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Daisy Finals Revision > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

1
Q

action taken if smear inadequate?

A

repeat in 3 months

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2
Q

first line mgt for menorrhagia?

A

IUS first line if requiring contraception
mefenamic acid or TXA first line if not requiring contraception - start on first day of period

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3
Q

what is sheehans syndrome?

A

hypopituitarism caused by ischaemic necrosis due to blood loss and hypovolaemic shock

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4
Q

features of sheehans syndrome?

A

agalactorrhoea
amenorrhoea
sx of hypothyroidism and hypoadrenalism

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5
Q

initial investigations for incontinence?

A

bladder diaries for min 3 days
vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
urine dipstick and culture
urodynamic studies

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6
Q

features of adenomyosis?

A

woman >30y
dysmenorrhoea
menorrhagia
enlarged, boggy uterus

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7
Q

investigations for women with suspected PCOS?

A

pelvic ultrasound, FSH, LH, prolactin, TSH, testosterone, sex hormone-binding globulin (SHBG)

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8
Q

risk factors for cervical ectropions?

A

COCP

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9
Q

risk factors for endometrial cancer?

A

PCOS

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10
Q

which cancers is nulliparity a risk factor for?

A

ovarian
breast
endometrial

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11
Q

which cancer is multiparity a risk factor for?

A

cervical

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12
Q

typical presentation of androgen insensitivity syndrome?

A

teenage girl
primary amenorrhoea
secondary sexual characteristics
blind ending vagina
-» 46XY

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13
Q

stress incontinence medication?

A

duloxetine

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14
Q

what malignancy does addition of progesterone to HRT increase the risk of?

A

breast

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15
Q

initial investigation when suspecting endometrial ca?

A

transvaginal uss

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16
Q

drug for medical mgt of ectopic?

A

methotrexate

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17
Q

most appropriate investigation to diagnose premature ovarian failure?

A

FSH level

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18
Q

genetic association with ovarian cancer?

A

BRCA1 and BRCA2

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19
Q

if 2nd repeat smear at 24 months is still hrHPV +ve?

A

colposcopy

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20
Q

first line management of endometriosis?

A

NSAIDs/paracetamol for symptomatic relief
COCP if that analgesia doesn’t help

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21
Q

what is the best way to detect ovulation?

A

day 21 progesterone (or 7 days before period starts)

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22
Q

what is a missed miscarriage?

A

gestational sac containing dead fetus before 20wks without sx of expulsion

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23
Q

what is an inevitable miscarriage?

A

heavy bleeding with clots and pain
cervical os open

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24
Q

features of ovarian hyperstimulation syndrome?

A

ovarian enlargement with multiple cystic spaces form
- inc in permeability of capillaries leads to fluid shift
can cause:
hypovolaemic shock
acute renal failure
VTE or arterial thromboembolism

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25
Q

medical abortion management?

A

oral mifepristone
followed by
vaginal misoprostol

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26
Q

2nd line mgt of endometriosis if NSAIDs/COCP not controlled sx?

A

GnRH analogues

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27
Q

management for moderate PMS symptoms?

A

COCP

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28
Q

management of severe symptoms of PMS?

A

SSRI

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29
Q

diagnostic criteria for HG?

A

5% pre preg weight loss
dehydration
electrolyte imbalance
(all 3 needed)

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30
Q

diagnostic criteria for PCOS?

A

infrequent or no ovulation (oligomenorrhoea)
clinical or biochemical signs of hyperandrogenism or elevated free or total testosterone
polycystic ovaries on US or inc ovarian volume

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31
Q

triad of features of meig’s syndrome?

A

benign ovarian tumour
ascites
pleural effusion

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32
Q

where is ectopic pregnancy most likely to be found?

A

ampulla

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33
Q

where is the most dangerous location for ectopic pregnancy?

A

isthmus

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34
Q

fluids for patient with HG who is hypokalaemic?

A

IV normal saline with potassium

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35
Q

which antiemetic first line for hyperemesis?

A

antihistamines - cyclizine or promethazine
phenothiazines - prochlorperazine or chlorpromazine

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36
Q

second line antiemetic for HG?

A

ondansetron (inc risk of cleft lip in first trimester)
metoclopramide or domperidone (meto for 5 days max)

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37
Q

smears during pregnancy?

A

reschedule to occur at least 12 weeks post delivery

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38
Q

primary tx for stage 2-4 ovarian cancers?

A

surgical excision
may be accompanied by chemo

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39
Q

medical tx for fibroids?

A

GnRH agonists

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40
Q

management for mag sulf induced respiratory depression?

A

calcium gluconate

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41
Q

booking visit?

A

8-12 weeks

42
Q

dating scan to exclude multiples?

A

10-13+6 weeks

43
Q

down syndrome screening inc nuchal scan?

A

11-13+6 weeks

44
Q

info on anomaly and blood results, if hb <11 consider iron. BP and urine dip?

A

16 weeks

45
Q

anomaly scan?

A

18-20+6 weeks

46
Q

routine care no 1 for primips: BP urine dip, symphisis-fundal height

A

25 weeks and only if primip

47
Q

routine care, if Hb<10.5 consider iron, first dose of anti-D to rhesus neg women

A

28 weeks

48
Q

routine care number 2 (if primip)

A

31 weeks

49
Q

routine care, second dose of anti-D to rhesus neg women, info on labour and birth plan

A

34 weeks

50
Q

routine care, check presentation (offer ECV), info on breastfeeding, vit K and baby blues

A

36 weeks

51
Q

routine care no 3 for primips
discuss options for prolonged pregnancy

A

40 weeks

52
Q

routine care, discuss labour plans and induction

A

41 weeks

53
Q

GDM glucose levels?

A

fasting glucose >= 5.6mmol
2 hour glucose >= 7.8
5678

54
Q

antibiotic prophylaxis for GBS in labour for women with pyrexia?

A

benzylpenicillin

55
Q

4 Ts of PPH?

A

Tone - uterine atony
Trauma eg perineal tear
Tissue eg retained placenta
Thrombin eg clotting/bleeding disorder

56
Q

folic acid dose for pregnant obese women?

A

5mg

57
Q

VTE prophylaxis for pregnant women with hx of VTE?

A

LMWH throughout pregnancy until 6 weeks postnatal

58
Q

raised AFP represents?

A

neural tube defects

59
Q

low AFP represents?

A

downs syndrome

60
Q

when should you refer to an obstetrician for lack of fetal movements?

A

24 weeks

61
Q

what is placenta accreta?

A

chorionic villi attach to the myometrium, rather than being restricted within the decidua basalis

62
Q

what is placenta increta?

A

chorionic villi invade into the myometrium

63
Q

what is placenta percreta?

A

chorionic villi invade through the perimetrium

64
Q

ABC management for PPH?

A
  • 2 cannulae 14g
  • lie woman flat
  • bloods inc group and save
  • commence warmed crystalloid infusion
65
Q
A
66
Q
A
67
Q
A
68
Q

mechanical mgt of PPH?

A

palpate uterine fundus and rub to stimulate contractions
catherisation to prevent bladder distension and monitor urine output

69
Q

medical management of PPH?

A
  1. IV oxytocin slow IV injection then infusion
  2. ergometrine
  3. carboprost IM (unless hx of asthma)
  4. misoprostol sublingual
    ? TXA
70
Q

surgical mgt of PPH?

A
  1. intrauterine balloon tamponade when caused by uterine atony
  2. B-lynch suture, ligation of the uterine arteries or internal iliac arteries
  3. hysterectomy as life-saving procedure if uncontrolled haemorrhage
71
Q

downs syndrome quadruple test results?

A

low AFP and oestriol
high hCG and inhibin A
(low AO high HI)

72
Q
A
73
Q

stage 1 of labour?

A

onset of true labour to when cervix is fully dilated
latent = 0-3cm dilated, takes 6h
active 3-10cm dilated, 1cm per hour

74
Q

stage 2 of labour?

A

from full dilation to delivery

75
Q
A
76
Q
A
77
Q
A
77
Q

which of previa and abruption is painful?

A

painless praevia
agony abruption

77
Q

stage 3 of labour?

A

from delivery of fetus to when placenta and membranes have been completely delivered

78
Q

plan for delivery in patients with intrahepatic cholestasis?

A

induction of labour offered at 37-38wks due to inc risk of stillbirth

79
Q

most important thing to assess prior to induction of labour?

A

bishop score

80
Q
A
81
Q

components of the bishop score?

A
  • cervical position
  • cervical consistency
  • cervical effacement
  • cervical dilatation
  • foetal station
82
Q
A
83
Q
A
84
Q

second degree perineal tear?

A

injury to perineal muscle, not involving anal sphincter
suturing on ward by experienced midwife or clinician

84
Q

third degree tear?

A

injury to perineum involving anal sphincter complex
3a less than 50% EAS thickness torn
3b more than 50% EAS torn
3c IAS torn
repair in theatre by suitably trained clinician

84
Q

first degree perineal tear?

A

superficial damage with no muscle involvement
no repair required

85
Q

fourth degree tear?

A

injury to perineum involving anal sphincter complex and rectal mucosa
repair in theatre by suitably trained clinician

86
Q

rhyme for remembering dates for antenatal visits?

A

The first visit is from eight
Check everything with mum is great
Urine, bloods and rhesus state
Give advice and educate

From eleven to thirteen
Is the best time to do the Down’s screen
While you’re at it, check the dates

At sixteen or ten plus six
Do BP and multistix

Second scan is at twenty
To check the fingers and toes
(Make sure there’s twenty.)

Once again at twenty-eight
Urine, blood and rhesus state
Anti-D if appropriate

Must give anti-D once more
When the week is thirty-four
And plan for the birth, what a chore

Check the lie at thirty-six
If breech offer a quick fix

Last visit at thirty-eight
All that is left it to wait

87
Q

bishop score values meanings?

A

<5 - labour unlikely to start without induction
>= 8 cervix is favourable - high chance of spontaneous labour

88
Q

recurrence rate of postnatal psychosis?

A

25-50%

89
Q

features of acute fatty liver of pregnancy?

A

usually 3rd trimester/immediately after delivery
abdo pain
n+v
headache
jaundice
hypoglycaemia

90
Q

severe acute fatty liver of pregnancy may result in?

A

pre-eclampsia

91
Q

investigation results in acute fatty liver of pregnancy?

A

ALT elevated eg 500

92
Q

management of delivery for women with grade III/IV placenta praevia?

A

ELCS at 37-38wks

93
Q

placenta covering part of cervix grade?

A

grade III

94
Q

placenta completely covering cervix?

A

grade IV

95
Q

when is anti d given to rhesus negative women?

A

28 and 34 weeks

96
Q
A

Daisy Finals Revision (25 decks)

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