Obstetrics And Gynacology

Front 1

What is the name of the newborn screening test?

Back 1

Guthrie test

Front 2

Define heavy menstrual bleeding

Back 2

excessive or prolonged mesntruation
>80ml/cycle (average is 35ml/cycle)

Front 3

What does the newborn screening test, test for?

Back 3

CF
PKU
Galactosemia
Congenital hypothryoidism
Amino acid disorder
Fatty acid metabolism disorders

Front 4

Incidence of heavy menstrual bleeding?

Back 4

10% of women

Front 5

What are two factors which can invalidate the results of the newborn screening test?

Back 5

Antibiotics
Lack of enteral feeding

Front 6

Cause of heavy menstrual bleeding in hepatic and renal failure:

Back 6

hepatic: decreased synthesis of coag factors and sex steroids
renal: excess estrogens

Front 7

List the benefits of the OCP?

Back 7

1. Decreases menorrhagia and dysmenorrhea
2. Acne
3. Ovarian and endometrial CA
4. PID
5. Regulation of menstral cycle
6. Benign cystic breast disease
7. Endometriosis
8. Contraception

Front 8

Normal frequency of changing pads/tampons in heaviest flow

Back 8

<2/hr
<21 whole time
clots <2.5cm
anemia also a signal of HMB

Front 9

List the side effects of the OCP?

Back 9

1. DVT
2. PE/Stroke
3. Hypertension
4. Weight gain
5. Nausea
6. Decreases libido

Front 10

Which patients with HMB get tested for coag disorders?

Back 10

if HMB since menarche or family hx

Front 11

What are some types of emergency contraception?

Back 11

1. Combo pill (100ug estrogen+0.75mg levonorgestrel) 2 doses 12 hrs apart
2. Progestin only (levonorgestrel 2 doses 12 hrs apart)
3. Mifepristone (abortifacent)
4. IUD

Front 12

Indications for ultrasound in HMB?

Back 12

uterus palpable abdominally
vaginal exam reveals a pelvic mass
pharmaceutical treatment fails
before IUS insertion

Front 13

What are the major fetal complications of multiple gestations?

Back 13

1. increased mortality (5-10x higher)
2. prematurity
3. Twin-twin transfusion
4. Cord accidents (twisting)
5. Conjoined twins
6. IUGR
7. Low birth weight
8. Operative delivery
9. Placenta previa/abruption more common

Front 14

Indications for endometrial biopsy in heavy menstrual bleeding

Back 14

if >40
persistent intermenstual bleeding
at risk of endometrial hyperplasia
treatment failure

Hint 14

In postmenopausal, abnormal uterine bleeding is endometrial cancer until proven otherwise (10% have malignancy: 8% endometrial Ca, others cervical, ovarian or secondary)

Front 15

What is the name of the drug which is given to stimulate ovulation in infertility (esp in PCOS)

Back 15

Clomiphene

Front 16

Indication for gynae referral < 40 years in the setting of heavy menstrual bleeding

Back 16

all intermenstrual/postcoital
at risk of endometrial hyperplasia

most common abnormality found on hysteroscopy = fibroid> polyo

Front 17

What are the major maternal complications of multiple gestations?

Back 17

1. HTN
2. PPH
3. Pre-eclampsia

Front 18

Management of HMB if no structural cause is suspected?

Back 18

myrena first line
2nd line: tranexamic acid, nsaids, ocp
3rd line: progestogens day 5-26/depo

Front 19

What are the most common infectious agents in mastitis?

Back 19

1. Staph aureus
2. Streptococcus species

Front 20

Mean blood loss reduction by common treatments for heavy menstrual bleedding

Back 20

IUS: >90%
tranexamic acid 40%
OCP slightly less than 40%
NSAIDS 30%
Progestogen 80%

Front 21

What is the treatment for mastitis?

Back 21

1. Continue breast feeding or pumping
2. Warm, moist heat
3. NSAIDs
4. Dicloxacillin
5. Surgical drainage in the case of breast abscess

Front 22

What medical treatments are not recommended for heavy menstrual bleeding

Back 22

oral progestogens in the luteal phase
danazol

Front 23

What are the benefits of breast feeding?

Back 23

1. Maternal-fetal bonding
2. IgA
3. Decreases PPH (uterus contraction)
4. Economical
5. Ideal solute load for kidneys
6. ?prevent diabetes?
7. Contraception
8. Decreases risk of breast cancer and ovarian cancer
9. Decreased AOM in baby
10. Decreased SIDS
11. Get to know baby quicker
12. Decreases infections (esp GI)
13. lower antigenicity than cows milk (cow's milk protein allergy or eczema)

Front 24

Criteria to be eligeble for endometrial abalation?

Back 24

woman does not want to conceive
suitable normal uterus or fibrpid <3cm
newer technique preferable e.g. baloon, thermoabalation
80-90% amenorrghea

Front 25

What are the risk/complications of breast feeding?

Back 25

1. Infection transfer (HIV)
2. Difficult to quantify amount of each feed
3. NO Vit D or Fe
4. Longer feeding times
5. Sore cracked nipples
6. Oral candidiasis

Front 26

Investigations for intermenstrual bleeding

Back 26

if at risk for sti- test
papsmear, TVUS and gynae referral if persistent

Front 27

In a glucose challenge test what is considered abnormal at 1 hour?

Back 27

50g glucose load
>7.7mmol/L
If >11mmol/L then diagnose with GDM

Front 28

Cardianal symptom of cervical ca

Back 28

postcoital bleeding
if recurrant warrants culposcopy even if smear is normal

Front 29

In a glucose tolerance test what is the diagnostic criteria?
0hrs?
1hr?
2hrs?
3hrs?

Back 29

0hrs >5.5 mmol/L
1hr >10.0 mmol/L
2hrs >8.0mmol/L

Front 30

Incidence of PCOS?

Back 30

5-10% of women of reporoductive age
infertility>hirsutism> irregular periods> obesity

Front 31

What are the fetal effects of GDM?

Back 31

1. Macrosomnia
2. Increased risk of shoulder distocia
3. Neural tube defects
4. Atrial/Ventricular septal defects
5. Transposition of vessels
6. Hypoglycemia after birth
7. Renal anomalies
8. Stillbirth

Front 32

Risk of diabetes in PCOS?

Back 32

5-10 fold increase

Front 33

What are the maternal risks/effects of GDM?

Back 33

1. predisposition to DM in later life (50%)
2. Increases C/S rate
3. infection
4. PPH
5. HTN/pre-eclampsia

Front 34

Most important factors in PCOS management?

Back 34

Weight management: BMI <25- screen for diabetes and metabolic changes
Other management is targeted at the problem at hand

Front 35

What are the beneficial effects of HRT?

Back 35

1. Hot flushes control
2. Osteoporosis
3. Urogenital symptoms
4. Vaginal dryness
5. Sleep improvements
6. Colorectal cancer

Front 36

Effectiveness of clomiphene for ovulation induction in PCOS

Back 36

80%

Front 37

What are the risks of HRT?

Back 37

1. DVT/PE/Stroke
2. Breast cancer
3. Endometrial/Ovarian cancer (estrogen only HRT)

Front 38

What is metformin useful for in PCOS?

Back 38

reducing fasting insulin and lowering triglyceride levels

not as effective as OCP in reducing androgen levels and returning menstrual patterns to normal

Front 39

What is a non-hormonal drug given to treat menorrhagia?

Back 39

Tranexamic acid

Front 40

Hormonal stimulation of lactation

Back 40

oestrogen: icnrease in number and size of ducts
progesterone increases number of alveoli
HPL: alveoli

Front 41

What is the Bishop score and what are the components?

Back 41

Measure of favourability for induction of labour
1. Consistency of cervix
2. Position of cervix
3. Dilitation of cervix
4. Effacement
5. Station

Front 42

How does mcroberts positioning work in reducing dystocia?

Back 42

tilting pelvis- orient symphysis more horizontally to fascilitate shoulder delivery

Front 43

What screening questions should be asked to screen for pre-eclampsia?

Back 43

Swelling of face or hands?
Headache?
Blurry vision?

Front 44

What is the normal orientation of the foetal skull as it traverses the pelvis?

Back 44

occipitotransverse when engaging--> occipitooblique in mid canity --> occipitoanterior at iscial spines

Front 45

Definition of antepartum hemorrhage?

Back 45

Bleeding after 20 weeks gestation to before delivery

Front 46

By how much can moulding decrease the biparietal diameter?

Back 46

by approximately 1cm
parietal bones override occipital and frontal
remember that only bones of vault are compressable- base of skull not compressable

Front 47

Major causes of antepartum hemorrhage?

Back 47

1. Placental abruption (30%)
2. Placenta previa (20%)
3. Uterine rupture (rare)
4. Vasa previa (rare)
5. Coagulopathy
6. Cervical incompetence
7. Threatened premature labour

Front 48

Ranges for foetal blood pH

Back 48

>7.25 normal
7.20-7.25- pre-asphyxia- expectant mx
<7.20- asphyxia. deliver

Front 49

Risk factors for antepartum hemorrhage?

Back 49

Previous abruption
Trauma
HTN
Cigarette smoking
Parity (increased)
Maternal age
Cocaine
PROM
Coagulopathies
Multiple pregnancies

Front 50

Peak effects of entonox

Back 50

after 10 breaths
used in 60% of parturients

drowsiness and light headedness, nausea

Front 51

Types of placenta previa?

Back 51

1. complete
2. partial
3. marginal
4 low lying (withing 2cm of os)

Front 52

At which level is an epidural performed?

Back 52

L3-4
at level of iliac crests

Front 53

Risk factors for placental previa?

Back 53

Endometrial scarring (increased parity, LSCS, maternal age, prior curette)

Increased demand for placental surface area ie increased oxygen demand(maternal smoking, multiple gestation, higher altitudes)

Early gestational age

Front 54

Sensation felt before injecting an epidural

Back 54

loss of resistance after puncturing lig. flavum

Front 55

Initial management of mod to severe abruption

Back 55

1. 2 large canulas
2. maternal vitals and hemodynamic status
3. Continuous CTG
4. IV fluid resus
5. Bloods: FBC, G&H cross match, QFMH, DIC screen, Coags

Front 56

Epidural dosing

Back 56

Up to 20ml initial bolus after test dose, onset of analgesia 20 min

Front 57

Management of PPH? (non-initial)

Back 57

1. All initial managment stuff (vitals, bloods etc)
2. Oxytocin infusion
3. Direct uterine massage
4. Correction of DIC
5. Prostaglandins
6. B-lynch suture
7. Uterine embolization
8. Hysterectomy

Front 58

Rate of difficult intubation at full term?

Back 58

1: 300 due to swollen airways, large breasts etc.
Also high risk of aspiration: manage with antacid premedication, rapid sequence induction and cricoid pressure

Front 59

What are some commonly used medications for overactive bladder?

Back 59

Ditropan (Oxybutynin)
Detrusitol (Tolterodine)
Tofranil (Imipramine)

Front 60

Why does desaturation during failed intubation occur more quickly in a pregnant woman?

Back 60

Decreased oxygen stores (FRC decreased by 20%)
Increased oxygen consumpton (60%)

Front 61

What are the risks associated with maternal smoking?

Back 61

Lower birth weight
Perinatal mobidity and mortality (PROM, abruption, preterm delivery, stillbirth and SIDS)

Front 62

Strategies to avoid or minimise neonatal depression after a caesar under GA?

Back 62

minimise volatile anesthetic dose
Use NO
Avoid or minimisa short-acting narcotics

Front 63

What is the criteria for Fetal Alcohol Syndrome?

Back 63

1. Prenatal alcohol exposure
2. Growth restriction pre and postnatally
3. Facial malformation (short palpebral fissures, thin upper lip, abnormal philtrum and hypoplastic midface
4. Neurdevelopmental disorders (language, motor, learning)

Front 64

When does autocaval compression become an issue in pregnant ppl requiring surgery?

Back 64

> 20/40 weeks

Front 65

S&S of Endometriosis?

Back 65

Recurrent dysmenorrhea
Dyspareunia
Low back pain
Infertility
Adnexal mass
Bowel/bladder symptoms

Front 66

Do post dural puncture headaches generally resolve spontaneously?
How are these managed?

Back 66

spontaneous resolution may take months to years
Conservative therapy ineffective
blood patch 70-98% effective

Front 67

What are some risk factors for Endometriosis?

Back 67

Early menarche
Late menopause
Shorter menstral cycle length
Longer duration of menstral flow
Not on OCP (is protective)

Front 68

Management of placenta praevia and accreta when doing a caesar

Back 68

anticipate massive transfusion
pre-emptive iliac artery baloon cath
uterotonic drugs
surgical: hysterectomy
embolisation

Front 69

What are some medical treatments for endometriosis?

Back 69

1. NSAIDs
2. OCP
3. IUD
4. Danazol (ovarian suppression)
5. GnRH analogue

Front 70

Management of maternal collapse during after a caesar

Back 70

intubate early
left lateral tilt
perimortum c-section @ 5 min

Front 71

What are some causes of post-menopausal bleeding?

Back 71

1. HRT
2. Atrophic changes (endometritis, cervicitis, vaginitis)
3. Cancer (endometrial, cervical, vaginal, vulvar)
4. Polyps
5. Endometrial hyperplasia
6. Trauma
7. Bleeding disorder

Front 72

What % of all pregnancies are ynplanned and what % of these result in an induced abortion?

Back 72

38%
6/10

Front 73

What are the risk factors for endometrial cancer?

Back 73

Medications - estrogen, tamoxifen
Family hx
Low parity, infertile
Endometrial hyperplasia
PCOS
HNPCC
Obesity

Hint 73

Hysteroscopy with biopsy (gold standard)
Dilation and curettage (misses 10%)
Outpatient endometrial biopsy (misses ~30%)
Ultrasound in postmenopausal: if endometrial thickness <4mm, endometrial cancer is very unlikely.

Front 74

What is the pearl index?

Back 74

number of unintended preg per 100 women per year

Front 75

What endometrial thickness is considered abnormal in a post-menopausal women?

Back 75

>4mm (if not on HRT)

Hint 75

Hysteroscopy with biopsy (gold standard)
Dilation and curettage (misses 10%)
Outpatient endometrial biopsy (misses ~30%)
Ultrasound in postmenopausal: if endometrial thickness <4mm, endometrial cancer is very unlikely.

Front 76

Failure rates of withdrawal

Back 76

25%/year
male condom: 12%/year
POP: 8%/year
(typical use) --> much lower in perfect use

Front 77

What investigations would you perform in a women with PMB?

Back 77

Pap smear
Endometrial biopsy
Transvaginal U/S (uterus, endometrial thickness, pelvic masses and free peritoneal fluid)
Hysteroscopy D&C

Front 78

What % of women continue to ovulate normally while on the POP?

Back 78

40%

Front 79

What pts would you book for colposcopy ?

Back 79

1. 2 LGSIL smears in 12 months
2. Any HGSIL
3. Any glandular abnormality on smear
4. Persistent post-coital bleeding
5. Abnormal appearing cervix

Front 80

When is it best to start the POP?

Back 80

if start in 1st 5d of menstrual cycle: immeadiate contraceptiom
any other time- take precautions 2days

Front 81

What strains of HPV are implicated in Low grade cervical dysplasia?

Back 81

HPV 6 and 11

Front 82

How effective is depot provera at inhibiting ovulation?

Back 82

>99%

start in 1st 5d of cycle for immeadiate protection- otherwise use other methods for 7 days

Front 83

What strains of HPV are implicated in High grade cervical dysplasia?

Back 83

HPV 16 and 18

Front 84

Advantages of depot?

Back 84

protects against uterine cancer
protects against PID

Front 85

What % of LGSIL regress?

Back 85

60-70%

Front 86

Chef effect of implanon?

Back 86

stops ovulation = chief effect
also causes thinning of lining of uterus

Front 87

What % of LGSIL progress to HGSIL?

Back 87

4%
<0.1% progress to cancer

Front 88

Incidence of perforation after IUD insertion?

Back 88

1/1000

Front 89

What % of CIN 2 regress?

Back 89

43%

Front 90

When is pelvic infection a problem after IUD insertion?

Back 90

in 1st 20d
irregular pain and bleeding is suggestive of such an infection

Front 91

What % of CIN 2 progress?

Back 91

22%

Front 92

Criteria for effectiveness of lactational amenorrhea?

Back 92

<6m
Amenorrhea
Full breast feeding

Front 93

What % of CIN 3 progress?

Back 93

14%

Front 94

Earliest possible ovulation postpartum?

Back 94

day 21
progesterone only methods usuallu used as COC shows a decrease in the volume of milk in case control studies
IUD/IUS can be put in 6 weeks PP

Front 95

What % of CIN 3 regress?

Back 95

32%

Front 96

How long after vasectomy are men donsidered sterile

Back 96

When there is no sperm in ejaculate- may take up to 6 months or 15 ejaculations

Front 97

What are the risk factors for cervical cancer?

Back 97

Preinvasive disease
smoking
HPV infection
Multiple sexual parters
Early age of first intercourse
Immunosuppression

Front 98

Is there legislation to legalise abortion in NSW?

Back 98

No, relies on common law interpretation of the crimes act or the criminal code act

Front 99

What is the treatment for bacterial vaginosis (gardnerella vaginalis)?

Back 99

Metronidazole 400mg bd x7days

Front 100

What is the earliest age for consent to a surgical abortion?

Back 100

14-16 years, "competant minors" : don't need parental consent for abortions performed in private clinics
= "gillick competancy"

Front 101

What is the treatment for Chlamydia?

Back 101

Azithromycin 1g stat dose OR
Doxycycline 100mg bd x 10days
No sex for 10days
Treat partners from last 6/12

Front 102

Cutoff for medical abortion?

Back 102

9 weeks after LMP

Currently 30% of TOPs under 9 weeks gestation are done using a medical method

Front 103

What is the timeframe of post-partum blues?

Back 103

First 10days
(peak 5 days)

Front 104

Timing of surgical abgortion using suction curette?

Back 104

7-15 weeks

Front 105

What is the timeframe of post-partum depression?

Back 105

First 6 months
(first 90 days greatest risk)

Front 106

Contraindications to mifepristone

Back 106

gestation > 9 weeks
known or suspected ectopic preg
adrenal failure
coagulation disorder
allergy
IUD in situ
clinical evidence of a pelvic infection

Front 107

Define lie

Back 107

Long axis of the fetus to the long axis of the uterus.
(Transverse or longitudinal)

Front 108

Average duration of bleeding after medical abortion?

Back 108

9-12 days - spotting can last up to 30 days or more and spotting can occur for 30 days or more.

Front 109

Define presentation

Back 109

Part of fetus felt on vaginal examination

Front 110

How do you see if a medical abortion is complete?

Back 110

abscence of gestational sac on ultrasound is key indicator

Front 111

Define position

Back 111

The rotational relationship defined by the presenting part as the denominator ie normally cephalic = occiput
(OA, OP, L or R OT

Front 112

When is manual vaccum aspiration done?

Back 112

Up to 10 weeks- flexible cannula used

Front 113

Define Engagement

Back 113

The station at which the maximum diameter of the presenting part is through the pelvic inlet. If vertex 1/5 palpable above symphsis pubis

Front 114

Antibiotic prophylaxis prior to a pregnancy termination

Back 114

dox/azithro +/- metronidazole
Chlamydia and BV mostly implicated
Screen + treat as well as universal prophylaxis- allows treatment of partener

Front 115

Describe the mechanisms of labour (stages)

Back 115

1. Descent
2. Flexion
3. Internal rotation
4. Crowning
5. Restitution
6. External rotation
7. Lateral flexion

Front 116

What % of TOP's in australai are done in the 2nd trimester?

Back 116

5%, 1% > 20 weeks

Front 117

What are some common signs of the begining of the second stage of labour?

Back 117

Feeling of wanting to push or have bowels open
Perineal flattening
Vaginal gaping
Large mucoid show
Anal pouting
No cervix felt on examination

Front 118

Procedure for a 2nd trimester TOP

Back 118

dilatation (PG- 2/3 hours prior or hygroscopic dilators) and evacuation

Front 119

What are the common causes of bleeding in early pregnancy?

Back 119

1. Misscariage
2. Ectopic
3. Normal bleeding
4. Non pregnancy related (cancer, trauma, urethra/UTI)

Front 120

When is the risk of a continuing pregnancy after a surgical termination increased?

Back 120

if done at very early gestations

Front 121

What are the treatment options for an ectopic pregnancy?

Back 121

Surgical: Laparoscopy or Laparotomy

Methotrexate IM (if small and stable)

Front 122

Incidence of major foetal anomalies

Back 122

affect 2-5% of neonates
account for 20-30% of perinatal deaths

Front 123

What is the normal rate of misscariage?

Back 123

1:5

Front 124

Detection rate of foetal abnormalities on FAS?

Back 124

30-80%

Front 125

What is the mechanism of action of the progesterone only pill?

Back 125

Viscous, hostile cervical mucous
Atrophic endometrium

Front 126

Major structural abnormalities associated with Down syndrome?

Back 126

30% duodenal artresea, TEF, esophageal atresia- may not be evident until 3rd tm

50% cardiac abnormalities: AVCD, VSD, ASF

Front 127

How does depo-provera work?

Back 127

Inhibits ovulation (progestogen containing)

Front 128

First trimester biochemistry and Down syndrome

Back 128

free beta HCG: decreases 10-14 weeks in humans, increased in trisomy 21
PAPP-A: increases between 10-14 weeks, decreased in trisomy 21

Front 129

How long does depo-provera last for ?

Back 129

12 weeks

Front 130

What is abnormal ductus venosus flow associated with at 10-13+6 weeks

Back 130

chromosomal abnormalities
cardiac defects
adverse pregnancy outcome

abnormal in 80% of Down foetuses and 5% of chromosomally normal ones during this period- reverse flow of A-wave (atrial systole)

Front 131

What are the side effects/disadvantages of depo-provera?

Back 131

Change in periods (irregular bleeding, amenorrhea)
Cannot be removed (side effects for 3 months
Delay in return of fertility
Weight gain
Depression
Mood swings
Headaches
Acne
Breast tenderness

Front 132

In what age groups do you empyrically give artificial surfctant for RDS?

Back 132

<28 weeks

Front 133

How long does Implanon last for?

Back 133

3 years

Front 134

What are causes of respiratory distress in the neonate in order of frequency?

Back 134

RDS > TTN > sepsis > mex > asphyxia

Front 135

How does Implanon work?

Back 135

Inhibits ovulation
Thickens cervical mucous
Thinning of endometrium (atrophic)

Front 136

What factors increase risk of transient tachypnoea of the newbown

Back 136

no labour
maternal DM

Front 137

How does the copper IUD work?

Back 137

Impede sperm transport (copper kills sperm)
Blocks fertilization
Blocks implantation

Front 138

Time course of TTN?

Back 138

Takes approx 12 hours to resolve

Front 139

How does the Mirena work?

Back 139

Suppresses endometrium
Thickens cervical mucous
(inhibs ovulation in 50%)

Front 140

Management of sepsis in neonate

Back 140

penicillin + gentamycin

Front 141

At what gestational age is a fetal morphology scan done?

Back 141

18-20 weeks

Front 142

Management of asphyxia

Back 142

therapeutic hypothermia to 33 degrees- within 6 hours of hypoxia

Front 143

What is the overall incidence of trisomy 21?

Back 143

1:660

Front 144

What is the most common congenital heart defect that presents straight after birth?

Back 144

TGA- will need surgery within first 7-10d of life

Front 145

What is the risk of trisomy 21 with a maternal age of 40years

Back 145

Approx 1:100

Front 146

Normal pH of vaginal discharge?

Back 146

3-4.5

Front 147

What is the detection rate of trisomy 21 using free bHCG, PAPPA, NT and age?

Back 147

90%

Front 148

Normal vaginal flora that is increased by sexual arousal

Back 148

Gardanella

Front 149

Which anesthetic is commonly used in epidurals?

Back 149

Low conc long acting (bupivacaine aka Marcane)

Front 150

Normal vaginal flora of pregnancy?

Back 150

staph epidermis

Front 151

What are the potential complications of epidurals?

Back 151

Dural puncture with post dural puncture headache
Hypotension
N/V
Shivering
Failure
Neurological injury
Epidural abcess
Epidural hematoma

Front 152

Normal vaginal flora on ectropion

Back 152

mycoplasma spp

Front 153

What is the definition of heavy menstral bleeding?

Back 153

>80ml lost per cycle

Front 154

Normal vaginal flora in atrophic vaginitis?

Back 154

streptococci

Front 155

How many pads or tampons used over a single mentral period is normal?

Back 155

<21 pads/tampons

Front 156

Why does trichomonas not cause systemic infection?

Back 156

does not invade beyond the superficial layers of the mucosa

Front 157

What are some causes of heavy menstral bleeding?

Back 157

Uterine causes
- Fibroids, polyps, adenomyosis, dysfunctional uterine bleeding

- thyroid, coagulation abnormal.
- IUD
- Cancer

Front 158

What % of women with trichomonas infection are asymptomatic?

Back 158

50%
symptoms include: frothy green malodorous discharge with high pH, pruritis, dysuria, superficial dyspareunia.
Symptoms worse during menses as T. vag is haemophagic

Front 159

What are the treatments available in menorrhagia where sinister abnormality is suspected?

Back 159

IUD
Transexamic acid
NSAIDs
OCP
Depot provera

Front 160

When soes a strawbery cervic occur

Back 160

1/3 of trichomonal infections

Front 161

What are some common causes of intermenstral bleeding?

Back 161

Polyps
Cancer
Fibroids
Clotting disorders
HPA dysfunction
HRT

Front 162

Diagnosis of trichomoniasis?
Management?

Back 162

Wet prep (50-80%)
Mx: metronidazole or tindazole
treat sexual contacts within the last 30-60days

Front 163

What conditions should be ruled out before a diagnosis of PCOS is made?

Back 163

- Congenital adrenal hyperplasia
- Cushing syndrome
- Androgen producing tumors
- Hyperprolactemia
- Acromegaly

Front 164

Why is vulvovaginal candidiasis less common after menopause?

Back 164

low oestrogen

Front 165

What is the diagnostic criteria for PCOS?

Back 165

2 of the following 3:
1. S&S of androgen excess (hirsuitism, acne, alopecia)
2. Oligo/amenorrhea
3. Polycystic ovaries

Front 166

What % of women with bacterial vaginosis have symptoms?

Back 166

50%

Front 167

What are some contradindications to medical termination of pregnancy?

Back 167

1. >9 weeks gestation
2. Known or suspected ectopic
3. Allergy to mifepristone/misoprostol
4. Adrenal failure
5. Hemorrhagic disorder or anticoagulant therapy
6. IUD in place

Front 168

Diagnosis of BV?

Back 168

vaginal smear- posterior fornyx dragging along lateral wall
gram stain/wet prep- polymicrobial (gardanella and mycoplasma often dominate)
pH 6
few polymorphs
clue cells
+VE amine test

Front 169

After medical TOP, how should a pt be counciled regarding side effects and symptoms?

Back 169

N/V
Diarrhea
Fever/chills
Cramping pain
Bleeding for 9-12 days
If soaking more than 2 pads/hr for more than 2 hours this is a warning sign

Front 170

What is the amine test

Back 170

add KOH- release volatile amines in presence of anaerobic bacteria

Front 171

What are some common causes of respiratory distress in newborns?

Back 171

1. RDS
2. TTN
3. Sepsis
4. Mec aspiration
5. Asphyxia (acidosis)

Front 172

What do lactobacilli metabolise?

Back 172

glycogen to lactic acid

Front 173

What combination of tumor markers produces higher sensitivity/specificity for ovarian cancer?

Back 173

CA -125
HE4

Front 174

Separation of diamnionic dichorionic trins

Back 174

<4
MCDA: 4-7
MCMA: 7-14
Conjoined: > 14

Front 175

Name some infections which impact mainly on the fetus

Back 175

TORCH
B19
GBS
LIsteria
Yersinia

Front 176

What does the twin peaks sign indicate?

Back 176

a dichorionic placenta

Front 177

Name some infections which impact mainly on the Mother

Back 177

Mastitis
Endometritis
Wound infection
Perineum
Pneumonia

Front 178

Wht % of twins undergo early foetal demise (<14w)

Back 178

singleton- 2%
Twins: 5% 1 demise
24% of which ultutimateky both

Front 179

Name some infections which impact both on the fetus and mother

Back 179

VZV
HBV
HCV
HIV Chorioamnionitis
UTI

Front 180

What does late foetal demise lead to in mono and dichorionic twins?

Back 180

di: preterm delivery, 5-10% death/handicap
mini: 25% neuro handicap
hypotension due to haemorrhage from live foetus into dead foetoplacental unit

Front 181

What are some causes of neonatal hypoglycemia?

Back 181

Maternal GDM
Sepsis
Hypothyroidism
In-borne errors of metabolism
IUGR
Chorioamnionitis
Prematurity

Front 182

Rate of structural abnormalities in minozygotic twins?

Back 182

2-3 x singletons
5-7%

Front 183

What are some common causes of female infertility?

Back 183

Ovulation abnormalities
Endometriosis
Pelvic adhesions
Cervical pathology
Uterine pathology

Front 184

What % of MC twins get twin-twin transfusion?

Back 184

15-30%
connections present in 100%

Front 185

What are some complications associated with placenta previa?

Back 185

1. Hemorrhage
2. Preterm delivery
3. Congenital malformations
4. Malpresentation
5. Placental abruption
6. Endometritis

Front 186

What determines the prognosis of twin-twin transfusion?

Back 186

Survival poorer when progresses to a higher stage over time
1/2 will progress
30% same
20% get to lower stage

Front 187

What is the most common cause of IUGR?

Back 187

Chronic hypertension

Front 188

What is the current mainstay of manageing twin transfusion syndrome?

Back 188

selective laser abalation of placental anastomoses
Use for stage 2 and above
fetoscope- direct visualisation of blood vessels
uterine relaxants and antibiotics move
PPROM 20%, placental separation 2%
Survival of at least 1 twin 70-80%
Both 30%

Front 189

What is the diagnostic criteria for pre-eclampsia?

Back 189

Pregnancy induced HTN that develops after 20weeks AND
>300mg of proteinuria in 24 hrs

Front 190

Frequency of antenatal visits for twins?

Back 190

2 weekly until 36 weeks then weekly
scans: 26, 30, 34

Front 191

What are some of the findings in pre-eclampsia?

Back 191

Edema
Proteinuria
Rapid weight gain
Headache
Epigastric abdominal pain
Visual disturbances
Hyperreflexia
Increased Cr
Pulmonary edema
Elevated LFTs

Front 192

Define postmenopausal bleeding?

Back 192

bleeding from the genital tract 6m or more after menopause
20% risk

Front 193

What are the types of cephalic presentations and what are their diameters?

Back 193

1. Vertex (9.5cm)
2. Deflexed vertex (11.5cm)
3. Brow (13.5cm)
4. Face (9.5cm)

Front 194

Most powerful risk factor endometrial cancer?

Back 194

obesity due to aromatization and unopposed oestrogen

Front 195

What are some medications which can be used in HTN disease of pregnancy?

Back 195

Hydralazine
Methyldopa
Labetalol
Nifedipine

Front 196

Metastatic workup for endometrial cancer?

Back 196

CT chest abdomen, pelvis
CA125- sign of peritoneal irritation

80% confined to uterus at diagnosis- mainstay of management is surgical (TAH/BSO with peritoneal cytology)

Front 197

What is HELLP syndrome

Back 197

H- hemolysis
EL - elevated liver enzymes
LP - low platelets

Front 198

Which patients with endometrial cancer get pelvic lymphadenectomy in addition to TAH/BSO?

Back 198

grade 3, deep invasion, clear cell, serous

Front 199

What is the reccomended daily intake of folate in a women (with no risk factors) trying to fall pregnant?

Back 199

0.5mg folate daily (at least 3 month prior and 3 months post falling pregnant)

Front 200

Staging of endometrial cancer?

Back 200

stage 1: disease confined to uterus
stage 2: spread to cervix
stage 3: local pelvic spread, noda disease/positive washings
stage 4: distant disease/intraperitoneal disease

Front 201

What is the reccomended daily intake of folate in a women with a high risk of neural tube defects, trying to fall pregnant?

Back 201

5mg daily (at least 3 months prior and 3 months post falling pregnant)

Front 202

What is adjuvant therapy for endometrial cancer?

Back 202

stage 1 and 2 node negative: vaginal brachytherapy
stage 3 and 4:
Nodal disease external beam RT
Peritoneal disease: chemotherapy: doxorubicin, provera

Front 203

What are some S&S of neonatal withdrawal?

Back 203

High pitched cry
Restlessness
Hypertonia
Jitterness
Tremors
Myoclonic jerks
Frequent yawning
Increased resp rate (>60/min)

Front 204

Managements of patients with endometrial Ca who are unfit for surgery?

Back 204

apparent early stage- pelvic RT
advanced disease- oral provera

Front 205

What is the name of the scale for assessing neonatal withdrawal?

Back 205

Finnegan scale

Front 206

Management of recurrent endometrial Ca?

Back 206

no prev RT- RT
Prev RT: chemo
pelvic exenteration of central local recurrence

Front 207

What is the difference in Complete breech and Frank breech?

Back 207

Complete - Hips and knees flexed

Frank - Hips flexed, knees EXTENDED

Front 208

Follow-up after endometrial cancer

Back 208

3 monthly for 2 years then 4 monthly for 2 years then 6 monthly for 2 years
clinical- no role for routine radiology
HRT- after cure and 2 yrs recurrence free (early stage)

Front 209

What dates correspond to the 1st trimester?

Back 209

0-12weeks

Front 210

Which endometrial cancers allow an attempt at fertility preservation?

Back 210

grade 1 in a patient with PCOS
MRI then high dose provera and serial sampling
metastatic disease and late recurrences

Front 211

What dates correspond to the 2nd trimester?

Back 211

13 - 28 weeks

Front 212

What % of women smoke in pregnancy?

Back 212

10-20% of women

Front 213

What dates correspond to the 3rd trimester?

Back 213

29weeks-birth (~40)

Front 214

Effects of smoking on pregnancy outcome?

Back 214

On average babies 200g lighter
dose dependent effect on birthweight- reversible if stop smoking early in the pregnancy
Increased impact if smoking >10/d in 3rd TM
Increased perinatal morbidity and mortality (PROM, abdruption, preterm delivery, stillbirth and SIDS)
Heavy smoking contributes to 13% of infertility

Front 215

What is the average weight range of a neonate born at 40weeks?

Back 215

2.5 kg to 4.0 kg

Front 216

What % of women cease smoking during pregnancy

Back 216

20-30%
aurgmented and pregnancy-specific intervention helps

Front 217

What are 3 signs of PROM?

Back 217

1. Pooling of vaginal fluid in the posterior fornix
2. +ve Nitrazine test paper pH>6.0-6.5 (normal vag pH is 4.5-6)
3. Ferning on a slide prepared from a thin layer of fluid obtained from vaginal wall.

Front 218

Prevalence of Marijuana use at conception

Back 218

9-20%
Most women obsrain once preg confirmed; 2-3% continue
1st TM cessation leads to severe n+v

Front 219

What is the cause of symmetric IUGR?

Back 219

Usually secondary to an early gestational insult

Front 220

Is binge drinking or chronic daily ingestion of alcohol worse for foetal outcome?

Back 220

binge
i.e. 5 at once worse than 1/d

Front 221

What is the normal range of the menstral cycle?

Back 221

21 to 35 days

Front 222

By how much do you limit caffeine in pregnancy?

Back 222

<2 cups or 250mg/d

Front 223

What is the prevalence of the post-partum blues?

Back 223

70%

Front 224

Risk of BMI <17

Back 224

LBW infants

Front 225

What is the prevalence of the post-partum depression?

Back 225

10-15%

Front 226

Define advanced maternal age

Back 226

>35 at time of delivery

Front 227

What is the prevalence of the peurperal psychosis?

Back 227

0.1%

Front 228

Epidemiology of urinary incontinence in females

Back 228

increases with age
30% in community
10% have a significant effect on QOL
1 millian women in australia

Front 229

What is the maternal death rate in Australia?

Back 229

10:10,000

Front 230

Initial assessment of urinary incontinence

Back 230

history
exam
MSU
bladder diary

Front 231

What physiological changes occur during pregnancy?
1. Cardiac output
2. Blood pressure (initially)
3. Stroke volume

Back 231

1. CO - Increases 40%
2. BP - Decrease slightly
3. SV - Increases (10-30%)

Front 232

Do symptoms alone reflect the cause of lower urinary tract dysfunction?

Back 232

not always
even if only symptom is stress incontinence, 5% will have detrusot overactivity as cause

Front 233

In neonatal resus. what should the rate of chest compression be per minute?

Back 233

Ratio of 3 compressions to 1 breath

90 compressions/ minute
30 breaths/minute

Front 234

What are the indications for urodynamics?

Back 234

complex symptomatology
fail to respond to first line treatment
prior to surgical intervention
when pain is part of symptomatology

Front 235

What are the stages in the progression of lochia?

Back 235

1. Lochia rubra
2. Lochia serosa
3. Lochia alba

Front 236

Commonest cause of female incontinence

Back 236

urodynamic stress incontinence
affects 5-15% of women
usually a result of childbirth
may respond to conservative management but mod-secere only cured by surgery

Front 237

What physiological changes occur during pregnancy?
Respiratory
1. RV
2. ERV
3. FRC
4. TV

Back 237

1. RV - decreases
2. ERV - decreases
3. FRC - decreases
4. TV - Increases

Front 238

Gold standard for management of urodynamic stress incontinence

Back 238

Mid urethral sling/tapes
85-90% cure
mesh replaces pubourethral lig
short hospitallisation

Front 239

What physiological changes occur during pregnancy?
Renal
1. Renal plasma flow
2. BUN
3. Cr
4. GFR

Back 239

1. RPF - increase
2. BUN - decrease
3. Cr - decrease
4. GFR - increases by 40%

Front 240

Meds for overactive bladder

Back 240

ditropan- oxybutinin
imipramine

start low dose, slowly increase
manu can be taken intermittently

take anticholinetrgics and do bladder training

other: solfenacin, intravesical botoc

Front 241

In a sperm count what is considered normal:
1. Number/ml
2. Motility %
3. Volume
4. Morphology %
5. pH
6. WBC

Back 241

1. Number/ml
>20million/ml
2. Motility %
>50% adequate motion
3. Volume
2-5ml
4. Morphology %
30% normal forms
5. pH
7.2 - 7.8
6. WBC
<10^6 WBC/ml

Front 242

Strongest risk factor for uterine prolapse?

Back 242

Childbirth: disruption of tissue and denervation of pelvic floor

Avulsion of puborectalis: 20% 1st deliv, risk doubled by forceps deliv and increases with maternal age. Increases probability of prolapse by 70%.

Front 243

Why is pregnancy a hypercoagulable state?

Back 243

1. Protein S decreases
2. Plasminogen activator inhibitor (PAI) increases
3. Fibrinogen increases

Front 244

Pudendal nerve denervation

Back 244

reversible in 60%
more common after forceps
related to: kength of 2nd stage, parity, birthweight
Occurs after vaginal but not after abdominal delivery

Front 245

Does ovarian forsion occur more often on the right or the left?

Back 245

slightly more often on the right

Front 246

What increases the risk of ovarian torsion?

Back 246

pathologic enlargement of the ovary
Most torsion occurs in ovaries measuring 6-10cm

Front 247

How do you diagnose an ovarian torsion?

Back 247

Doppler ultrasound: 100% will have abscence of venous flow on doppler (sensitive), >70% will have a cystic/solid adnexal mass
MRI/CT: limited value when doppler is non-diagnostic
If suspect diagnosis go to laparoscopy

Front 248

Where is the pain felt with an adnexal mass

Back 248

originates in the iliac fossa and radiates to the flank

Front 249

What are ultrasound findings indicative of malignancy in an ovarian mass?

Back 249

solid component that is not hypoechoic and is nodular/papillary
thick septations (>2-3mm)
Doppler flow in solid component
Ascites (any in post menopausal, small amount of fluid in premenopausal may be normal)
Peritoneal masses

Front 250

Which postmenopausal women with an ovarian cyst may undergo expectant management?

Back 250

asymptomatic, normal pelvic exam, normal CA125
5cm commonly used as threshold: >5cm--> meed exploratory surgery

Front 251

What % of ovarian masses found incidentally in women >50 are malignant?

Back 251

50%

Front 252

What is the most common type of ovarian cancer?

Back 252

65% epithelial
risk factors include nulliparity, early menarche, late menopause, caucasian, family history
OCP, tubal ligation, pregnancy is protective
tend to present when advanced:

Front 253

Are ovarian masses managed with cystectomy or oophorectomy?

Back 253

depends on age, size of cyst, ease of removal
older women tend to go for oophorectomy
laparoscopy may not provide sufficient staging and risk of rupturing cyst- so laparotomy preferred (gynae oncologist makes this decision)

Front 254

Where is the most common site for ectopic pregnancy?

Back 254

fallopian tube (98%): 70% of these are ampullary

Front 255

What is the prevalence of ectopic pregnancy among women who go to ED in first trimester of prenancy?

Back 255

6-16%

Front 256

Chance of recurrance of ectopic prenancy after 1?

Back 256

15%

Front 257

Classic triad of ectopic prenancy?

Back 257

amenorrhea
abdominal pain
vaginal bleeding

Front 258

When is methotrexate appropriate for the management of ectopic pregnancy?

Back 258

<3.5cm, unruptured, without actuve bleeding, no foetal heart tones
no hepatic, renal, haematogenous disease

Front 259

Treatment of fibroids (indications)

Back 259

Only if symptomatic, rapidly enlarging or menorrhagia

Hint 259

more likely to mx conservatively if sx minimal or absent
<6-8cm
not submucosal

Front 260

Treatment of fibroids (medical and surgical)`

Back 260

medical (antiprostiglandins, tranexamic acid), OCP/depo provera
GnRH agonist to shrink prior to sur

Front 261

Cause of prolonged latent phase?

Back 261

o Is idiopathic
o More common in primigravidae
Cervix remains ‘unfavourable’
There is rarely a serious cause: May lead to maternal exhaustion from discomfort over a number of days

Front 262

Management of prolonged latent phase?

Back 262

o If possible, resist intervening to speed things up (eg by rupturing membranes/administering oxytocics) as this may increase risk of further obstetric intervention in what might have been an uneventful labour

Front 263

Describe incoordinate uterine contraction?

Back 263

o Normal contraction begins at a pacemaker point close to junction of uterus and fallopian tube (ie. near fundus) and spreads downwards. Maximal intensity is at fundus, where the muscle is thickest, intermediate at the mid-zone, and least at lower segment.
o Incoordinate contractions have maximal intensity at lower segment and weakest at the fundus. This is inefficient.

Hint 263

Resting tone is increased throughout so threshold for pain is reached earlier in the contraction

Front 264

Causes of incoordinate uterine contractions?

Back 264

No known specific cause
More common in primigravidae
Uterine activity may improve as the cervix dilates
Many cases resolve spontaneously with time (contractions get better as labour goes on)

Hint 264

Cephalopelvic disproportion is associated w incoordinate contractions, possibly because the presenting part isn’t well applied to the cervix to dilate it.

Front 265

Who gets syntocin in incoordinate uterine contractions?

Back 265

Used in primigravidae
Use with caution in multipara
IV infusion, titrating to achieve 3-4 contractions every 10 min
VE every 2-3 hours to ensure adequate progress

Hint 265

Not used if:
Suspected foetal distress
Membranes not ruptured
Cephalopelvic disproportion is suspected/there is malpresentation

Front 266

Cause of obstructed labour?
Difference between true and relative?

Back 266

(head too big/pelvis too small)
Diagnosed only if the head doesn’t become engaged despite adequate uterine activity
Not possible to predict accurately antenatally – many considered to be at risk on u/s have a normal vaginal delivery
Very unlikely if mother has had a previous vaginal delivery

Hint 266

Relative: o Occurs with malposition, especially occipitoposterior position of head (rather than occipitoanterior). This may lead to slower first and second stage but spontaneous delivery, or may lead to secondary arrest.

Front 267

Major determinant of sucessful delivery?

Back 267

The size and shape of the pelvic inlet is the major determinant of successful delivery

Hint 267

Gynaecoid shape is most common and is obstetrically ideal. Anthropoid (long oval) is relatively common and associated with occipitoposterior presentation.
Platypelloid (flat brimmed) and android (triangular) are minor variations associated with poor nutrition in infancy and childhood.

Front 268

How do you assess for the cause of secondary phase arrest?

Back 268

Strength of contractions is difficult to assess but observation of mother and abdominal palpation help
Vaginal examination:
Assessment of position and presentation to look for malpresentation or malposition

Hint 268

Caput and moulding suggest cephalopelvic disproportion

Front 269

When can instrumental delivery be performed?

Back 269

Can be performed in 2nd stage only

Front 270

Criteria for instrumental delivery?

Back 270

• Cervix fully dilated and membranes ruptured
Head at station 0 or below, with no head palpable abdominally
Position of the head knownBladder empty
Analgesia satisfactory

Front 271

Medical management of fibroids

Back 271

(generally poor response)
GnRH analogues shrink fibroids, but regrow on cessation of Rx. Causes hypo-oestrogenism
hot flushes & bone loss

Front 272

Surgical management of fibroids

Back 272

Hysteroscopic resection – for small submucous fibroids
Myomectomy (open/lap) – if larger and wish to retain fertility
Adjuvant GnRH analogues reduce bleeding risk.
Hysterectomy

Hint 272

Uterine artery embolization: healthy myometrium revascularises immediately by collaterals, while fibroids shrink by ~50% (sustained effect). Considerations: very painful (requires opiates), possible infection, fibroid expulsion, deaths rare.
Malignant – specific to cause

Front 273

Management of primary dysmenorrhea

Back 273

Prostaglandin synthesis inhibitors (NSAIDs) reduce PGF2α production
Combined OCP suppress ovulation and very effective
Depot progestogens suppress ovulation and may be useful
Levonorgestrel intrauterine system (LNG-IUS; “Mirena”) reduce blood loss and dysmenorrhoea. May be difficult to insert in women who have not been pregnant.

Front 274

Causes of amenorrhea?

Back 274

Physiological
Ovulatory disorders (25%)
Other disorders
Congenital
Medications (hormones, antidepressants, corticosteroids, chemo)
Endometriosis (15%)
Pelvic adhesions (12%)
Surgery or nontubal disease (appendicitis)
Pelvic TB
Tubal blockage (11%)
Other tubal abnormalities (11%)
Hyperprolactinemia (7%)

Hint 274

Male factors
Idiopathic (45%)

Front 275

What is the most common ovarian tumour aged 10-30?

Back 275

Mature cystic teratoma (dermoid cyst) – benign germ cell tumor;
XR: calcification; US: complex cyst. Blilateral in ~10%.

Front 276

Aetiology of postmenopausal bleeding?

Back 276

Atrophy (59%)
Polyps (12%)
Endometrial cancer (10%)
Endometrial hyperplasia (10%)
Hormonal effect (7%)
Cervical cancer (<1%)
Other (eg, hydrometra, pyometra, hematometra: 2%)

Front 277

Types of ovarian cancer?

Back 277

Serous (70%) – commonly bilateral, CA-125 usually markedly elevated.
Mucinous (5-10%) – commonly unilateral, large and low grade.
Endometrioid (20%) – assoc with endometriosis, 1/5 have assoc endometrial Ca.
Clear cell – assoc with endometriosis, usu. confined to ovary at Dx. CA-125 often normal.

Front 278

How useful is Ca125 in testing for ovarian cencer?

Back 278

Over 90% of advanced ovarian cancers have CA-125
50% of stage 1 ovarian cancers will have a normal CA-125

Front 279

What are the high risk populations you screen for ovarian cancer?
What screening is done?

Back 279

1st degree relative with ovarian cancer, Ashkenazi Jews, known mutation – BRCA1 BRCA2 or HNPCC

Hint 279

The current recommendation is 6–12 monthly CA-125 and transvaginal ultrasound.
bilateral salphingo-oophorectomy is the most effective risk reducing strategy
In BRCA carriers it also reduces risk of BrCa by 50%.
In HNPCC carriers should include hysterectomy (50% risk of endometrial Ca).

Front 280

Options after finding CIN2/3 on colposcopy?

Back 280

LEEP (loop electrosurgical excision procedure) [same as LETZ (loop excision of the transformation zone)]. Risk of preterm delivery.

Hint 280

Cone biopsy (cold knife conisation) for women with suspected microinvasion, and suspected adenocarcinoma in situ (risk of cervical incompetence and very preterm delivery).

Front 281

Staging of cervical cancer?

Back 281

0: CIN
I: Growth into the deeper cervical tissues, but no further.

Hint 281

II: Spread outside the cervix to surrounding tissues.
IIA: Upper 1/3 vagina
IIB: Upper 2/3 vagina + parametrial disease
III: Spread further away from the area surrounding the cervix.
IV: Advanced spread to organs other than cervix and uterus.

Front 282

Management of cervical cancer by stage?

Back 282

1A1– local excision (cone) or simple hysterectomy
IA2 – simple hysterectomy and pelvic lymphadenectomy;

Hint 282

IB and IIA – radical hysterectomy or radiotherapy; ≥IIB – radiotherapy+ chemotherapy

Front 283

Hx in ovarian cancer (in order of prevalence)

Back 283

abdo swelling
pain, anorexia, N&V, weight loss, abnormal vaginal bleeding, frequency.

Hint 283

Physical exam: pelvic mass, abdo mass, ascites, pleural effusion, hepatomegaly, cervical lymphadenopathy

Front 284

Management of ovarian cancer?

Back 284

Rx: radical surgical debulking (usually hysterectomy and bilateral oopherectomy) followed by platinum-based chemotherapy (cisplatin or carboplatin)

Hint 284

Chemo for all ovarian cancer unless well differentiated IA. Late presentation is common, so Rx is often palliative.

Front 285

Prevalence and presenting sx of fallopian tube carcinoma?

Back 285

Very rare tumor (<1.0% of female genital tract cancer); mean age 55. More likely than ovarian Ca to present early.

Hint 285

Hx/PE: Presentation often nonspecific. The most common symptom is vaginal discharge or bleeding. Classic triad (though rarely present): watery vaginal discharge (hydrops tubae profluens), pelvic mass, and pelvic pain (may be colicky). Ascites may be present in advanced disease.

Front 286

What should you avoid doing for 24 hours after a culposcopy?

Back 286

douche
use tampons
use vaginal medications
have sex

Front 287

What are the two types of anterior prolapse?

i.e. cystocele more likely to0 have voiding and storage sx/urinary retention

Back 287

Urethrocele - prolapse of the urethra into the vaginal wall causing a bulbous swelling to appear in the vagina, particularly on straining. Associated with previous childbirth. Rx: surgical repair to remove laxity and better support to the urethra and the vaginal wall.

Hint 287

Cystocele – prolapse of the base of the bladder in women; usually due postpartum pelvic floor weakness, causing bulging of the anterior wall on straining. When accompanied by stress incontinence of urine, surgical repair (anterior colporrhaphy) is indicated.

Front 288

What does a rectocele cause

Back 288

constipation
may need straining/digitation to evacuate stool

Hint 288

Manage with a posterior repair

Front 289

Stages of uterine prolapse?

Back 289

1st degree – descent of the cervix within the vagina
2nd degree – descent of the cervix to the level of the introitus
3rd degree – protrusion of the cervix through the vagina

Hint 289

Procidenta – cervix, uterus and vaginal wall completely prolapsed through the introitus

Front 290

Absolute contraindications to the OCP?

Back 290

•< 6 wks postpartum
•smoker over the age of 35 (>15 cigarettes per day)
•hypertension (systolic > 160mmHg or diastolic > 100mmHg)

Hint 290

•current of past histroy of venous thromboembolism (VTE)
•ischemic heart disease
•history of cerebrovascular accident
•complicated valvular heart disease
•migraine headache with focal neurological symptoms
•breast cancer (current)
•diabetes with retinopathy/nephropathy/neuropathy
•severe cirrhosis, liver tumour (adenoma or hepatoma

Front 291

What are some relative contraindications to the OCP?

Back 291

•smoker over the age of 35 (< 15 cigarettes per day)
•adequately controlled hypertension
•hypertension (systolic 140 - 159mmHg or diastolic 90 - 99mmHg)
•migrain headache over the age of 35
•currently symptomatic gallbladder disease
•mild cirrhosis

Hint 291

•history of combined OCP-related cholestasis
•users of medications that may interfere with OCP metabolism

Front 292

Contraindications to progesterone only contraception

Back 292

Breast cancer (current or recent)
Advise against in situations with increased VTE/PE risk – SLE, antiphospholipid syndrome, BMI>30, <3wks postpartum
Avoid in unexplained vaginal bleeding

Front 293

Dosing of emergency contraception?

Back 293

Single oral dose of 1.5 mg (same SE profile as split dose)
Repeat the dose if vomiting occurs within 2 h

Hint 293

SEs: nausea, vomiting, breast tenderness, vaginal bleeding, headache.

Front 294

o >24 hours late taking an active pill, or if you have severe vomiting or diarrhoea for more than 24 hours?

Back 294

 if you are late taking an active pill take it as soon as you remember and take the next pill at the usual time (this may mean taking 2 pills on the same day or at the same time)
 continue with the daily pill and use another contraceptive method until you have taken active pills for 7 days in a row

Front 295

What do you do if you miss your POP?

Back 295

3 hours late taking a pill: take it immediately; contraception should not be affected.

Hint 295

>3 hours late taking a pill, or if you have severe vomiting or diarrhoea, the pill will not be as effective:
take it as soon as you remember and take the next pill at the usual time (this may mean taking 2 pills on the same day or at the same time)
continue with the daily pill and use another contraceptive method for the next 48 hours

Front 296

Success rates of medical abortion?

Back 296

95% have complete expulsion
5% require surgical evacuation (other medical Rx options are higher)

Front 297

When is suction curetage used until?

Back 297

14-15 wks

Hint 297

failure: 2-3 in 1,000 (higher before 7 wks)
infection up to 10% (usually minor), less with “screen and treat” policy or prophylactic antibiotics

Front 298

When is manual vacum evacuation used?

Back 298

surgical method used in first trimester, especially prior to 7 weeks
lower failure rate than suction curettage for very early terminations
similar side effects and complication rates to suction curettage

Front 299

What do you do to get an abortion after 20 weeks?

Back 299

There is an obligation to refer a case to a termination review committee (ethics committee) The committee is there to provide advice, and while its judgement is not binding, going contrary to the committee’s advice has not been tested legally.

Hint 299

Requires induction of labour
potential for the delivery of a live foetus following a medical termination of pregnancy increases as gestation advance, therefore consider feticide by intra-cardiac KCl or digoxin injection for non-lethal anomalies at ≥22 wks.

Front 300

Define miscarriage?

Back 300

pregnancy loss before 24wks (WHO defines as loss when <500g)

Front 301

How common is miscarriage in the antiphospholipid syndrome?

Back 301

15% of recurrent miscarriage
Subsequent miscarriage rate 90%; if low-dose aspirin from 1st +ve pregnancy test, reduced to 30%.
Complications: thrombocytopaenia, pre-eclampsia, IUGR and arterial or venous thrombosis

Front 302

Most co0mmon features of ectopic pregnancy?

Back 302

pain is most common
others include: amenorrhea, PV bleeding

Front 303

How long does it take for the uterus to involute?
When is it no longer palpable?

Back 303

Involutes over next 6 weeks. No longer palpable above symphysis pubis after day 10-14

Hint 303

Palpable at umbilicus after 3rd stage of labour
Fundal height reduces by about a finger’s breadth per day

Front 304

Descrive the 3 kinds of lochia?

Back 304

Red first 3-4 days. Brownish pink 3rd-12th day. Thrombosed vessels become organised
Yellow/white after 12th

Front 305

When is HPL and beta HCG no longer detectable

Back 305

HPL: 2d
Beta HCG: 10d

Front 306

When do E and P reach non-pregnant levels?

Back 306

day 7

Front 307

Prevalence of postnatal anaemia?

Back 307

25-30%

Hint 307

Constipation (20% of women in puerperium) may be due to: fear of defecation after perineal trauma, reduced mobility, codeine, iron supplements
Haemorrhoids (20% of women): more common in primiparous women and instrumental delivery. Often persist for some time after birth

Front 308

What % of women experience incontinence in the puerpurum?

Back 308

o 10% experience incontinence (usually stress incontinence). In most women it resolves in a few weeks. Pelvic floor exercises help

Hint 308

Back pain: Affects 25% of puerperal women. Over half also had back pain during the pregnancy.

Front 309

Timecourse of postpartum psychotic depression?

Back 309

Begins around day 3-7 and peaks at 2 weeks

Hint 309

15% have recurrence in subsequent pregnancy. 1/3-1/2 develop a non-puerperal psychosis

Front 310

Main benefits of HRT?

Back 310

hot flushes
urogenital symptoms
sleep problems
osteoporotic fracture
colorectal cancer (combined HRT)

Front 311

Risks of HRT?

Back 311

DVT, PE
stroke
breast cancer (combined HRT)
endometrial cancer (oestrogen-only HRT)
ovarian cancer (oestrogen-only HRT)

Front 312

Absolute contraindications to HRT?

Back 312

acute liver disease
undiagnosed vaginal bleeding
cancer
thromboembolism

Front 313

Adverse effects of HRT

Back 313

HRT increases the risk of:
DVT, PE
stroke
breast cancer (combined HRT)
endometrial cancer (oestrogen-only HRT)
ovarian cancer (oestrogen-only HRT)

Hint 313

HRT does not appear to affect:
weight gain
headache, migraine
breast cancer (oestrogen-only HRT)
colorectal cancer (oestrogen-only HRT)

Front 314

Epidemiology of gestational tophoblastic disease?

Back 314

1/1000 preg
Geohraphic variation (1/125 in Taiwan)
Increased

Hint 314

80% benign
15% locally invasive
5% metastatic
cure rate > 95%

Front 315

What is a complete mole?

Back 315

diffuse trophoblastic tissue, swollen villi, no foetal tissue
most common
46XX or 46YY: 90% paternal origin
2 sperm fertilize 1 egg or one sperm with reduplication

Hint 315

15-20% preogression to malignant sequillae

Front 316

Presentation of molar preg

Back 316

Vaginal bleeding 97%
excessive uterine size for LMP
theca lutein cyst
pre-eclampsia
hyperemesis
hyperthyroid
beta HCG >100000
no foetal heart detected

Hint 316

Partial mole typically presents similar to threatened/spontaneous/missed abortion
pathological diagnosis often made after D&C

Front 317

What is a partial mole?

Back 317

hydropic villi and focal trophoblastic hyperplasia are associated with foetus or foetal parts
often triploid (XXY, XYY, XXX) with chromosome complement from both parents

Hint 317

usually due to single ovum fertillized by 2 sperm
<4% (low) risk of malignant progression
foetus: growth restricted, multiple congenital abnormalities

Front 318

What are features of molar pregnancies that are at high risk of developing persistent GTN?

Back 318

local uterine invasion 31%
beta hcg> 100000
excessive uterine size
promenant theca lutein cysts

Hint 318

follow up with serial beta HCG weekly until negative x3 then monthly for 6-12m
increase or plateu--> GTN (needs chemo)

Front 319

What are the types of GTN?

Back 319

invasive mole or persistent GTN (4% mets)
choriocarcinoma: often present with sc of mets (may follow normal pregnancy, abortion or ectopic)
placental site trophoblastic tumour

Hint 319

placental site trophoblastic: rare, aggresive GTN
abnormal growth of intermediate throphoblastic cells
low beta HCG, high HPL
relatively insenitive to chemo

Front 320

Do you biopsy GTN mets?
Management of GTN?

Back 320

no, they bleed
manage with chemo for all stages, follow up for 1 year after beta hcg returns to normal (stg 4 2 years)

Hint 320

most common = lungs (80%)
also vagina, pelvis, liver, brain
brain mets: CSF beta HCG

Front 321

Size of premenopausal and postmenopausal ovary?

Back 321

premenopausal 6-8cm3
postmenopausal 3cm3

Front 322

80% of ovarian cancers are...

Back 322

epithelial

Hint 322

80% of ovarian cancer
• 2 diagnosed each day
• 3 women die each day
• Traditional model: arise ovarian
surface epithelium ( tubal
epithelium…serous peritoneal
cancers)
•Middle & upper classes
• Industrialized countries
• Disease of elderly

Front 323

Germ cell cancers

Back 323

young
dysgerminoma
fertility sparing surgery
chemo in most
LDH AFP ß hCG

Front 324

Sex cord and stromal ovarian cancer

Back 324

5%
old and young
unilateral
granulosa cell

Hint 324

E FSH LH Inhibin Testosterone
Manage with THBSO

Front 325

Age at diagnosis of ovarian cancer?

Back 325

9% < 40 years
21% < 50 years

Hint 325

Ovarian cancer disease of older women
Risk malignancy increases 12 fold from
ages 20-29 to 60-69
Overall risk of malignancy in an adnexal mass: Premenopausal women 6-11%; Postmenopausal woman 33-56%

Front 326

Why should laparoscopy NOT form part of the pre-op workup for ovarian ca?

Back 326

A smooth walled external
surface does not equal
benign
An irregular surface not
equal cancer

Front 327

CA125

Back 327

Sensitive but not specific
• Elevated in 80% non-mucinous ovarian cancers
• Elevated in only 50% stage I cancers

Front 328

CA19.9

Back 328

• 76% of mucinous and 27% serous carcinomas of ovary
• Lower sensitivity & specificity than CA-125 in ovarian tumour

Hint 328

CEA
• Elevated in 37% mucinous ovarian cancers

Front 329

HE4

Back 329

• Elevated in majority of ovarian carcinomas that produce CA125
as well as 50% that do not
• Not elevated in many common benign conditions

Hint 329

Also expressed in lung adenocarcinomas,
breast and some pancreaticobiliary
carcinomas

Front 330

Role of CT scanning in ovarian Ca

Back 330

•Limited role
• Delineation of internal
morphology poor
• Findings correlate
poorly with pathology
• Useful to investigate
upper abdomen:
omental disease,
diaphragm disease

Front 331

What is the risk of malignancy index>

Back 331

RMI=U x M x CA-125

RMI > 200--> refer to Gynae oncology

Hint 331

u = 0 if ultrasound score 0
1 if 1
3 if 2-5

multilocular/solid/bilateral/ascites/intra-abdominal mets

Front 332

Ovarian mass in pregnancy?

Back 332

1:1000 pregnancies ovarian tumour
• 3-6% malignant
•Markers may not be helpful
• MRI

Hint 332

Germ cell, borderline, sex cord 70%
Majority dermoids, cystadenomas,
functional cysts

Front 333

What kind of postmenopausal ovarian cyst is unlikely to be malignant?

Back 333

< 3-5cm

Front 334

When do dermoids get ruptured and why is this a problem?

Back 334

1-2% risk of malignancy
•Increased with increasing
age
Reported spillage 100%
laparoscopy vs 4%
laparotomy

Front 335

Major factor for initiating menarche?
follows peak heigh velocity or 2 years following breast budding

Back 335

When menarche occurs before the individual reaches the age of 12 years, it is associated with increases in weight and body mass index Genetics accounts for the majority of the variability; other factors include overall health, social environment (such as family stress or the presence of an adult nonbiologically-related male), and possibly environmental exposures, such as endocrine disruptors (environmental contaminants that may affect endocrine processes)

Hint 335

The earliest secondary sexual characteristic in most girls is breast/areolar development (thelarche) (picture 2A), although a substantial minority have pubic hair as the initial manifestation

Front 336

Gold standard for diagnosis of endometriosis?

Back 336

The optimal way to diagnose endometriosis is by direct visualization of the implant(s)

Hint 336

If the diagnostic impression is most consistent with endometriosis after a complete initial evaluation, then most experts consider empiric medical therapy without surgical confirmation a safe and effective approach. However, a satisfactory response to empiric treatment cannot be construed as definitive confirmation or exclusion of the diagnosis. Options include a three-month trial of combined continuous oral contraceptive pills or a GnRH agonist.

Front 337

Normal semen analysis?

Back 337

•Volume — 1.5 mL
•Sperm concentration — 15 million spermatozoa/mL
•Total sperm number— 39 million spermatozoa per ejaculate
•Morphology — 4 percent normal forms
•Vitality — 58 percent live
•Progressive motility — 32 percent
•Total (progressive + nonprogressive motility) — 40 percent

Hint 337

toronto: vol 2-5ml
count 20million/ml
motility: 50% forward
morphology >30% normal
abscence of pyospermia, hyperviscosity, agglutination

Front 338

14 weeks pregnant. 3 pregnancies in 4 years. Blood test results where given

Back 338

(answer was Iron Def anaemia)

Front 339

Diagnosis of ectopic pregnancy

Back 339

answer was >1500 HCG and lack of intrauterine gestational sack on vaginal ultrasound.

Front 340

Erythema Toxicum Neonatorum

Back 340

ETN is characterized by multiple erythematous macules and papules (1 to 3 mm in diameter) that rapidly progress to pustules on an erythematous base

Hint 340

Wright-stained smear of the contents of a pustule that demonstrates numerous eosinophils and occasional neutrophils

Front 341

MILIA

Back 341

Milia are white papules caused by retention of keratin and sebaceous material in the pilaceous follicles. They are frequently found on the nose and cheeks, and resolve in the first few weeks of life.

Front 342

NEONATAL ACNE

Back 342

Neonatal acne may be present at birth, or develop over the first 2-4 weeks of life.

Hint 342

The condition consists of pustules over the cheeks primarily, but also involves other areas of the face and the scalp. As opposed to infantile acne (which develops after 2 months) and acne of adolescence, there are no comedomes in the neonatal form.

Front 343

Miliara

Back 343

Accum of sweat beneath eccrine sweat ducts that are obstructed by keratin at the level of the stratum corneum.

Front 344

Sucking blisters

Back 344

Congenital sucking blisters, a diagnosis of exclusion, are noninflammatory oval, thick-walled vesicles or bullae that contain sterile fluid [28]. The lesions may be unilateral or bilateral and typically are located on the dorsal or radial aspect of the wrists, hands, or fingers of neonates who are noted to suck excessively at the involved regions

Front 345

Mongolian spots

Back 345

Mongolian spots typically appear as congenital blue-grey pigmented macules with indefinite borders, although they can also be greenish-blue or brown

Hint 345

Fade in first decade of life
common in asian infants

Front 346

Treatment of pain in endometriosis

Back 346

Mild: NSAIDS, OCP if need contraception
Mod: if above do not work: GnRH agonist if want to avoid bmd loss:progestin

Hint 346

if v. severe/advanced: surgical therapy +/- medical maintenance

Front 347

Treatment of pelvic mass in endometriosis

Back 347

Therefore, surgery is the preferred therapeutic approach.

Front 348

Treatment of deep endometriosis

Back 348

surgical rather than medical therapy for pelvic pain, dyscopesis, dyspareunia

Front 349

Baby poor feeding, hypothermic (35.9), cool, mottled- what do you do?

Back 349

these are signs of hypothyroidism (prolonged jaundice, delayed passage of stools, hypothermia, poor tine, mottled skin, poor feeding) – screening should be repeated even if the original screening result was normal. Screening programs miss some cases of ceongenital hypothyroidism as a result of early discharge, lab errors improper or no specimen collection, hospital transfers, sick neonates, prematurity, low birth weights and home deliveries.

Front 350

Maternal Mortality statistics

Back 350

1 in 10,000 (they had 10 in 100,000 so this was correct)

Front 351

Apgar scoring

Back 351

Appearance: Blue or white- Acrocyanosis- Pink
Pulse: absent, <100, >100
Grimace: absent, grimace of beeble cry, cry

Hint 351

Activity/tone: floppy/some flexion/moving
respiration: Absent-Weak/irregular/gasping-Cry

Front 352

Let down reflex

Back 352

Nerve impulses from sucking reach hypothalamus  stimulate posterior pituitary to release oxytocin  stimulates myoepithelial cells surrounding alveoli to contract  milk is ejected from alveoli and small ducts to flow to large ducts and nipple
Negative emotional and physical factors can reduce the letdown reflex

Front 353

Breat feeding with hep C, hep B , HIV

Back 353

Hep C: yes: • Overall – risk of Hepatitis C Virus via breastfeeding is very low (lower than for HIV)
• No effective preventive therapies (IG or vaccine) exist
• Current position – no data exist that indicate that HCV is transmitted through breast milk
The infants should be tested at 3 months and 12-15 months of age for HCV status

Front 354

PROM – which is correct:

Back 354

an option was Antibiotics delay the onset of labour (this is correct im pretty sure)

Hint 354

HIV UN Recommendation: No (in developed countries)
Hep B Yes (vaccinate and Ig)

Front 355

Baby poor feeding, hypothermic (35.9), cool, mottled- what do you do?

Back 355

these are signs of hypothyroidism (prolonged jaundice, delayed passage of stools, hypothermia, poor tine, mottled skin, poor feeding) – screening should be repeated even if the original screening result was normal. Screening programs miss some cases of ceongenital hypothyroidism as a result of early discharge, lab errors improper or no specimen collection, hospital transfers, sick neonates, prematurity, low birth weights and home deliveries.

Front 356

Maternal Mortality statistics

Back 356

1 in 10,000 (they had 10 in 100,000 so this was correct)

Front 357

Apgar scoring

Back 357

Appearance: Blue or white- Acrocyanosis- Pink
Pulse: absent, <100, >100
Grimace: absent, grimace of beeble cry, cry

Hint 357

Activity/tone: floppy/some flexion/moving
respiration: Absent-Weak/irregular/gasping-Cry

Front 358

Let down reflex

Back 358

Nerve impulses from sucking reach hypothalamus  stimulate posterior pituitary to release oxytocin  stimulates myoepithelial cells surrounding alveoli to contract  milk is ejected from alveoli and small ducts to flow to large ducts and nipple
Negative emotional and physical factors can reduce the letdown reflex

Front 359

Breat feeding with hep C, hep B , HIV

Back 359

Hep C: yes: • Overall – risk of Hepatitis C Virus via breastfeeding is very low (lower than for HIV)
• No effective preventive therapies (IG or vaccine) exist
• Current position – no data exist that indicate that HCV is transmitted through breast milk
The infants should be tested at 3 months and 12-15 months of age for HCV status

Front 360

PROM – which is correct:

Back 360

an option was Antibiotics delay the onset of labour (this is correct im pretty sure)

Hint 360

HIV UN Recommendation: No (in developed countries)
Hep B Yes (vaccinate and Ig)