/4
244
Epidural is administered in
epidural space
245
Spinal anaesthesia is administered in
Subarachnoid space into CSF
246
In pregnancy the placenta produces
Corticotropin-releasing hormone (CRH)
247
CRH then stimulates
ACTH production in the pituitary
248
ACTH then stimulates the production of
* Aldosterone from zona glomerulosa * Cortisol from zona reticularis
249
In pregnancy aldosterone
Increases blood pressure- causing pre-eclampsia
250
In pregnancy cortisol
causes oedema and insulin resistance- gestational diabetes
251
1st trimester
up to 12 weeks
252
2nd trimester
28 weeks
253
3rd trimester
40 weeks
254
In the first trimester
BP decreases, HR increases
255
Premature dates
* Extreme pre-term: 24-28 weeks * Very preterm: 28-32 weeks * Preterm: 32-37 weeks * Term: 37-40
256
Oestriol is a measure of
Foetal vitality
257
At every pregnancy appointment check
* Fundal height * BP * Proteinuria * Psych evaluation
258
Screenings at 10 weeks
* Booking visit with midwives * First blood tests * Urine culture
259
Screenings at 10-13 weeks
Booking scan
260
Screening at 11-13 weeks
* Down Syndrome Scan (nuchal translucency)
261
Screening at 16 weeks
Check for proteinuria
262
Screening at 18-20 weeks
Anomaly scan
263
Screening at 28 weeks
* Second screening for anaemia + RBC alloantibodies * First Anti-D prophylaxis
264
Screening at 34 weeks
Second Anti-D prophylaxis
265
Screening at 36 weeks
External cephalic version
266
Healthy Start Scheme Vitamins
* **Folic acid 400 micrograms** (12 weeks before and after conception) 5mg for Diabetics/ Epileptics Prophylaxis against neural tube defects * **Vitamin D 10 micrograms** * **Vitamin C 70mg**
267
Take Vitamin C if you have
CF Beware as it is teratogenic
268
Food/behaviours to avoid in pregnancy
* Delhi foods, cheese, tune, pate, liver, raw eggs * Alcohol * Smoking *
269
Extra calories needed in pregnancy
250
270
Breastfeeding should be encouraged for
6 months - 1 year
271
Hyperemesis Gravidarum "Morning Sickness"
* 1st trimester * Extreme sickness and vomiting * Loss in weight and reduced liver function * Caused by B-hCG
272
Treatment for Hyperemesis Gravidarum
Cyclizine Prochlorperazine
273
Gestational Diabetes
* Increase in insulin due to the increased exposure to glucose * Can lead to macrosomia, organomegaly, polyhydramnios Tx: Decrease sugar intake immediately
274
Pre-Eclampsia
HTN and proteinuria in pregnancy * 140/90 twice or 160/110 once after 20th week gestation * Oedema * Proteinuria \>0.3g/l
275
Notch sign on umbilical cord artery is a predictive sign of
Pre-eclampsia
276
Prophylactic treatment for pre-eclampsia
Aspirin from week 12 onwards
277
First line treatment for Pre-eclampsia
**Labetalol** Contraindicated in asthmatics- use nifedipine
278
Eclampsia is
Pre-eclampsia and a seizure
279
Treatment for Eclampsia
Delivery baby via C-section * Magnesium sulphate (to control seizure) * If seizure persists then Diazepam Post-partum (after delivery): use sytoncinin (oxytocin) to contract uterus
280
Oxytocin causes
* Uterine contractions * The uterine to fully contract in on itself after delivery * Bonding between mother and child
281
Ergometrine
Contracts uterus causes HTN
282
Haemolysis Elevated Liver enzymes Low Platelets
HELLP Syndrome Happens in some cases of pre-eclampsia * RUQ pain
283
Braxton Hicks Contractions
Pre-labour contractions that train your uterus for labour
284
Latent phase of Labour
* 4-10cm dilated cervix * mild irregular contractions * last around 10s
285
Active phase of labour
* 4-10cm dilated cervix * foetus descends * rhythmic contractions 3-4 within 10 mins * last 45 seconds
286
Second phase of labour
* 10cm until delivery * Nullparis women (\<2hr) * Multiparis women (\<1hr) If women have had an epidural then expect to add 1 hr
287
Third phase of labour
* Delivery until expulsion of the placenta * 5-10 mins (\<30mins) * Active management: give syntometrin
288
Syntometrin
Oxytocin and ergometrine
289
Bishop's Score * Dilated * Effacement (thin/ripe cervix) * Position * Station * Consistency (soft cervix)
Means it is safe to induce labour * \<3 = induction will be unsuccessful (C-section) * \< 5 = need induced * 9+ = labour will be spontaneous (normal)
290
During labour
Oestrogen increases Progesterone decreases
291
The foetus secretes ACTH to the mother to produce
oxytocin which helps induce contractions
292
Hyaluronic acid is responsible for
softening the cervix
293
As progesterone decreases during labour
Prolactin increases
294
Pelvic inlet
Transverse is wider than AP diameter
295
Pelvic Outlet
AP is taller than the transverse width "because P comes out"
296
At the Pelvic inlet the baby's head is
transverse and in line with the ischial spines
297
After head is transverse and in line with ischial spines
Engagement You can only feel 2/5ths of the baby's head (The rest is inferior)
298
After engagement comes
Flexion of the neck (chin on chest)
299
After flexion of the baby's head in labour comes
Internal rotation
300
After internal rotation comes
Extension of the neck at pelvic outlet (Occipitoanterior) "Baby's hair is at pubic pair"
301
After extension of the neck comes
Crowning of the baby's head
302
After crowning comes
external rotation when the head is fully out
303
External rotation allows
posterior shoulder to be delivered first
304
Once fully delivered you should
* Allow skin to skin contact * Delay cord clamping for 3 mins (5 mins in premature)
305
CTGs
``` # Define Risk = Low/high? ``` Contractions: regular? how many in 10mins Baseline RAte: 110-160 HR? Variation: 10-15bpm is goal Accelerations: \>15bpm Decelerations: Early = fine, late = bad Overall thoughts
306
If there is failure to progress then do a USS doppler
* Every 15 mins during active phase * Every 5 mins during second phase
307
Treatment for pain in labour
* Nitrous oxide (Entonox) * Pethidine injection (opioid) * Epidural
308
Breech presentation management
* Complete (2 feet down): C-section * Footling (1 foot down): C-section * Frank (bum down): External cephalic version at 36 weeks
309
Transverse presentation management
C-section
310
OP presentation management
C-section
311
OA presentation management
Normal delivery
312
3 P of foetal distress
* Power: Contractions * Passage (shape of pelvis) * Passenger (wrong position)
313
To increase contractions give
Syntocin (oxytocin)
314
Normal Pelvis
Gynaecoid pelvis
315
Pelvis with large AP length "Easter egg-shaped"
Antrhopoid
316
Triangle/heart shaped
Android shaped "Androids do have hearts!"
317
pH \>7.25 in labour is
expected
318
pH \<7.2 is
C-section immediately
319
If foetus is distressed
* Stop syntocin (contractions) * Give terbutaline (stops contractions)
320
If a baby is born pre-term give them
* Steroids for lung maturation * Magnesium sulphate for neuro protection
321
Types of Antepartum Haemorrhage (APH)
* Miscarriage * Ectopic Pregnancy * Molar pregnancy * Chorionic haematoma * Placenta previa * Placenta accreata * Vasa previa * Placentra abruption * Uterine rupture
322
Miscarriage presents with
More blood than pain
323
Types of miscarriages
* **Missed** (OS closed + no bleeding + no foetal HR/ empty sac) * **Threatened** (OS Closed + vaginal bleeding + foetal HR) * **Inevitable** (OS open + bleeding + products above OS) * **Incomplete** (OS open + bleeding and some products in vagina, some remain in uterus) * **Complete** (OS open + bleeding + all products in vagina)
324
Ectopic pregnancy
More pain than blood Shoulder and abdo pain (usually specific to one side)
325
Ectopic pregnancy investigations
* B-hCG is raised * USS shows empty sac * If ruptured: whirlpool effect
326
Treatment of Ectopic pregnancy
Surgery (salpingectomy)
327
Chorionic Haematoma
* The pooling of blood between the chorion and the uterine wall * Self-resolving * Cramping pain
328
* Painless bleeding * Soft non-tender uterus
Placenta previa Placenta is attached near OS * \>2cm from os = vaginal delivery * \<2cm from os = C-sectiom
329
In placenta previa do not do
vaginal exam
330
Investigations for AHP
TVUS
331
Placenta accreta
Placenta is attached too deeply (into the myometrium) * Risk of severe bleeding when placenta is expelled at delivery
332
Treatment of placenta accreta
Internal iliac balloon
333
Vasa previa
* Cord is overlying the OS * Painless bleeding * Has usually had a C-section in the past
334
Treatment for Vasa Previa
* C-section at 35-36 weeks * Admit at 32 weeks and give steroids
335
Placental abruption
Placenta becomes detached from uterus * Sudden severe pain * 'woody', hard and tender uterus * vaginal bleeding
336
Uterine wall rupture
* Loss of contractions * Abdo pain and shoulder tip pain * Very tender * Collapsed patient * Excessive vaginal bleeding
337
Classification of APH
* \<50ml: Minor * 50-1000ml: Major * \>1000ml: Massive
338
Classifications of Post-partum Haemorrhage
* 500-1000ml : minor * \>1000ml: Major
339
Atonic uterus
Uterus won't contract Tx: Massage / oxytocin
340
Sepsis in neonate is usually caused by
Group B strep
341
Foramen ovale is between
Right atrium and left atrium Closes at birth due to the increased pressure of the left atrium
342
Ductus arteriosis is from
Pulmonary artery to the aorta Closes at birth due to O2 in lungs and reduces prostaglandins
343
Persistent pulmonary hypertension of the newborn (PPHN)
Pulmonary hypertension that causes hypoxemia secondary to right-to-left shunting of blood at the foramen ovale and ductus arteriosus * Upper limb has 10% more O2% than Lower limb
344
Transient tachypnea of the newborn (TTN)
Respiratory problem that can be seen in the newborn shortly after delivery. It is caused by retained fetal lung fluid due to impaired clearance mechanisms * Common in C-sections
345
Potter's syndrome
Baby is born without kidneys Dies in womb or within a few days
346
Hemorrhagic disease of the newborn
Deficiency in Vitamin K Tx: Vitamin K
347
Meconium Ileus
* Distention, pain * Common in CF Tx: Enema or surgery
348
Necrotising Enterocolitis
Leaky bowel wall Tx: Antibiotics
349
Phenylketonuria (PKU) is screened for at birth with
Guthrie card
350
APGAR
* Activity * Pulse * Grimace * Appearance * Respiration
351
Normal healthy weight of a newborn
2.5-4kg
352
Jaundice in newborn
\<24hr : bad \>24hr: physiological Can be prolonged for 2 weeks 3 weeks in preterms
353
Neonates HR
100-160
354
Neonate Resp Rate
40-60
355
Neonate SpO2
\>90%
356
Neonate temperature
36.5 - 37.4
357
Neonate BP
* Term: 70/40 * Pre-term: 45-60/30
358
Small gestational age
\<10th centile
359
Investigations (USS doppler)
C-section at * ​Abnormal: 24-32 weeks * Normal: 32-37 weeks
360
Large for gestational height
\>2cm fundus height above predicted
361
Gestational Diabetes Investigations
HbA1c: \>6.5% is good
362
Macrosomia
\>90th centile Inv: OGTT
363
DCDA Twins
Dichorionic Diamniotic Split day 1-3
364
MCDA Twins
Monochorionic Diamniotic Split days 4-8
365
MCMA
Monochorionic Monoamniotic Split days 8-12
366
Conjoined twins
Split Day 13
367
Polyhydramnios
Overproduction of amniotic fluid Tx: Amniocentesis Indomethacin
368
Breast Pathology
* Fibroadenoma * Fibroadenosis (Fibrocystic change) * Mammary Duct Ectasia * Duct Papilloma * Fat necrosis * Breast Abscess * Galactocoele * Mastitis * Sclerosing adenosis * Cyclical Breast Pain * Breast Cancer
369
* Grey/white * Mobile * Small * Non-tender * \< 30s * Afro-carribean
Fibroadenoma Tx: \>3cm then excise
370
* Painful * Lumpy breasts * Middle-aged * Worse prior to menstruation
Fibroadenosis * Tx: Reassure or sometimes take out * Danazol- for pain (antioestrogen)
371
* Green discharge * Common around menopause * Lump around areola * Smoker
Mammary Duct Ectasia Dilatation of large breast ducts Staph aureus, Step pyogenes
372
* Middle-aged * Blood stained discharge * Sub-areolar duct proliferation
Intraduct Papilloma
373
* Obese * Hard irregular lump * Follows trauma * Yellow swelling * "Foamy macrophages" on biopsy * On warfarin
Fat Necrosis
374
* Ret, hot and tender collection of pus * Breastfeeding
Breast abscess Usually due to Staph Aureus
375
* Painless lump * Milk filled cyst
Galactocele Self limiting
376
Painful, red, swollen breast from breastfeeding
Mastitis Tx: Reassure and continue to breastfeed + Flucloxacillin (if penicillin allergic then erythromycin)
377
Cyclical Breast pain
Unknown cause ## Footnote Tx: Bromocriptine (inhibits prolactin) Cabergoline
378
Sclerosing adenosis
Benign, disordered proliferation of acini and stroma that can cause a mass or calcification
379
Gynaecomastia
enlargements of a man's breasts Tx: Tamoxifen
380
* Change in size or colour of breast * Nipple dimple * Lump * Clear or bloody discharge * Nipple change (pulling)
Breast Cancer
381
Types of Breast Cancer
* **Invasive ductal carcinoma** * **Invasive lobular carcinoma** * Medullary breast cancer * Mucinous (mucoid or colloid) breast cancer * Tubular breast cancer * Adenoid cystic carcinoma of the breast * Metaplastic breast cancer * Lymphoma of the breast * Basal type breast cancer * Phyllodes or cystosarcoma phyllodes * Papillary breast cancer
382
Most common type of Breast Cancer
Invasive ductal carcinoma
383
Lobular carcinoma
* High risk of both breasts getting invaded * Epithelial cadherin protein problem * CDH1 gene
384
Phyllodes tumours are
benign * Look like a leaf
385
Paget's disease of the breast
* Breast cancer on/below nipple * Eczema on nipple
386
Unexplained breast symptom without pain \>30
Urgent referral
387
Aromatase
Produces oestrogen from fat
388
Breast Carcinomas are
Adenocarcinomas
389
Atypical lobular hyperplasia
\<50% of lobe affected
390
Lobular carcinoma in situ
\> 50% of lobe affected
391
Risk factors for breast cancer
Increased oestrogen BRCA 1 or 2
392
1st degree relative with breast
doubles the risk of breast cancer
393
Post-mastectomy radiotherapy
Involvement of more than 3 nodes Positive surgical margins Tumours larger than 5cm
394
Treatment for breast cancer if oestrogen receptor positive (ER+)
1st: Tamoxifen 2nd: Letrozole (aromatase inhibitor)- for postmenopausal women 3rd: Gosrelin (GnRH inhibitor)
395
Treatment for breast cancer if HER2+
Trastuzumab (monoclonal antibody) "Trust HER"
396
Breast screening
Age 50-70 Mammogram every 3 years (Mediolateral oblique and Craniocaudal)
397
Investigations for breast cancer
\< 40s: USS \> 40s: USS + mammogram If USS is solid then Fine/core needle aspiration
398
Mastectomy
Removes all breast tissue
399
Lumpectomy
Breast conserving surgery Leave a 1mm margin aim for 1cm
400
Neoadjuvant therapy is used
Before surgery
401
Adjuvant therapy is used
after surgery
402
Breast staging
* T0: In situ * T1: \<2cm * T2: 2-5cm * T3: \>5cm * T4: Cancer has spread to surrounding structures
403
Mastectomy is used when
Lesion is \>4cm

Finals Club (Dundee Medicine Master Summary Deck) (8 decks)

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