Term
|
Definition
orally active
prevents hot flushes in post menopausal women
levels peak immediately before mid cycle
it has a beneficial effect on the HDL/LDL ratio |
|
|
Term
a women presents with severe abdo pain requiring morphine injections for pain control. she is 28 weeks pregnant but her fundal height is measuring at 32 weeks
what is the most probable cause? |
|
Definition
red degeneration of fibroid
because fundal height is much bigger than expected
this is a rare complication of a fibroid in pregnancy. there is haemorrhage within the centre of the fibroid because it is growing rapidly and outgrowing its supply |
|
|
Term
| a girl is on the pill but has break through bleeding. she is febrile with generalised lower abdominal tenderness. on PV exam she has cervical excitation and purulent PV discharge. most likely diagnosis? |
|
Definition
PID
break through bleeding in young pill users often associated with PID |
|
|
Term
| define antepartum haemorrhage and causes? |
|
Definition
between from genital tract after 24 weeks gestation
causes:
placenta preavia: painless
placenta abruption: painful
undetermined origin
uterine rupture: painful
vasa praevia
UTI
cervical ectropion |
|
|
Term
| when does the lower segment of the uterus form? |
|
Definition
3rd trimester
placental praevia is when placenta is implanted into the lower segment |
|
|
Term
| causes for placenta praevia? |
|
Definition
idiopathic
twins
high parity
increased age
scarred uterus eg previous c sec |
|
|
Term
| complications of placenta preavia? |
|
Definition
transverse lie
obstruct engagement of fetal head
haemorrhage as lower segment is less able to contract and constrict maternal blood supply |
|
|
Term
| what is the term when placenta implants so deep into a previous c sec scar that it prevents the placenta from separating and can lead to massive haemorrhage? |
|
Definition
placenta percreta
massive haemorrhage may require hysterectomy |
|
|
Term
| clinical features of placenta preavia? |
|
Definition
transverse or breech lie is common
fetal head is high
never do PV exam as it can provoke massive bleed so only do pv exam if placenta praevia has been excluded with USS
painless bleeding |
|
|
Term
|
Definition
C sec at 39 weeks
admit women with bleeding, give anti D if R negative
steroids if les than 34 weeks |
|
|
Term
| causes of placental abruption |
|
Definition
idiopathic
IUGR
preE
AI
smoking
drugs: cocaine
previous hx of abruption
multiple pregnancy
high maternal parity
rare: trauma, ECV or rupture of membranes in a women with polyhydramnios |
|
|
Term
| how can the uterus feel in placental abruption? |
|
Definition
| it can be contracting but in severe cases it will be 'woody hard' |
|
|
Term
| FETAL HEART IN ABRUPTION? |
|
Definition
absent or abnormal
there is usually no distress in CTG in placenta praevia |
|
|
Term
| features of major placenta abruption |
|
Definition
collapse
coagulopathy
fetal distress
wood hard uterus
poor urine output or AKI |
|
|
Term
|
Definition
admit even if there is no bleeding but pain and uterine tenderness
IV fluid
Steroids if <34 weeks
opiate analgesia
antiD to rhesus negative women
blood transfusion should be considered |
|
|
Term
| in placental abruption with fetal distress how should you proceed? |
|
Definition
|
|
Term
| in placental abruption with no fetal distress and pregnancy > 37weeks how should you proceed? |
|
Definition
| induction of labour with amniotomy |
|
|
Term
| painfull or painless bleeding in vasa preavia? |
|
Definition
|
|
Term
| what epithelium in in the uterus? |
|
Definition
|
|
Term
what are the BP targets for pregnant women with chronic uncomplicated and complicated HTN?
this is HTN that is present at booking or before 20 weeks or the women may already has a diagnosis and be on meds when she is referred to maternity |
|
Definition
uncomplicated chronic HTN target <150/100mmHg
Complicated chronic HTN eg there may be end organ damage: target <140/90mmHg |
|
|
Term
|
Definition
pregnant and HTN <150/100
pregnant and HTN and end organ damage <140/90 |
|
|
Term
| what extra foetal monitoring do we do in HTN mothers? |
|
Definition
USS growth of fetus between 28-30 and 32-34 weeks
amniotic fluid volume measure
umbilical artery Doppler
if normal we do not repeat after 34 weeks
only do CTG if foetal activity is abnormal |
|
|
Term
| intrapartum care of HTN mothers. who should get hourly BP measurements and who should get continuous? |
|
Definition
mild-moderate HTN = hourly BP
severe SBP >160 DBP >100 = continuous BP monitoring |
|
|
Term
| what should happen to the use of antihypertensives during labour? |
|
Definition
|
|
Term
| in women with chronic HTN who have given birth what is the target BP? |
|
Definition
|
|
Term
| if a woman is on methyldopa when should be stopped and why? |
|
Definition
| stop it 2 days post birth because it can cause depression |
|
|
Term
| define gestational diabetes? |
|
Definition
| New HTN presenting after 20 weeks gestation and NO significant proteinuria |
|
|
Term
T/F
in gestational HTN there is significant proteinuria? |
|
Definition
FALSE!
gestation HTN is new HTN after 20 weeks gestation with NO significant proteinuria |
|
|
Term
| 1st line antihypertensive in pregnancy? |
|
Definition
Labetalol
OTHERS ARE METHYLDOPA AND NIFIDIPINE
stop methyldopa 2 days after birth as it can cause depression |
|
|
Term
| risk factors for gestational HTN |
|
Definition
nulliparity
age 40 or >
> 10 year interval between pregnancies
FHx of pre eclampsia
multiple pregnancy
obesity
existing kidney or vascular disease |
|
|
Term
| fetal monitoring in gestation HTN? |
|
Definition
USS growth
Doppler umbilical artery
amniotic fluid volume assessment
if normal do not repeat after 34 weeks
if a women presents at 34 weeks with HTN do not do these tests |
|
|
Term
| postnatal BP care in women with HTN? |
|
Definition
| measure BP daily 1st 2 days post birth and at least once between day 3 and 5 |
|
|
Term
| dose of magnesium sulphate in pre eclamsia? |
|
Definition
loading dose 4g IV over 5 minutes
followed by 1g/hour 24hours |
|
|
Term
| steroids used in pregnancy to mature foetal lungs? |
|
Definition
| 12mg betamethasone IM 24 hours apart |
|
|
Term
| what are we trying to do in a membrane sweep? |
|
Definition
| separate the chorionic membrane from the decidua |
|
|
Term
| early onset neonatal sepsis is sepsis presenting within how many hours after birth? |
|
Definition
48 hours
>48 hour is late onset sepsis
early onset: GBS
late onset: staph epidermis/ aureus |
|
|
Term
| VBAC is contraindicated in which situations? |
|
Definition
classical C sec scar
previous episodes of uterine rupture
placenta praevia |
|
|
Term
| absolute indications for c sec are? |
|
Definition
CPD
placenta praevia grade 3/4 |
|
|
Term
| other indications for c section |
|
Definition
preE
post maturity
HIV
fetal distress in labour: prolapsed cord
failure of labour to progress
active herpes
cercival cancer with disseminated cells |
|
|
Term
| risks of c sec that should be explained to the mother |
|
Definition
wound and abdo discomfort in first few months
increased risk of repeat c sec in future vaginal delivery attempts
haemorrhage
infection
laceration to baby
bladder injury |
|
|
Term
| factors for shoulder dystocia? |
|
Definition
high maternal BMI
fetal macrosomia
DM
prolonged labour |
|
|
Term
| which two meds are safe to continue in diabetes and pregnancy? |
|
Definition
metformin and insulin
if women cannot tolerate metformin but declines insulin then you can give gliblencamide |
|
|
Term
| risk factors for gestational diabetes? |
|
Definition
previous large baby
BMI> 30
previous gestational diabetes
1st degree relative with diabetes
ethnicity |
|
|
Term
when do we offer OGTT for diabetes in pregnancy?
results remember 5.6.7.8! |
|
Definition
24-28 weeks
diabetes diagnosed if
fasting glucose >5.6
2 hour glucose >7.8 |
|
|
Term
| what happens to BP during pregnancy? |
|
Definition
| BP falls in 1st half of pregnancy and then rises to pre pregnancy levels |
|
|
Term
| what should women who are at high risk of preE take from 12 weeks until birth? |
|
Definition
75mg aspirin OD
high risk:
CKD
HTN disease in previous pregnancy
AI disorders including SLE/antiphospholipid
type I/II diabetes |
|
|
Term
| define HTN in pregnancy ie the numbers |
|
Definition
SBP > 140 or DBP > 90 or
an increase from booking readings of > 30 SBP or 15 DBP |
|
|
Term
assessment for VTE prophylaxis should be done at booking. there are many risk factors including
age >35
BMI>
multiparity
IVF
Previous
smoker
gross varicose veins
current pre-E
immobility
what counts as high risk? what is the management? |
|
Definition
4 or > risk factors? = immediated rx with LMWH continued until 6 weeks postpartum
if 3 risk factors? = start LMWH at 28 weeks and continue 6 weeks postpartum |
|
|
Term
| what is the treatment of choice for VTE prophylaxis in pregnancy? |
|
Definition
|
|
Term
|
Definition
| onset of regular and painful contractions associated with cervical dilation and descent of the presenting part. |
|
|
Term
|
Definition
1 = onset of true labour to cervix dilated 10cm
2 = fully dilated cervix to expulsion of fetus
3 = expulsion of fetus to delivery of placenta and membranes |
|
|
Term
| in monochorionic twins what is the main aim of USS done between 16 and 24 weeks? |
|
Definition
to detect TTTS
management: laser ablation of interconnecting vessels
after 24 weeks scans are done to detect fetal growth restriction |
|
|
Term
|
Definition
rest
USS for dx and monthly checks
additional iron and folate
more antenatal care e.g weekly >30 weeks
precautions at labour e.g. 2 obstetricians present |
|
|
Term
|
Definition
pulse
colour
resp effort
muscle tone
reflex irritability
7-10 = baby in good state |
|
|
Term
|
Definition
age > 40
nulliparity or new partner
multiple pregnancy
BMI>30
DM
pregnancy interval more than 10 years
FHx of preE
previous preE
pre existing HTN or renal disease |
|
|
Term
| mx of chicken pox exposure in pregnancy |
|
Definition
check immunisation hx. if they are unsure check for varicella antibodies
if they are not immune give varicella immunoglobulin. this can be given any time and is effective up to 10 days after exposure |
|
|
Term
| features of threatened miscarriage |
|
Definition
painless pv bleed
os closed |
|
|
Term
|
Definition
blood loss of > 500ml can be primary or secondary
primary occurs within 24 hours
most common cause is uterine atony |
|
|
Term
|
Definition
ABC
IV syntocin 10u or IV ergometrine 500mcg
IM carboprost
other options: B-lynch suture, ligation of internal iliac arteries or uterine artery
if severe then life saving hysterectomy can be done |
|
|
Term
when does secondary PPH occur
what is the most common cause? |
|
Definition
between 12 hours and 12 weeks
most common cause: retained placental tissue or endometriosis |
|
|
Term
| when to give Anti D to rhesus negative women? |
|
Definition
|
|
Term
|
Definition
36 weeks
remember one week before term at 37 weeks |
|
|
Term
| a Bishops score less than what indicates that induction will be likely? |
|
Definition
< 5
a score > 9 suggests labour will occur spontaneously |
|
|
Term
| medication and mx for pregnancy induce cholestasis and pruritis? |
|
Definition
ursodeoxycholic acid
induction at 37 weeks |
|
|
Term
| at lump commonly appears in women who have stopped breast feeding and is due to occlusion of lactiferous duct? |
|
Definition
galactocele
it is painless with no surrounding skin changes |
|
|
Term
| features that would warrant continuous CTG monitoring during labour |
|
Definition
BP > 160/110
?sepsis/choriamnionitis with temp >38
use of oxytocin
presence of significant meconium
fresh vaginal bleeding that develops in labour |
|
|
Term
| baseline bradycardia in CTG is HR <100 causes may include? |
|
Definition
maternal beta blocker usage
increased fetal vagal tone |
|
|
Term
| baseline tachycardia on CTG is HR > 160 min causes include? |
|
Definition
maternal pyrexia
chorionamnionitis
hypoxia and prematurity
hypoxia and prematurity can also cause loss of baseline variability of < 5 beats/min |
|
|
Term
| define early decelerations |
|
Definition
deceleration that commences with inset of maternal contraction and returns to normal on completion of contraction
interpretation: innocuous feature and suggest head compression |
|
|
Term
| define late decelerations |
|
Definition
this is slowing in fetal HR that lags onset of maternal contraction and does not return normal until after 30 seconds following the end of the contraction
interpretation: fetal distress, asphyxia or placental insufficiency |
|
|
Term
| what may variable decelerations indicate? |
|
Definition
|
|
Term
|
Definition
TONE
TISSUE
TRAUMA
thrombin |
|
|
Term
| if uterine atony is cause of PPH what shold you do? |
|
Definition
bimanual uterine compression trialed and pass a foley catheter to ensure bladder is empty
medical: 10u iv syntocin 500mcg iv ergometrine, im carboprost
Surgical: uterine balloon tamponade
fluid challenge: 3.5 l warm crystalloid at an appropriate rate whilst waiting for blood |
|
|
Term
| uterine tenderness, foul smelling discharge, maternal fever and 35 weeks pregnancy what you thinking? |
|
Definition
chorionamnionitis
there may also be baseline fetal tachycardia |
|
|
Term
| red degeneration of fibroids usually present in which semester? |
|
Definition
|
|
Term
| a serious complication of prolonged rupture of membranes that is dangerous for both mum and baby? |
|
Definition
|
|
Term
|
Definition
| vaginal discharge containing blood, mucus and uterine tissue that may continue for 6 weeks after birth |
|
|
Term
| what to administer after ABC in a women with PPH who has developed DIC? |
|
Definition
FFP and croprecipitate
upto 4U FFP
upto 10U Cryoprecipitate |
|
|
Term
| in a c section which structures does the obstetrician need to go through from the skin to get to the uterus? |
|
Definition
skin
superficial fascia
deep faschia
anterior rectus sheath
rectus abdominus
tranversalis fascia
extraperitoneal CT
peritoneum
uterus |
|
|
Term
|
Definition
IUS
transexamic acid, COCP
GnRH agonists can reduce size but are used short term
surgical: myomectomy, hysteroscopic endometrial ablation, hysterectomy, uterine artery embolisation |
|
|
Term
| what infusion should be started 4 hours before c section of HIV positive mother? |
|
Definition
|
|
Term
| which antidepressants from SSRI class are ok for breastfeeding mother? |
|
Definition
paroxetine
sertraline
avoid fluoxetine because of its very long half life |
|
|
Term
| which anti epilepsy med associated with neural tube defects? |
|
Definition
|
|
Term
| which AED is associated with cleft palate? |
|
Definition
|
|
Term
| if a women is on lamotrigine and decides to get pregnant what do you need to do to the drug dose? |
|
Definition
|
|
Term
| pregnant women who are taking phenytoin are advised to be given which vitamin to prevent clotting disorders in the new born? |
|
Definition
vitamin K
this should be given in the last month of pregnancy |
|
|
Term
|
Definition
tocolytics to reduce cord compression and allow c sec
advise pt to go on all 4s
the cord should not be pushed back into the uterus but the presenting part of foetus can be pushed back into uterus to avoid compression
immediate C sec is the delivery method of choice. |
|
|
Term
| hyperemesis gravidarum is common between which weeks? |
|
Definition
8-12 weeks but can persist up to 20 weeks
mx: antihistamines eg promethazine
ginger and p6 acupuncture
admission for IV hydration |
|
|
Term
if a women has opted for an active 3 rd stage what drug should be given and when?
what if she has HTN? |
|
Definition
she can be given oxytocin or ergometrine
this should be given once she has delivered the anterior shoulder
if she is hypertensive then do not give ergometrine as it mays HTN worse. |
|
|
Term
| risk factors for breech presentation? |
|
Definition
placenta preavia
uterine abnormalities eg fibroids
poly or oligohydramnios
fetal abnormality
prematurity |
|
|
Term
| indications for induction of labour |
|
Definition
prolonged pregnancy > 12 days after estimated date of delivery
prelabour PROM where labour does not start
diabetic mother > 38 weeks
rhesus incompatibility |
|
|
Term
| what methods are used to induce labour? |
|
Definition
membrane sweep
PV prostaglandin
breaking of waters
oxytocin |
|
|
Term
| GBS detected which ABx would you give? |
|
Definition
| penicillin and clindamycin |
|
|
Term
|
Definition
admission
regular obs to ensure chorionamnionitis isn't developing
PO erythromycin for 10 days
steroids to reduced respiratory distress syndrome
delivery can be considered at 34 weeks: this is considered a good trade off |
|
|
Term
women at high risk should have 5mg of folic acid until week 12 of pregnancy
what would make them high risk? |
|
Definition
previous child with NTD, partner had NTD or FHx of it
women is taking AED
women has coeliacs, diabetes or thalassemia trait
women is obese defined as BIM > 30 |
|
|
Term
| in which condition is there rupture of membranes followed immediately by vaginal bleeding and fetal bradycardia is classically seen? |
|
Definition
|
|
Term
| a women has a low lying placenta at week 20 how would you manage this? |
|
Definition
rescan at 34 weeks
if grade 1/2 then scan every 2 weeks
if at 37 weeks high presenting part or abnormal lie then c sec should be done. |
|
|
Term
| define minor, major and massive hemorrhage |
|
Definition
minor <50ml
major 50-1000ml no signs of shock
massive haemorrhage >1000ml and or signs of clinical shock |
|
|
Term
| situations in which anti-D should be given |
|
Definition
delivery of rhesus positive infant whether live or stillborn
any TOP
miscarriage if >12 week gestation
ectopic pregnancies that are surgically managed
ECV
APH
Amnioscentiesis,CVS, fetal blood sampling |
|
|
Term
|
Definition
1 - removal of clitoris
2 - clitoris and labia minora
3 - infundibulum
4 -any other procure to vagina for non medical purposes. |
|
|
Term
| definition of still birth in UK and WHO |
|
Definition
UK: death before or during birth after 24 weeks
WHO: 28 weeks |
|
|
Term
| define perinatal mortality |
|
Definition
| stillbirth plus neonatal deaths under 7 days |
|
|
Term
| stillbirth plus neonatal death under 7 days is known as? |
|
Definition
|
|
Term
| risk factor for stillbiths |
|
Definition
infections TORCH
postmaturity
maternal fever
DM, preE, renal disease, HTN
malformation and chromosomal abnormalities |
|
|
Term
| paroxetine is ok to give to postpartum mothers who are suffering from depression but do not want CBT but its use in 1st trimester pregnancy is associated with what? |
|
Definition
|
|
Term
| ebsteins anomaly associated with? |
|
Definition
lithium use.
congenital heart defect of tricuspid valve |
|
|
Term
| if HIV positive or on co trimoxazole prophylaxis what does of folic acid should you be on when pregnant? |
|
Definition
|
|
Term
| when administering magnesium sulphate what needs to be monitored? |
|
Definition
tendon reflexes and RR every 15 mins
you should stop rx if RR < 14, loss of tendon reflexes or urine output <20ml/min |
|
|
Term
| what should you give in case of magnesium sulphate toxicity? |
|
Definition
|
|
Term
| in placental insufficiency growth is asymmetric or symmetric?? |
|
Definition
it is asymmetric.
the head circumference is spared
this suggests baby has been starved |
|
|
Term
| what is the name of the incision in lower segment c section? |
|
Definition
|
|
Term
| what is mendelsons syndrome? |
|
Definition
| pneumonia occurring post op due to general anaesthesia and aspiration of gastric contents |
|
|
Term
| why should you avoid halothane for GA in emergency c sec? |
|
Definition
| it causes uterine muscle relaxation and this increases bleeding |
|
|
Term
|
Definition
| conception has not occurred after 1 year of regular unprotected intercourse |
|
|
Term
| 4 basic conditions for pregnancy? |
|
Definition
egg needs to be produced
male factor
sperm needs to reach egg
embryo must implant |
|
|
Term
|
Definition
at the start of the cycle estrogen levels are low. this has a positive feedback to the hypothalamus.
hypothalamus releases GnRH this causes AP to release FSH/LH.
these cause stimulation of many immature oocytes. these oocytes release small levels of estradiol. the estradiol has a negative feedback on FSH. this means less FSH/LH is available so only the strong oocytes can compete for the reduced FSH/LH. development of the dominant follicle is also regulated by inhibin B that suppresses FSH.
as the follicle matures, it secretes more estradiol. at a high level estradiol has a positive effect on the hypothalamus and this causes LH/FSH levels to rise again. this peak surge of LH causes ovulation and the eggs spills out.
the empty follicle is now called the corpus luteum. it releases oestrogen and progesterone that maintains a secretory endometrium suited for embryo implantation
if implantation doesn't occur CL involutes, hormone levels fall and menstruation occurs 14 days after ovulation
if implantation occurs
the hCG made by trophoblast acts on CL to main estrogen and progesterone until fetoplacental unit takes over at 8-1o weeks gestation. |
|
|
Term
|
Definition
| mid luteal phase progesterone levels. |
|
|
Term
|
Definition
you need 2 of the 3
PCO on USS
irregular period > 35 days apart
Hirsutism |
|
|
Term
| findings in some one with PCOS? |
|
Definition
raised LH
insulin resistance and compensatory raised insulin levels |
|
|
Term
|
Definition
weight loss
exercise
COCP
anti androgens but avoid contraception
metformin |
|
|
Term
| eflornithine. what is it? whats it used for? |
|
Definition
anti androgen topical
for facial hirsutism |
|
|
Term
| Kallmans syndrome is a cause for subfertility what happened here? |
|
Definition
| GnRH secreting neurons have failed to develop |
|
|
Term
| in Sheehans what is reduced and what is normal? |
|
Definition
| FSH/LH reduced due to damaged pituitary but GnRH levels normal as hypothalamus is ok |
|
|
Term
| induction of ovulation in PCOS? |
|
Definition
|
|
Term
| features of ovarian hyper stimulation syndrome |
|
Definition
hypovoleamia
electrolyte disturbance
ascites
VTE
pulmonary oedema |
|
|
Term
| normal semen analysis features |
|
Definition
volume >2ml
sperm count > 20 million/ml
progressive motility > 50% |
|
|
Term
| define oligo and severe oligospermia |
|
Definition
oligosperma <20million/ml
severe < 5million/ml |
|
|
Term
| other causes of infertility in women |
|
Definition
|
|
Term
| in measuring serum progesterone, what level suggest ovulation? |
|
Definition
|
|
Term
| which 2ndary care ix looks at the shape of the uterine cavity and patency of tubes, diagnoses uterine malformations, adhesions and tubal patency? |
|
Definition
|
|
Term
| when was human fertilization and embryology act updated? |
|
Definition
|
|
Term
| how long can you keep an embryo for? |
|
Definition
| until the appearance of its primitive streak or 14 days which ever one comes first |
|
|
Term
|
Definition
they can keep the baby even if it is not genetically related to them
surrogacy arrangements are not legally enforceable even if a contract has been signed
the surrogate is the legal mother unless parenthood is transferred. this needs to be applied for and in order to apply at least one of the parents needs to be genetically related to the child
application must be made within 6 months |
|
|
Term
| NICE recommends up to 3 cycles of IVF on the NHS if which factors are met? |
|
Definition
women 23-39 at time of rx
one or both have been diagnosed with fertility problems
they have been infertile for > 3 years |
|
|
Term
| how is endometriosis diagnosed? |
|
Definition
|
|
Term
mx of endometriosis
laparoscopy is gold standard |
|
Definition
NSAIDs
COCP
progesterones
GnRH to induce mini menopause
Mirena
Surgery: laser ablation, hysterectomy |
|
|
Term
division before day 3 of twins leads to what type?
how do we get monochorionic diamniotic twins? what are they associated with? |
|
Definition
dichorionic diamniotic
division between 4-8 days gets us monochorionic diamniotic twins. these are associated with TTTS |
|
|
Term
|
Definition
| using the quintero system |
|
|
Term
| which kind of pregnancy is internal podelic version allowed? |
|
Definition
|
|
Term
| sx mx of endometrial cancer? |
|
Definition
hysterectomy with BSO
pts with extensive disease may get radiotherapy after surgery |
|
|
Term
| features of endometrial cancer |
|
Definition
pc: post menopausal bleeding
endometrial biopsy needed for dx
radiotherapy used more than checmo
75% pts present with stage 1 disease that is treated surgically
surgical mx: hysterectomy + BSO |
|
|
Term
| risk factors for endometrial cancer? |
|
Definition
obesity
nulliparity
DM
PCOS
early menarche
late menopause
unopposed estrogen
tamoxifen |
|
|
Term
| ix in ?endometrial cancer |
|
Definition
TV USS if <4mm then high negative predictive value
hysteroscopy with endometrial biopsy |
|
|
Term
| staging of ovarian cancer |
|
Definition
1 - confined to ovary
2 - outside ovary but within pelvis
3 - outside pelvis but within abdomen
4 distant mets |
|
|
Term
| define primary amenorrhoea |
|
Definition
no periods by age 14 and no secondary sexual characteristics OR
no periods by aged 16 and development of secondary sexual characteristic |
|
|
Term
| age and frequency bands for cervical smear test |
|
Definition
age 25-49 every 3 years
50-64 every 5 years
over 65 - only those who haven't been screened since 50 or who have had recently abnormal tests |
|
|
Term
| borderline or mild dyskariosis is found on cervical screening what do you do next? |
|
Definition
| test sample for HPV. if negative the pt goes back to routine screening. if positive then refer for colposcopy |
|
|
Term
| CIN II is consistent with what type of dyskariosis. what is the next step |
|
Definition
moderate dyskariosis = CIN II
refer for colposcopy |
|
|
Term
severe dyskariosis = CIN III
how quickly should you refer to colposcopy? |
|
Definition
within 2 weeks
this is the same for if you suspect invasive cancer. |
|
|
Term
| if a women has 3 inadequate smears what can you do? |
|
Definition
|
|
Term
| amsels criteria for BV you need 3 of the 4 |
|
Definition
positive whiff test
clue cells PH > 4.5
thin white homogenous discharge
mx: metronidazole PO 5-7 days |
|
|
Term
| features and mx of urge incontinence |
|
Definition
over active detrusor activity
ix: bladder diary 3 days
PV exam to exclude cystocoele
urine dipstick and culture
mx: bladder retraining for 6 weeks to try and increase the time between voiding, antimuscarinics |
|
|
Term
| features and mx of stress incontinence |
|
Definition
leaking small amounts when coughing or laughin
ix: bladder diary, PV exam and urine dipstick
MX: pelvic floor retraining for min 3m (8 contractions tds)
surgical: retro pubic mid urethral tape |
|
|
Term
| gram neg diploccoci and purulent discharge for 2 weeks what you thinking and whats the mx |
|
Definition
gonorrhoea
im ceftriaxone and azithromycin |
|
|
Term
| how wold you determine the correct HRT regime? |
|
Definition
find out if
there is a uterus
if the women is perimenopausal or menopausal
if local or systemic effect is wanted |
|
|
Term
| in perimenopausla women going on HRT the cyclical combine HRT is recommended. why? |
|
Definition
produces predictable withdrawal bleeding
continuous regimes cause unpredictable bleeding |
|
|
Term
| why is system estrogen only HRT inappropriate in a women with a uterus? |
|
Definition
| there is an increased risk of endometrial cancer |
|
|
Term
a women has painless heavy periods,
you have the option to prescribe mefenamic acid or tranexamic acid. which one do you give and why? |
|
Definition
tranexamic acid because its painless so you don't need mefenamic acid (NSAID)
tranexamic acid is a plasminogen activator inhibitor and acts as an anti fibrinolytic to prevent heavy bleeding |
|
|
Term
| surgical mx for tubal ectopic? |
|
Definition
salpingectomy,
if there is contra lateral tubal damage then the women may be offered a salpingotomy |
|
|
Term
what secretes HCG
how early can it be detected in the blood |
|
Definition
secreted by syncytiotrophoblasts
can be detected in the blood as early as day 8 after conception |
|
|
Term
| which vaccines are routinely offered to pregnant women? |
|
Definition
|
|
Term
| after 24 weeks how much would you expect the fundal height to increase by per week? |
|
Definition
|
|
Term
|
Definition
mcroberts: hyperflex legs onto abdomen and apply suprapubic pressure
rubin: press on posterior to allow anterior shoulder extra room
woodscrew: hand in vagina and rotate head 180 degrees
zavenelli: push head back in vagina and attempt c sec
you can also try episiotomy |
|
|
Term
| what does the whirlpool sign on USS suggest? |
|
Definition
ovarian torsion
also seen in volvulus |
|
|
Term
| ovarian cancers stage 2-4 are treated primary how? |
|
Definition
| surgical excision of the tumour and this may be accompanied by chemotherapy |
|
|
Term
|
Definition
ABCD
Johnson manoeuvre: slowly push uterus back up
if this fails
osullivans technique: infuse warm saline into vagina
laparotomy |
|
|
Term
|
Definition
1 superficial, no muscle involvement
2 perineal muscle does not involve anal sphinter
3 perineal muscle and anal sphincter
4 perineum, anal spinchter and rectal mucosa |
|
|
Term
postnatal mood changes
which is evident by day 3?
which is evident by 2 weeks?
which can last up to months if not treated? |
|
Definition
baby blues by day 3 and clears up by day 10
plueralpsychoses manifests within 2 weeks
depression can last for months if not treated
do Edinburgh depression scale. > 10 suggests depression. |
|
|
Term
rx of cervical cancer
80% squamous
20% adenocarcinoma |
|
Definition
cone biopsy alone in early stage disease
palliative radiotherapy for haemorrhage
in high stage disease platinum based chemo improves survival and reduces reoccurance
wertheims hysterectomy: hysterectomy, pelvic node clearance, removal of parametrium and upper third of vagina |
|
|
Term
| features of lichen sclerosis |
|
Definition
itchy white plaques on vulva
associated with other AI disease such as type I DM
mx: topical steroids and emollient
complications: increased risk of vulval cancer |
|
|
Term
| common complication of hysterectomy with anterior posterior repair? |
|
Definition
enterocoele
vaginal vault prolapse |
|
|
Term
|
Definition
PO metronidazole 400mg BD 5-7
the 2g stat dose is not recommended in pregnancy |
|
|
Term
| US markers for Edwards trisomy |
|
Definition
cardiac malformation
choiroid plexus cysts
clenched hands
rocker bottom feet
small placenta
single umbilical artery
clubbed feet
neural tube defects |
|
|
Term
| complication of post term delivery to baby? |
|
Definition
meconium aspiration
reduced placental perfusion
oligohydramnios |
|
|
Term
| complication of post term to mother? |
|
Definition
increased rates of intervention including forceps and c sec
increased rates of labour induction |
|
|
Term
|
Definition
|
|
Term
|
Definition
rupture of membranes
followed by painless PV bleeding
fetal bradycardia on CTG |
|
|
Term
| features suggesting abnormal CTG |
|
Definition
HR >180 <100
Variability: <5 for over 90minutes
decels: late decelerations for over 30mins not improving with conservative measures or a single decal lasting 3 mins or more or fetal bradycardia |
|
|
Term
| a baby born to a mother positive for Hep B is found to be surface antigen positive. how would you manage her? |
|
Definition
Hep vaccine and 0.5ml of HepB immunoglobulin within 12 hours of birth
further hepatitis vaccine at 1-2 months and again at 6 months |
|
|
Term
T/F
HIV and Hep B can be transmitted in breasfeeding? |
|
Definition
FALSE
only HIV
Hep B cannot be transmitted in breast feeding |
|
|
Term
when is ECV offered in a nulliparous women
is it the same in multiparous women? |
|
Definition
ECV in nulliparous 36 weeks
ECV in multiparous 37 weeks |
|
|
Term
| a young women is reported to have a simple cyst on her overy 4cm. what should be done? |
|
Definition
repeat USS in 12 weeks and if still there then refer to gynae
in post menopausal women refer all cysts |
|
|
Term
| how are the reflexes in placental abruption? |
|
Definition
|
|
Term
| 1 day post c sec a women has pain and heavy PV bleeding a smelly lochia. her uterus is poorly contracted and above the umbilicus. you suspect retain products what is the next thing to do? |
|
Definition
| examination under anesthesia |
|
|
Term
| what is the link between smoking and hyper emesis gravidarium? |
|
Definition
| smoking is associated with a decreased incidence of hyperemesis gravidarium |
|
|
Term
| key points from 1967 Abortion ACt |
|
Definition
2 medical practionners need to sign the form. in an emergency only one is needed.
the pregnancy has not exceeded 24 weeks..
continuation of pregnancy would involve greater risk than if it were terminated to the physical/mental health of the women or existing children or family
termination necessary to prevent grave mental/physical injury to the pregnant women |
|
|
Term
method for TOP < 9
medical |
|
Definition
| mifepristone (anti progesterone) then 48 hours later prostaglandins to stimulate uterine contraction |
|
|
Term
| surgical method available for pregnancy TOP < 13? |
|
Definition
| surgical dilatation and suction of uterine contents |
|
|
Term
| method for TOP > 15 weeks? |
|
Definition
surgical dilatation and evacuation of uterine contents
OR
late medical abortion that induces mini labour |
|
|
Term
Abortion Act 1967
2 doctors must agree |
|
Definition
pregnancy < 24 weeks
continuing the pregnancy would have greater risk than terminating it to the physical/mental health of the mother or existing child or her family
termination is needed to prevent grave permanent injury to physical/mental health of pregnant women
continuation would involve risk to the life of the pregnant women greater than if it were terminated
substantial risk that if the child were born they would have physical and mental abnormalities rendering them handicap |
|
|
Term
|
Definition
| they tend to have a bi cuspid aortic valve, aortic valve stenosis or regurge |
|
|
Term
| what results would you expect in screening for T21? |
|
Definition
High HCG
thickened nuchal translucency
Low AFP, oestriol and PAPP-A |
|
|
Term
| what is involved in combined tests? |
|
Definition
nuchal translucency thick in T21
PAP-A - reduced in T21
bHCG - raised in T21 |
|
|
Term
| what is involved in quadruple test? |
|
Definition
bHCG - raised in T21
AFP - low in T21
eostriol - Low in T21
inhibin A - raised
Inhibin A levels correlate with bHCG so they are the same e.g both high |
|
|
Term
mx of genital warts
multiple non keratinised versus solitary keratinised lesion |
|
Definition
multiple non keratinised: topical podophyllum
solitary keratinised lesions: cryotherapy |
|
|
Term
AFP
raised in neural tube defects and decreased in? |
|
Definition
|
|
Term
| causes for decreased AFP? |
|
Definition
downs
trisomy 18
maternal DM |
|
|
Term
findings in molar pregnancy
high bHCG low TSH high tyroxine
explain the results |
|
Definition
bHCG has a simila shape to LH, FSH and TSH
that being said it stimulates thyroid lad to make T4 and T3. they have a negative feedback on TSH and that is how we get raised bHCH, low TSH and high thyroxine |
|
|
Term
| When can we used MTX to manage an ectopic? |
|
Definition
When sac is < 35mm
No foetal HR
bHCG < 1500
no intra uterine pregnancy
no pain
the pt needs to attend for follow up |
|
|
Term
| if ectopic is > 35mm, causing pain or bHCG > 1500 what should we offer? |
|
Definition
salpingectomy or
if fertility already compromised then salpingotomy |
|
|
Term
| snow storm bunch of grapes appearance on USS indicates? |
|
Definition
|
|
Term
| antenatal USS shows hyperechogenic bowel. which condition is this most likely associated with? |
|
Definition
CF
downs syndrome
cytomegalovirus |
|
|
Term
what is a normal bladder detrusor pressure and peak flow?
what findings would indicate a bladder outlet obstruction? |
|
Definition
normal values:
detrusor pressure < 70
peak flow urine > 15ml/sec
bladder outlet obstruction indicated by
high detrusor pressure > 70 and low flow of urine < 15 |
|
|
Term
| T/F ciprofloxacin is CI throughout pregnancy |
|
Definition
|
|
Term
|
Definition
confidential enquiry into maternal and child Health
it reviews maternal deaths to make motherhood safer
it is a confidential enquiry into maternal deaths in the UK |
|
|
Term
| anatomy of female pelvis in relation fetal skull and implications |
|
Definition
the transverse diameter of the inlet is the biggest whereas the AP diameter of the outlet is the biggest. this means that the baby must rotate when passing through pelvic canal in order to present its head to the biggest part.
a gyaenacoid pelvic is desired for the least difficult child birth |
|
|
Term
| which pelvis shape gives the least difficulty during child birth? |
|
Definition
gynaecoid pelvis
round pelvic brim and short blunt ischial spines |
|
|
Term
pelvic inlet average measurements
it is wider transverse than AP
pelvic outlet average measurements?
it is wider AP than transverse. This means baby has to rotate so it presents its head to the widest dimension.
Transverse is shorter than AP. this is the opposite of the pelvic inlet |
|
Definition
AP 12cm
transverse 13cm
pelvic outlet
AP 12.5cm
transverse 11cm
this means baby has to rotate to present its head to the widest part of the pelvic outlet |
|
|
Term
which is the small space that baby must get through during vaginal birth?
is it in the pelvic inlet or the outlet? |
|
Definition
|
|
Term
| the anterior fontanel is AKA ? |
|
Definition
the bregma
this has a diamond shape
the posterior fontanelle has a triangular shape |
|
|
Term
| when is episiotomy performed? |
|
Definition
usually in second stage of labour
the cut is a posterior lateral cut |
|
|
