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139 Cards in this Set
- Front
- Back
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Choronic Villous Sampling Indications |
The Combined Test Risk >150. Structural abnormality on USS. Known familial genetic risk. |
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The Combined Test |
1st trimester, 90% detection, 5% false positives.
1. Maternal age 2. USS (for nuchal translucency) 3. Biochemistry (PAPP-A, hCG at 11-14wks) |
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Choronic Villous Sampling Details |
10-13 weeks Transabdominal (or transcervical) 1% risk of pregnancy loss. USS guided thin needle O/P procedure, 5 mins. |
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Energy Intake formula |
Intake = energy expended+stored+excreted |
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Child Energy Intake Requirements and EAR (estimated energy requirements) |
5kcal/gram tissue deposited 1m- 115 kcal/kg/day 3yr- 95 5yr- 82 18yr- 34 |
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WHO recommendations for breast feeding |
6m Breast feeding exclusively. Then gradual intro of solids as signs of readiness shown. Supplemental breast mild until 2yrs. Vitamin supplements from 6m to 4yrs. |
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Advantages of Breast Milk |
Fats more digestable. Lipids goods for neutral development.
Prevention of GI/resp/UTI/ear infection, allergies, obesity, metabolic syndrome, DM, Ca (leukaemia and SIDS). Protect mother from breast/ovarian Ca, premenopause osteoporosis, fracture, PPH, aids uterine involution, contraception. |
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Preterm Baby Nutrients |
Breast Milk (not formula, esp in growth restricted to avoid NEC - necrotising enterocolitis) +/- protein, phosphorus supp. |
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Causes of Failure to thrive |
Non-organic - insufficient food / presentation, emotional neglect (maternal depression), lack of nurturing.
Organic - inadequate intake (impaired suck or swallow (cleft, oro-motor dysfunction/neuro), chronic illness (renal/liver fx), vomiting (GORD)), malabsorption (coeliac, CF, short gut), metabolic/utilisatiom disorder (chromosomal disorder, prem, infection, hypothyroid, amino acid disorder), excess energy use (Ca, CF, congenital heart disease, renal fx, chronic infection, thyrotoxicosis). |
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Failure to Thrive Investigations |
May not need any. Sweat test, stool fat, immunoglobulins, FBC, TFT, GH stimulation test, urine dip (protein). |
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Pattern of Failure to Thrive for Hormone cause v Diet or Disease |
Hormone- heights drops off (weight maintained) Diet/disease- weight drops off (height maintained) |
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Hormonal control of growth |
Insulin- most important growth hormone <2yr. Released by eating so link to feeding and height. Boost muscle bulk in adulthood. Thyroid- important in brain development, some impact on height. GH- works through IGF but other factors can also impact. IGF level genetic link -> heigh determinant. Oestrogen - closes epiphises, hence girls stop growing earlier. |
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Post Natal Depression Diagnosis |
2/3 of: Depression Reduced energy Reduced enjoyment |
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Embryological cause of cleft lip and palate |
Lack of fusion of the lateral nasal prominence and the maxillary nasal prominence. Usually occurs around week 7 |
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Types of spina bifida |
Oculta (dimple or hair patch) Meningocele (cyst) Myelomeningocele (cyst with nerves in) |
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Neonatal Circulation |
Nutrients cross placenta. Umbilical v. -> ductus venosus shunt through liver -> into RA -> foramen ovale -> LA -> LV -> aorta -> ?iliac ?IVC-> umbilical a. |
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At first breath |
PGs close DA ? (?and DV?). Umbilical vein supply closes. Foramen ovale folds closed by functional pressure change. |
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Products Of the Ectoderm |
Skin and CNS: Skin and surfaces (lens, tooth enamel, ant pituitary, hair, epidermis, cutaneous glands, mammary glands) Neural tube and crest (CNS, retina, pineal body, post pituitary, cranial and sen ganglia and nerves, medulla or adrenals, pigment cells, pharyngeal arch cartilage). Others (head mesenchye and con tis, bulbar and conal region of heart). |
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Products of the Mesoderm |
Serous membranes, muscles, blood vessels, cartilage, con tis. Head (cranium, con tis, dentin) Paraxial mesoderm (muscles of head, skeletal muscles, dermis, con tis) Intermediate (urogenital system ducts, gonads, accessory glands) Lateral (visceral muscles and con tis, serous membranes, blood and lymph cells, spleen, adrenal cortex). |
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Products of the Endoderm |
Epithelium . Epithelial tracts - GI, liver, pancreas, urinary bladder, urachus. Epithelial parts of areas - pharynx, thyroid, tympanic cavity, pharyngotympanic tube, tonsils, parathyroid glands.
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Causes of Amenorrhoea |
Physiological - pregnancy, lactation, pre-puberty constitutional delay, menopause. Hypothalamic- primary (congenital), secondary (low body fat, stress, exercise; leptin related). Pituitary- sheehan's (rare), hyperprolactinaemia (common, adenoma or prolactinoma). Ovarian- primary ovarian failure, disorder of Sex diff (eg. AIS), turners (XO), PCOS. |
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Sheehan's |
Inc lactotrophs in pregnancy causing ant pit enlargement -> post partum haemorrhage -> ischaemia -> necrosis.
(Post pituitary not effected as has own blood supply) |
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PCOS Diagnostic criteria |
2/3 of: ◾irregular cycle / amenorrhoea ◾hirsutism or acne (hyperandrogenism) ◾polycystic ovaries |
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PMS definition |
Cyclic presence of somatic, psychological, emotional symptoms that worsens as menses approach and go on onset of menstrual flow. |
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Endometriosis definition |
Ectopic areas of endometrium. (Retrograde menstruation or embryonic displacement) |
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Endometriosis Treatment |
Medical- suppress cycle (COCP progressing to GnRH). Surgical- diathermy, excision, wash out, oophorectomy. |
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Amenorrhoea Investigations |
Pelvic USS Gonadotropins (LH, FSH, testosterone, prolactin) on day 3-9 of cycle. |
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Causes of DUB |
Fibroids Adenomyosis Polyps Hyperplasia Malignancy PID IUCD
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Menorrhagia Definition and Investigation |
Frequent, prolonged heavy or unpredictable bleeding >80mls. Measure Hb, pelvis USS, diagnostic endometrial Bx. |
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Menorrhagia Treatment |
NSAIDs, tranexamic acid, hormone treatment (progesterone coil, POP, COCP). Endometrial ablation, Hysterectomy. |
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Cervical screening frequency |
25-50 every 3 years 50-64 every 5 years |
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Somatisation disorder features |
Multiple physical sx 2 years Refusing to accept reassurance or neg test results |
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Hypochondrial disorder features |
Persistent belief of underlying serious disease. Refuses to accept reassurance and neg results. |
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Baby blues features |
Day 3 - 7. Anxious Tearful Irrirable |
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Baby blues management |
Reassurance and support. Key role of health visitor. |
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Postnatal depression features |
Start at 1m, peak at 3m. Depression sx (low mood, anergia, anhedonia) Effects 10%+ |
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Postnatal depression rx |
Reassurance, support. CBT. SSRIs (sertraline, paroxetine - go into breast milk but not harmful to infant) |
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Puerperal psychosis features |
Onset 2 - 3w after birth. Severe mood swings, disordered perceptions eg auditory hallucinations. |
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Puerperal psychosis rx |
Admit. 20% recurrence. |
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Ovarian Ca tumor marker |
CA125 |
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Ovarian cancer features |
Abdo distention/ bloating, abdo/pelvic pain, urinary sx, bowel sx, early satiety. |
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Hb levels in pregnancy |
1st trimester - > 110 2nd/3rd trimester - > 105 Puerperum - > 100 WHO - supplement at 105 |
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Pica def |
Craving for non - food substances, eg. Coal, soap, chalk. Rare. Cause unknown. |
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Maternal PE/VTE RFs |
PMH of PE or VTE FHX Age >35 Obesity Operative delivery Sickle cell (more VTE) |
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Haem changes in pregnancy |
Anaemia (low Hb, high MCV) Low platelets (thrombocytopenia) Inc WBC (neutrophilia) Inc ESR Inc procoag (F VIII, vWF) Dec anticoag (protein S) Dec fibrolysis (TPAi inc, TPA dec) |
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Obstetric haemorrhage RFs |
Placenta pravia, placental abruption, prolonged labour, emergency C section. |
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Cx of sickle cell disease in pregnancy |
Inc morbidity. Infection, painful crisis, low birth weight, inc VTE risk. |
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Sickle cell AN care |
Partner testing, high risk obstetric service. vaccines, organ function monitoring, folate supplement. Exchange transfusion as needed. |
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Warfarin in pregnancy |
CROSSES PLACENTA. Embryopathy risk highest 6-12w: Intracerebral haemorrhage, Hydrocephalus, Neuro development abnorm. Haemorrhage risk (mat/neo) |
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LMWH in pregnancy |
Doesn't cross placenta. Safe in breast feeding. STOP for epidural. Rx dose - 100 units/kg BD. prophylactic - 5000 units OD or BD. |
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Med risk VTE in preg rx |
6w postnatal LMWH prophylactic dose (5000units OD or BD) |
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High risk VTE in preg rx |
AN + 6w postnatal LMWH prophylactic dose (5000 units OD or BD) |
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V high risk VTE in preg rx |
AN + 6w postpartum LMWH therapeutic dose (100units/kg OD or BD), + specialist care. |
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Fibroid presentation |
Asymptomatic. Menstrual disorders, swelling/bloating, infertility, miscarriage, pain. |
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Fibroid rx |
Depends on size, location, etc. C - watch and wait (shrink at menopause). M - COCP for menorrhagia, GnRH analogue. Esmya (progesterone injection). S - embolisation (band or bead), myomectomy, hysterectomy. |
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DUB definition |
Bleeding that is not cyclical |
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RFs for GDM |
Previous GDM, FHX, previous macrosomic baby, previous unexplained stillbirth, bmi>30, glycosuria on 2+ occasions, polyhydramnios, large for dates baby. |
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COCP contras |
VTE, HTN, migraine with aura, Ca, recent pregnancy, smoking, >35, obesity, CV disease, Fhx. |
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Emergency contraceptive options |
Levonorgestrel (progesterone, x2 POP) <72hrs Ella ONE <5d |
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COCP instructions |
99.7% perfect use, realistic 91%. Prevents ovulation, thins endometrium, thickens mucus. Start on day 1 of cycle. Stop after 21 days for bleeding. Condom 7 days after start. If miss one, restart Asap, condoms. UNLESS it's the one at end or beginning (pill free interval can allow HPG axis to wake - do not take pill free break!) Window: 12hr, more treat as missed pill. |
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POP instructions |
99% Prevents ovulation (med-high dose), thickens cervical mucus. Take continuous (no break for bleeding). 20% ammen, 40% reg, 40% irreg. Window: 3 hrs. Condoms 7 days. |
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Types of miscarriage |
Complete (pain+cramps, scan - uterus empty) Incomplete (pain+cramps, scan - retained product) Missed (no sx, scan - no heartbeat). Inevitable (open os) Blighted ovum (scan - yolk sac, no fetus) Septic (any misc with sx of sepsis) |
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Misc management |
C - watch and wait. Advise - pain, bleeding, 2w. M - misoprostol PV. S - SMM/ERPC. (Lower failure rate) |
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IUS mechanism of action |
>99% Mirena. Thickens cervical mucus, kills sperm (prevents fertilisation). Some endometrial thinning. Lasts 5yrs. Jaydess 3yrs (silver ring, CONTRA in silver allergy) Useful in migraine. Contras- current infections, suspected/known preg, unexplained unusual bleeding (investigate first), uterine cavity abnormality. |
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Shoulder dystocia management |
HELPERRR Help (call for) Episiotomy evaluation Legs - McRoberts manoeuvre. Pressure suprapubically Enter - PV rotational manoeuvres Remove post arm (sweep across chest) Roll pt to hands and knees Record keeping Then - clavicle #, zavenilli manoeuvre, symphysiolotomy, cleidotomy |
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Shoulder dystocia complications |
Neonate - brachial plex injury, hypoxaemia, still birth. Mother - perineum lacerations, uterine rupture, haemorrhage. |
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Shoulder dystocia - things not to do |
Ask patient to push Apply fundal pressure Panic |
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Cord prolapse assessment and management |
Assess - fetal status, cord (pulsation), replaceability of cord, lie + presentation.
Transverse lie - CS Pulsating, stage 1 - stop pressure on cord manually, ocolytics (Mg SO4, salb), CS. Pulsating, stage 2 - expede delivery, resus of newborn. Not pulsating - scan, deliver safest manner for M. |
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CTG interpretation |
DR C BRAVADO Define Risk Contractions Baseline Rate (And) Variability (5-25) Accelerations (15 for 15) Deceleration (15 for 15) Overall impression |
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Prostaglandin types |
Vasodilatory (⬇ plt, inflam) - PGE, PGI
Vasoconstrictory (⬆plt) - PGF, Tx |
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Hormone Products of ovaries |
Prog, test - ⬇hypothalamus, pituitary.
Inhibin, activin - ⬆GnRH, LH, ⬇FSH. |
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Molar pregnancy triad of sx |
Abnormal bleeding, big uterus, hyperemesis (due to high bhCG).
Twice amount if M chromosomes. Partial (2 sperm + egg chrom) Complete (2 sperm, no egg chrom) |
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HELLP syndrome + further Ix |
Haemolysis, Elevated LFTs, Low Platelets. ⬇Hb, plt. Ix: retics, LDH, blood film, Haptoglobin |
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Eclampsia sx + def |
Suboptimal tropoblast invasion. Yucky leaky vessel disease! vasculitis, coagulopathy, widespread.
Seizures, ⬆BP, ICH, visual disturbance, pulm oedema, RUQ pain, ⬆LFT (trans), proteinuria, oliguria, oedema, hyperreflexia. |
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PPH rx |
HAEMOSTASIS Help Assess vitals + resus as per Etiology (T's) Massage uterus Oxytocin / PGs Stabilise clotting + switch to theatre Tamponade (balloon / packing) Apply sutures Systematic devascularisation Interventional radiology (uterine a. ligation) Subtotal/total hysterectomy |
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Integrated test details |
1. Maternal age 2. Scan (NT) 3. Blood (PAPP-A (10w), oestriol, hCG, AFP, Inhibin A (15w)) 85% detection, 1-2% false positives |
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Adenomyosis RFs |
Parity, TOP, C/S |
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Adenomyosis presentation and diagnosis |
W >35, Cyclical pelvic pain and menorrhagia, progressing to daily pain. Dx - TVS, MRI |
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Subfertility Ix |
F - FSH, LH, testosterone, PL, TFT (day 2-5) Progesterone (mid-luteal), Screening (rubella, chlamydia), AMH, hysterosalpingogram or lap.
M- FSH, karyotyping (Y microelectronics, 47XXY, CF), semen analysis. |
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Subfertility rx |
C - diet, s, a, exercise, folic acid, med review (antispermatogenic, anti androgen, erectile/ejac dysfunction) M - clomifene (SERM), metformin, gonadotropin, dopamine agonist, sympathomimetic. S - tubal, ovarian diathermy, endometriosis removal, epidid block removal. ART - IUI, IVF, ICSI, PGD, egg donor, donor insem. |
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Subfertility def |
Couple who fails to conceive after 1 year of regular unprotected intercourse. 84% will conceive in 1yr 92% in 2yrs. |
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Pregnancy symptoms |
NV, backache, constipation, cravings/aversions, amenorrhoea, emotional, tired, mouth tastes. Vulval pigment, spider naevi, linea negra, Inc vaginal d/c, cervical softening, breast tenderness and growth, Carpel tunnel. |
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Pregnancy lifestyle advice |
Folic acid, Vit D, Exercise, eat well. AVOID - Vit A, Fe supplement, meds, unpasteurised cheese/meat, shellfish, cat litter, out of date foods, X-ray, s, a, vigorous exercise. |
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HRT adv/dis/contras |
Contra - ca (or suspected), preg, liver disease, DVT risk.
Adv - vasomotor sx, colorectal Ca, bone mass, alzheimers.
Disadv - breast Ca, endometrial ca, urinary inco, CV event. |
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Effects of oestrogen, prog, bhCG in pregnancy |
Oest - oestriol, uterine hypertrophy, breast development, CV changes, metabolic changes.
Prog - decidualisation, smooth muscle relaxation, breast development, thick cervical mucus, mineralocorticoid effect. BhCG - from day 10 to 8 weeks doubles every 2 days, maintains corpus luteum. Similar structure to LH/FSH. |
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Progesterone POP or implant SEs |
Skin changes (acne), bloating, anxiety, aches/pains, weight gain, depression, breast tenderness. |
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Puerperal changes |
Insulin resistance normalises -immediately. CV changes normalise - 2w. Hypercoagulability - 6w. Uterus lochia bleeding - 6w.
Uterus shrinks back into pelvis - 10d. Lactation: colostrum day 1/2; milk day 3/4 onward.
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Dyskaryosis definition |
abnormality of cell nucleus |
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Cervical Screening Results |
smear then biopsy (colposcopy)
low or mid grade dyskaryosis - CIN I high grade dysk (moderate) - CIN II high grade dysk (severe) - CIN III |
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Cervical Cancer Staging |
FIGO staging (also for endometrial, ovarian cancer)
stage 1- confined to area 2- spread to pelvis 3- spread beyond pelvic brim 4- distant metastasis |
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Abnormal vaginal bleeding Causes |
Post menopausal bleeding = endometrial cancer until proven otherwise. Post coital bleeding = cervical cancer until proven otherwise. |
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CIN RFs |
s, HPV 16/18, Immunocompromise |
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Teratoma |
Young women Mostly asymptomatic unless causes rupture. |
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Risk of malignancy index (ovarian mass) |
USS (1-3) x Menopause (1-3) x CA125. >250 refer to gynae oncology |
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Most common types of ovarian cancer |
Serous carcinoma |
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Diagnosis of labour |
1. Regular (<5mins apart) and increasingly painful uterine contractions that bring about
2. Progressive cervical effacement and/or dilation. |
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Hormone stimulation of labour |
Prostaglandins Steroids (NOT oxytocin) |
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Causes of slow labour |
Power - MOST COMMON inadequate, uncoordinated contractions. (rupture membranes, or oxytocin). Passage - inadequate pelvis (injury, surgery, bony disease eg. rickets), full bladder, loaded rectum. Passenger - large (obesity, diabetes, genetics), mal positioning. |
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Diagnosis of Shoulder Dystocia |
Head plates overlapping and dont push appart Failure of cervix to dilate as swollen No descent on contraction |
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Prerequisites for Assisted Vaginal Delivery |
Head 0-1/5 palpable Not large baby Cervix fullt dilated Membranes ruptured Not excessive caput poulding Satisfactory fetal condition Empty bladder Suitable presentation and position Descent with contractions and bearing down |
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Stage 3 Active Management |
Give little pull and look for lengthening and small blood spurt, Left hand above pubic symphysis to hold uterus, Controlled cord traction, Check for completeness,estimate blood loss, Check for tears and suture. |
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Vaginal Tear Grade |
1 - Submucosal tear 2 - External anal spincter involvement 3 - Int anal sphincter involvement 4 - Includes rectal mucosa |
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Puerperium Mortality Causes |
Sepsis Thrombo-embolism Pre-eclampsia or eclampsia PPH |
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Puerperium Definition |
From time of delivery to 42 day post natal (non pregnant state) |
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Hormones of Lactation |
oestrogen, progesterone, prolactin (PRL), human placental lactogen Oestrogen+suckling cause PRL secretion causing milk secretion by glandular cells. Suckling causes oxytocin release which stimulates milk ejection and helps stop bleeding. |
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Serum integrated test |
1. Mothers age 2. Bloods (PAPP-A (10w), oestriol, hCG, AFP, Inhibin A (15w) ) 85% sensitivity, 2-7% false positives. |
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Double / triple / quadruple tests |
16w. 5-6% false positives, sensitivity 60, 71, 75% respectively. Double - hCG, AFP. Triple - + oestriol. Quadruple - + Inhibin A. |
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ANC dates |
Booking - 8-12w. Bloods: FBC, blood group, RBC alloab, haemopathies, hep B, rubella, Syphilis, Urine MC&S, HIV offer. Anaemia / Atypical red cell alloantibody test - booking, 28w. DM screen - 28w. Info - 16w (bloods/screening results), 34w (labor / birth plan), 36w (breast feeding, vit K, baby blues) Anti-D - 28w, 34w. External cephalic version if needed - 36w. Every visit - BP, Urine dip, SFH. |
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Gynae cancers RFs |
Endometrial - oestrogen exposure. Cervical - intercourse + HPV. Ovarian - ovulations, BRCA |
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Ectopic pregnancy rx |
C - w+w, likely miscarry. Regular TVS, bhCG. If - pain free, small (<3cm), stable, no heartbeat/free fluid, low bhCG + progesterone. M - methotrexate. Serial bhCG. Avoid preg 6m. As above w/ normal U&E, LFT. BhCG <3-5000. S - salpingectomy, salpingostomy. BhCG 1w later to check falling, +TVS. |
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The Abortion Act 1967 |
A: risk to mothers life (>term). B: necessary to prevent grave permanent maternal p/m injury. C: =< 24 / 40 and maternal p/m injury risk (>term). D: = < 24 / 40 and existing children p/m injury risk (>term). E: substantial risk the child would suffer p/m abnormalities as to be 'seriously handicapped'.
<16 can consent (encourage parental involvement). GMC - not let personal beliefs interfere. Have to refer. |
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TOP preparation |
Counselling Bloods (FBC, G&S, HIV, HBV, HCV, haemoglobinopathies) USS (gestation, exclude ectopic) STI screen Smear |
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TOP rx |
Prophylactic abx (met 1g STAT+ (doxycycline 100mg BD 7d or azith 1g STAT)
M - mifepristone+misoprostol (or gemeprost) S - >7w, MVA or dilation + evacuation (>15w) Aftercare - Anti-D, info, 2w f/u, contraceptive advice. |
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Episiotomy cx |
Perineal pain, dyspareunia, infection, inco, bowel fistula/fissure, body image, prolapse. |
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Episiotomy indications |
Fetal distress, instrumental delivery, shoulder distocia, rigid perineum, clinical discretion, maternal risk of vagal manoeuvre (HTN, cardiac). |
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Types of prolapse |
Cystocele Urethrocele Apical prolapse Enterocele (upper post vag wall, loop of bowel in pouch) Rectocele |
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Grade of prolapse |
0 - no descent on straining. 1 - descent >1cm above hymen ring. 2 - descent <1 cm below hymen ring. 3 - descent >1 cm below hymen ring. 4 - vagina completely everted. |
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HRT (contras, benefits, risks) |
Contras - Malignancy, DVT HX, liver disease, pregnancy. Benefits - ⬇vasomotor sx, urogenital sx, osteoporosis, colorectal Ca. Risk - ⬆breast Ca, endometrial Ca, VTE, gallbladder disease. |
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Injection contraceptive instructions |
Depo provera. 99.8% 1st yr, 94% typical user. 150mg medroxyprogesterone acetate, inhibit ovulation. Start day 1-5 or use precautions. Lasts 12w IM, 13w SC. Up to 1yr delay to fertility. BMD so caution in teens >50s. SE - weight / bleeding. |
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Implant contraceptive instructions |
Nexplanon. 99.9% effective. Progesterone, inhibits ovulation. Enzyme inducer drug interaction. Lasts 3yrs. Start day 1-5 of cycle or protection 7d. SEs: bleeding, headache, acne, bloating (mood, weight, hair loss) |
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IUD instruction |
Copper coil. >99% effective. 5-10yrs. Causes inflammation so can't implant. Religious beliefs - doesn't stop fertilisation! Try to remove if fall pregnant (misc risk), and check preg is intra abdo (ectopic). Contras- current infections, suspected/known preg, unexplained unusual bleeding (investigate first), uterine cavity abnormality. |
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Causes of pain in pregnancy |
Misc, ectopic, constipation, round ligament pain, UTI, red degeneration, appendicitis, intestinal obstruction, acute cholecystitis, annexation torsion, pancreatitis. >24w - labour, braxton hicks contractions, pubic symphysis dysfunction, reflux oesophagitis, uterine rupture, placental abruption, pre-eclampsia, HELLP, acute fatty liver of pregnancy. |
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Chlamydia trachomatis |
MOST COMMON BACTERIAL (intracellular). 80% F asymptomatic. Sx - DC, PCB, IMB, lower abdo pain. Swab (endocervix/vulva) + PCR. Rx- doxy 100mg BD (7d) or azith 1g STAT. (preg - eryth 500mg BD 14d) Cx - reactive arthritis, PID, salpingitis (ectopics), perihepatitis, HIV susceptible x3-4, neonate conjunctivitis/pneumonia, misc, preterm, PP infection. |
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Gonorrhoea |
Neisseria gonorrhea, -ve intracellular diplococcus. Often other infections as well. 50% asymptomatic. Sx - DC (white purulent), IMB, pelvic pain, dysuria, frequency. Swab (endocervix) + NAAT, test for other STIs. Rx - cefixime 400mg STAT. Or ciproflox, amox. Pharyngeal - ceftriaxone 250mg IM STAT. 72hrs f/u. Cx - PID (infertility, ectopic), septic arthritis, perihepatitis, HIV susceptible x4-5, neonate conjunctivitis (emergency!), misc, preterm, PP infection. |
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Trichomoniasis |
Trichomonas vaginalis (flagellate protozoa). 10-50% asymptomatic. Often coexists with gonorrhoea. Sx - DC (fishy, yellow/green, frothy), itching, strawberry cervix, dysuria. Wet smear microscopy, pH (>4.5), triple swab. Rx - metronidazole 2g STAT or 400mg TDS 5d (preg). Partner rx. Cx - HIV susceptibility, preterm delivery, low birth weight,⬆ mortality. |
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Bacterial vaginosis |
Most common cause of DC but non pathological. Anaerobes Overgrowth with less lactobacilli. More common in TOP, IUCD, PID. Sx - DC (fishy), itch, not inflam. Ix - whiff test (kOH 10%), pH >5.5, triple swab, culture, microscopy (clue cells). Rx - metronidazole 2g PO stat or 400mg TDS (5d), clindamycin 2% cream ON 7d. Cx - prem labour, Inc HIV susceptible, infection risk (post natal / surg). |
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Candidiasis |
Fungal overgrowth of candida albicans or glabrata. RFs - immunosup, DM, high dose COCP, anaemia, preg. Sx - DC (cottage cheese), itchy, fissuring, dysuria, sup dyspareunia. Ix - speculum (white plaques), pH>4.5, triple swab, culture, microscopy (budding yeast spores), smear. Rx - topical clotriamazole (1-6 nights), oral fluconazole (150mg PO STAT). preg - topical only. |
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Herpes Simplex |
DNA virus. Type I - oral, Type II - STI, genital lesions. Sx - 1: painful ulceration, urinary retention, flu like sx, inguinal lymphadenopathy. 2: shorter reactivation, less severe, due to stress, sexual intercourse, menstruation. Ix - viral culture, Ab Levels. Rx - acyclovir 400mg QDS 5d / 500mg BD 2d. And analgesia/ice packs. Cx - meningitis, sacral radiculopathy, transverse myelitis, disseminated infection. |
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HPV |
Most common STI in UK (Type 6, 11). 70% transmission, many asymptomatic. Sx - clustered warts like skin tags, usually painless. Ix - biopsy, smear, colposcopy. Rx - treat partner! Often regrow. Podophyllin paint, podophyllotoxin solution, trichloroacetic acid (weekly), cryotherapy, surgery. |
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Syphilis |
Treponema pallidum spirochete. Sx - 1: [10-90d post inf], chancre (painless solitary ulcer), painless lymphadenopathy. 2: [2yrs] rash (trunk, palms, soles), papules, lymphadenopathy, genital condyloma lata. 3: [>2yrs latency] neurosyphilis (dementia, tabes dorsalis), CV (aneurysm, aortic regurge), gummatas. Ix - dark field miscroscopy, VDRL, RPR, FTA abs. Rx - contact tracing, pen G 750mg IM (10d), benpen 2.4MU IM STAT, doxy 100mg PO BD (14d) (pen allergic), erythro 500mg QDS (14d) (pen allergy + preg). |
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AIS types |
46 XY female. X-linked recessive androgen receptor gene preventing wollfian structure development. CAIS - (Complete) Female genitalia (+core gender identity), short blind ended vagina, absent uterus/fallopian tubes. PAIS - (partial) broad spectrum. Phenotypic F w/ citral enlargement -> phenotypic M w/ hypospadius. MAIS - (mild) puberty high pitched voice w/ gynaecomastia. |
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AIS diagnosis |
Prenatal - CVS karyotyping not matched to USS. Birth - inguinal hernia / labial swelling found to contain testes. Puberty - normal breast development,⬇pubic/axillary hair, absent menstruation. |
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AIS Rx |
C - MDT, info, support groups, open door psych. M - HRT (oestrogen) lifelong postpuberty. S - gonadectomy postpuberty (malignancy risk intra abdominally), vaginal lengthening (dilators). |
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CAH Rx |
MDT (urologist, endo, psych, gynae). Glucocorticoid replacement, fludrocortisone if salt losing. Other - anti androgen, Inc dose in preg (fetal aromatase destroys excess hydrocortisone), in utero dexameth if prenatal dx, surgery. |
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CAH presentation |
46XX Male. Autosomal recessive cyp21 gene mutation on chrom 6. 90% 21-hydroxylase deficiency inhibiting cortisol/aldosterone production and precursor conversion to androgen. Neonate - salt wasting, hypoglycaemia, ambiguous genitalia. Childhood - virilization, accelerated growth, short stature (M). Adolescence - late onset hirsutism, oligomenorrhoea, cystic ovary changes. |
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Pre-eclampsia diagnosis |
BP >= 140/90 with >= 300mg proteinuria (24hr) [after 20/40]
HTN: BP⬆>=30/15 with >=300mg proteinuria (24hr) [higher risk]
Severe: BP >=170/110 with >=1g proteinuria (24hr) OR maternal cx. |
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Pre-eclampsia rx |
OP if BP <160/110, protein <300mg AND asymptomatic. Sx advice + Bloods (wkly), BP/urine (twice wkly). Mild/mod - BP (4hr), Urine, CTG (daily), Bloods (2-3d+), USS (2wkly growth, twice wkly liquor vol). Severe - inform seniors, Bloods, fluid balance, CTG, USS. Nifedipine 10mg twice 30min apart then labetolol IVI. +/- hydralazine. Eclampsia - senior help, resus, MgSO4, monitor, diazepam (repeat seizure), deliver when stable. |
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Pre-eclampsia antihypertensives |
Use when BP >160/110. 1. Labetolol 100mg BD (NOT asthma) [max 600mg QDS]. 2. Nifedipine 10mg BD [max 300g TDS] 3. Methyldopa 250mg BD [max 1g TDS] 4. Hydralazine 25mg TDS [max 75mg QDS] |
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Pre-eclampsia immediate delivery criteria |
Worsening ⬇plt/coagulation, ⬇renal/liver function, Severe maternal sx (esp RUQ pain), Fetal distress/ reversed umbilical a flow, HELLP syndrome, Eclampsia. |
