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3a > Obgyn > Flashcards

Obgyn Flashcards

1
Q

Which ovarian tumour is associated with the development of endometrial hyperplasia?

A

Granulosa cell tumours

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2
Q

Endometrial hyperplasia definition

A

abnormal proliferation of endometrium in excess of normal proliferation of menstrual cycle

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3
Q

features of endometrial hyperplasia

A

abnormal vaginal bleeding eg. intermenstrual

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4
Q

Mx endometrial hyperplasia

A

simple w/o atypia - high dose progestogens, repeat sample 3/4 months (Levonorgestrel IUS)
Atypia - hysterectomy

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5
Q

PPH blood loss

A

> 500mls

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6
Q

4 T’s PPH

A

Tone, Trauma, Tissue, Thrombin

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7
Q

In case of PPH caused by uterine atony, what is most appropriate mx

A

Uterine massage

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8
Q

Continuous CTG monitoring if:

A 
?chorioamniocentesis/sepsis/fever
HTN >160/110
Oxytocin use 
significant meconium
fresh vaginal bleed developing during labour
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9
Q

Chickenpox exposure during pregnancy

A

If unsure/no previous exposure, check varicella Abs

If not immune -> varicella immunoglobulin (<10 days after exposure, any point in preg) <20/40

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10
Q

Primary amenorrhoea in woman with normal secondary sexual characteristics - action?

A

refer to gynae - likely mechanical obstruction

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11
Q

causes primary amenorrhoea

A

Turner’s syndrome
Testicular feminisation
congenital adrenal hyperplasia
congenital malformations of GU tract (imperforate hymen

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12
Q

Primary amenorrhoea definition

A

failure to start menses by 16

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13
Q

Secondary amenorrhoea definition

A

cessation of established, regular menstruation >6/12

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14
Q

causes secondary amenorrhoea

A 
pregnancy
hypothalamic amenorrhoea (stress, excess exercise)
PCOS
hyperprolactinaemia 
premature ovarian failure
Thyrotoxicosis (hypothyroidism) 
Sheehan's
Asherman's (IU adhesions)
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15
Q

Amenorrhoea Ix

A 
bhCG 
gonadotrophins 
prolactin
androgen levels 
oestradiol
TFTs
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16
Q

amenorrhoea with low gonadotrophin levels

A

hypothalamic cause

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17
Q

amenorrhoea with high gonadotrophin levels

A

Ovarian problem (premature ovarian failure)

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18
Q

Can instrumental delivery be used before full dilation of cervix?

A

No

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19
Q

contraindications to prostaglandins and oxytocin

A

Foetal distress

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20
Q

Post menopausal bleeding Ix

A

Transvaginal USS - endometrial thickness
pipelle biopsy - sample endometrium - dx endometrial cancer
hysteroscopy with direct sampling (dilation+curettage)

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21
Q

definitive tx for Bartholin cyst

A

Marsupialisation procedure

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22
Q

Endometrial carcinoma stage 1/2 tx

A

Total abdominal hysterectomy with bilateral salpingo-oophrectomy

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23
Q

hormonal tx for endometrial carcinoma

A

Provera (medroxyprogesterone acetate) - progesterone - slows growth of malignant cells in endometrium

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24
Q

Tx stage 2b endometrial carcinoma

A

Wertheim’s radical hysterectomy (includes removal of lymph nodes)

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25
Q

Endometrial cancer risk factors

A 
Post menopausal 
obesity
nulliparity 
early menarche + late menopause 
unopposed oestrogen 
DM
Tamoxifen 
PCOS
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26
Q

If post menopausal bleeding, what is dx until proven otherwise?

A

Endometrial cancer

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27
Q

What drug must be avoided in breastfeeding

A 
Amiodarone (antiarrhythmic)  
aspirin
Abx - ciprofloxacin, tetracycline, chloramphenicol, sulfonamides 
Li, Benzos
Carbimazole
MTX
sulfonylureas
cytotoxic drugs
cocp
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28
Q

risk for women with PCOS undergoing IVF?

A

Ovarian hyperstimulation syndrome

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29
Q

pathophysiology ovarian hyperstimulation syndrome?

A

multiple luteinized cysts > high levels oestrogen/progesterone + vasoactive Vascular Endometrial Growth Factor > increased membrane permeability > loss fluid intravascular space

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30
Q

OHSS mild sx

A

abdo bloating, pain

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31
Q

OHSS moderate sx

A

+ n/v, USS evidence ascites

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32
Q

OHSS severe sx

A

+ clinical ascites, oliguria, haematocrit>45%, hypoproteinaemia

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33
Q

OHSS critical symptoms

A

+ thromboembolism, ARDS, anuria, tense ascites

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34
Q

PID definition

A

Inflammation and inflammation pelvic organs: uterus, FTs, ovaries, surrounding peritoneum

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35
Q

PID causes

A 
Ascending infection from endocervix 
Chlamydia trachomatis - the most common cause
Neisseria gonorrhoeae
Mycoplasma genitalium
Mycoplasma hominis
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36
Q

PID symptoms

A 
lower abdo pain, 
fever
deep dyspareunia 
dysuria, menstrual irregularities 
smelly vag/cervical discharge 
cerevical excitation 
perihepatitis - RUQ pain
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37
Q

PID Ix

A

Screen for chlamydia, gonorrhoea

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38
Q

Mx PID

A

pain relief - paracetamol/ibuprofen
Abx - 1 x ceftriaxone IM, doxycycline, metronidazole 14 days
? removal of IUS

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39
Q

1st degree tear

A

within vaginal mucosa

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40
Q

2nd degree tear

A

into subcutaneous tissue

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41
Q

3rd degree tear

A

laceration extends into external anal sphincter

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42
Q

4th degree tear

A

laceration extends through external anal sphincter into rectal mucosa

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43
Q

Perineal tears: 3rd degree subset

A

3a: less than 50% of External Anal Sphincter thickness torn
3b: more than 50% of EAS thickness torn
3c: IAS torn

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44
Q

risk factors for perineum tears

A 
primigravida
large babies
precipitant labour
shoulder dystocia
forceps delivery
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45
Q

Which questionnaire is used for post-partum mental health?

A

Edinburgh Post-natal depression scale

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46
Q

What score or higher in Edinburgh PND scale indicates depression of varying severity

A

13

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47
Q

If missed POP but less than 3 hours late, what action needed?

A

Take missed pill now, no further action required

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48
Q

If missed POP > 3 hours, what should you do?

A

take missed pill as soon as possible, if more than 1 pill missed just take 1 pill
Take the next pill at the usual time which might mean taking 2 on the same day
Continue with rest of pack
Condoms given until reestablished 48hours

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49
Q

What cyst is sometimes referred to as a chocolate cyst due to it’s external appearance?

A

Endometriotic cyst

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50
Q

Commonest ovarian cancer

A

Serous Carcinoma

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51
Q

23yo female with recurrent UTI. USS shows 3cm ‘simple cyst’ on L ovary. she is asymptomatic. What type of cyst?

A

Follicular cyst

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52
Q

commonest type of ovarian cyst

A

Follicular cyst

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53
Q

What causes follicular cyst?

A

non-rupture of the dominant follicle or failure of atresia in non-dominant follicle
Commonly regress after several menstrual cycles

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54
Q

What causes a corpus luteum cyst and how would it commonly present?

A

In cycle if pregnancy does not occur, CL usually breaks down, if this fails then CL fills with blood/fluid
Presents with intraperitoneal bleeding

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55
Q

What is a dermoid cyst?

A

Mature cystic teratoma - lined with epithelial tissue and may contain skin appendages, hair and teeth
most common benign ovarian tumour in woman <30
Bilateral in 10-20%
Usually asymptomatic.
Torsion is more likely than with other ovarian tumours

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56
Q

What type of ovarian cyst is a benign germ cell tumour?

A

Dermoid cyst

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57
Q

which ovarian tumours are benign epithelial tumours?

A

serous cystadenoma

mucinous cystadenoma

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58
Q

Serous cystadenoma

A

commonest benign epithelial tumours

bilateral in 20%

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59
Q

mucinous cystadenoma

A

typically large, may become massive

rupture > pseudomyxoma peritonei

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60
Q

First line pharma mx to stop bleeding in PPH

A

IV syntocinon

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61
Q

Other pharma mx of PPH

A

IV ergometrine

IM carboprost

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62
Q

Sx intervention for PPH

A

First line IU balloon tamponade
Then b-lynch suture
ligation of uterine arteries/int illiac arteries
Finally hysterectomy

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63
Q

second screen for anaemia and atypical red cell alloantibodies

A

28 weeks

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64
Q

Nuchal scan when?

A

11-13+6 weeks

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65
Q

Urine culture to detect asymptomatic bacteriuria

A

8-12 weeks

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66
Q

When is the booking visit?

A

8-12 weeks

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67
Q

what does the booking visit entail?

A

General info - diet, alcohol, smoking, folic acid, vit D, antenatal classes
BP, urine dipstick, BMI
FBC - blood group, Rh status, RC alloabs, Hbopathies
HepB, syphilis, rubella
HIV offered to all women
urine culture - asx bactiuria

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68
Q

When is the early scan to confirm dates/screen for multiple pregnancy?

A

10-13.6 weeks

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69
Q

Which other screening occurs 11-13.6 weeks?

A

Down’s screening, Nuchal scan

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70
Q

When does the anomaly scan occur?

A

18-20.6 weeks

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71
Q

When are doses of prophylactic Anti-D given to Rh negative women?

A

28, 34 weeks

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72
Q

What happens at 28/40 antenatal care-wise?

A

Routine care: BP, urine dipstick, SFH

Second screen for anaemia and atypical red cell alloantibodies. If Hb < 10.5 g/dl consider iron

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73
Q

Children under what age are considered unable to consent for sexual intercourse?

A

13

If concerned about this, children’s services involvement

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74
Q

If had unprotected sex, when should STI tests be done?

A

2 and 12 weeks after

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75
Q

Mx women at high risk of pre-eclampsia

A

from 12 weeks on, take aspirin 75mg OD - birth

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76
Q

high risk of pre-eclampsia if:

A

HTN previous pregnancy
CKD
AI - SLE/antiphospholipid syndrome
1/2DM

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77
Q

Moderate gestational HTN first line tx:

A

Oral labetolol

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78
Q

Cervical screening age ranges in UK

A

25-64

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79
Q

25-49 how often is screening offered (cervical)

A

3 yearly

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80
Q

How often are women recalled for cervical screening in 50-64yos?

A

5 yearly

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81
Q

26yo nulliparous, HTN 155/110 39/40. +++ protein. Mx?

A

IV labetolol with target diastolic 80-100

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82
Q

In pre-eclampsia, what are target BPs?

A

systolic < 150

diastolic 80-100

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83
Q

women on COCP, with post-coital bleeding, what is common finding:

A

cervical ectropion

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84
Q

Cervical ectropion

A

ectocervix transformation zone
meeting of stratified squamous - coloumnar ep of cervical canal
caused by elevated estrogen levels

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85
Q

if troublesome cervical ectropion sx, tx?

A

Ablative tx

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86
Q

NICE guidelines on drinking in pregnancy?

A

0 units. Do not do it

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87
Q

If ectopic is located in a certain location there is increased risk of rupture. What is this location?

A

Isthmus

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88
Q

Methotrexate in those planning a pregnancy

A

Both men and women must stop 6 months before trying

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89
Q

What can RA patients take during pregnancy?

A

sulfasalazine and hydroxychloroquine are considered safe in pregnancy

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90
Q

When can NSAIDs be taken up until during pregnancy and what does their use after this increase the likelihood of?

A

32 weeks

risk early closure of ductus arteriosus

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91
Q

Placental abruption

A

painful vaginal bleeding
tense uterus
fetal heartbeat absent
woman in shock

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92
Q

placenta praevia

A

painless vaginal bleeding

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93
Q

When might you feel a woody hard uterus? Why?

A

Placental abruption

retroplacental blood tracks into the myometrium

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94
Q

Mx placental abruption

A

delivery when woman stable

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95
Q

What is there an increased risk of in placental abruption?

A

PPH

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96
Q

How will intrahepatic cholestasis of pregnancy present?

A

Pruritis

No rash

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97
Q

What will the bloods findings be of IHC of pregnancy be?

A

raised bilirubin

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98
Q

Mx of IHC of pregnancy?

A

ursodeoxycholic acid
LFTs weekly
deliver at 37/40 - induce

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99
Q

Cx of IHC of preg?

A

stillbirth increased risk

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100
Q 
abdominal pain
nausea &amp; vomiting
headache
jaundice
hypoglycaemia

are sx of?

A

Acute fatty liver of pregnancy

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101
Q

When does AFLP present?

A

3rd trimester-post birth

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102
Q

what are the investigation findings for AFLP?

A

ALT>500

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103
Q

Mx AFLP

A

supportive, definitive - delivery

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104
Q

which conditions may be exacerbated by AFLP during pregnancy?

A

Gilbert’s, Dubin-Johnson

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105
Q

HEELP

A

Haemolysis
Elevated Liver Enzymes
Low Platelets

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106
Q

what is the effect of pre-eclampsia on reflexes?

A

Brisk tendon reflexes

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107
Q

Which device is most effective form of emergency contraception and is not affected by BMI?

A

Copper IUD

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108
Q

28yo Indian woman, 18/40, increasing SOB, chest pain, coughing clear sputum. Apyrexial, 140/80. 130bpm. Sats 94% 15L O2. Mid diastolic murmur, bibasal creps. Mild pedal oedema. Suddenly deteriorates - respiratory arrest. CXR - whiteout both lungs

A

Mitral valve stenosis
(commonest cardiac abnormality of pregnant women)
(related to rheumatic heart disease - developing countries)

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109
Q

What are the complication risks of someone with Mitral valve stenosis in pregnancy?

A

AF

Rapid decompensation

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110
Q

Tx mitral valve stenosis pregnancy?

A

Balloon valvuloplasty

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111
Q

28yo, 30/40, sudden onset chest pain associated with LOC. 170/90, sats 15L o2 93%, 120bpm, apyrexial. Early diastolic murmur, occasional bibasal creptitations and mild peal oedema. ECG - ST elevation in leads II, III and aVF.

A

Aortic dissection

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112
Q

When is aortic dissection likely to present in pregnancy?

A

3rd trimester

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113
Q

What are CT disorders (Marfan’s, Ehlers-Danlos) associated with in pregnancy (cardiac)?

A

Aortic dissection

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114
Q

Common presenting features of aortic dissection in pregnancy?

A

Tearing chest pain, transient syncope

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115
Q

How to repair aortic dissection in <28/40

A

aortic repair with fetus kept in utero

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116
Q

Repair aortic dissection 28-32/40?

A

depends on fetal condition

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117
Q

Repair aortic dissection >32/40?

A

Primary cessarian section, with aortic repair at same operation

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118
Q

28yo, 18/40 pregnant, sudden onset chest pain. 150/70. 92% 15L o2. 130bpm. No murmurs and chest is clear. Signs of thrombophlebitis in L Leg

A

Pulmonary Embolism

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119
Q

How does PE classically present in pregnancy?

A

chest pain, hypoxia, clear chest on auscultation

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120
Q

How to confirm PE in pregnancy?

A 
half dose scintigraphy - vent/perfusion 
CT chest (underlying lung disease)
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121
Q

Treatment of PE in pregnancy?

A

LMWH throughout pregnancy and 4-6 weeks post partum

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122
Q

Can you give warfarin in pregnancy?

A

No - contraindicated

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123
Q

8/40, abdo pain and vaginal bleeding. Tender RIF and suprapubic region. Speculum examination - open cervical os. USS confirms IU pregnancy.

A

Miscarriage

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124
Q

Ectopic risk factors

A

damage to tubes - salpingitis/surgery
previous ectopic
IVF
endometriosis

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125
Q

typical history of ectopic

A

6-8/40
lower abdo pain, constant, may be unilateral
vaginal bleeding after

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126
Q

where else might pain be referred to in ectopic?

A

shoulder tip

also pain on defectation/urination

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127
Q

painless vaginal bleeding before 24/40

os closed

A

threatened miscarriage

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128
Q

gestational sac with dead fetus pre 20/40
no expulsion yet
light vaginal bleeding/discharge

A

missed (delayed) miscarriage

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129
Q

blighted ovum/anembryonic pregnancy: definition

A

gestational sac >25mm no embryonic/fetal part can be seen

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130
Q

os is open

heavy bleeding with clots and pain

A

inevitable miscarriage

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131
Q

not all products of conception have been expelled

A

incomplete miscarriage - medical mx

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132
Q

pain over the pubic symphysis which radiates to groins and medial aspects of thighs
waddling gait

A

Symphysis pubis dysfunction

- ligament laxity increases in response to hormonal changes of pregnancy

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133
Q

Pre-eclampsia / HELLp syndrome abdo pain

A

typically in RUQ / epigastric

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134
Q

uterine rupture - when does it occur?
risk of it occuring?
presents?

A

normally during labour, also 3rd tri
previous CS
maternal shock, abdo pain, PV bleeding

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135
Q

where does appendicitis pain present during each trimester of pregnancy?

A

1 - RLQ
2 - umbilicus
3 - RUQ

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136
Q

what is a UTI during pregnancy associated with?

A

pre-term delivery and IUGR

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137
Q

What are some UKMEC4 risks (unacceptable) for COCP?

A 
>35yo, >15 fags/day
migraine with aura
Hx thromboembolic disease/thrombogenic mutation
Hx stroke/IHD
breast-feeding<6/52 postpartum
uncontrolled HTN
current Breast cancer
major surgery - prolonged immoblisiation
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138
Q

Some UKMEC3 (disadvantages outweigh the advantages) COCP?

A 
>35, <15fags/day
BMI>35
FHx thromboembolic disease 1st degree <45yo
controlled HTN
immobility
BRCA1/2 carrier
current gallbladder disease
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139
Q

which type of contraception associated with weight gain?

A

depo-provera injection

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140
Q

Placenta praevia is associated with low lying placenta - true/false?

A

True

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141
Q

What increased likelihood of low-lying placenta?

A

previous CS
multiparity
presentation of bleeding/no pain

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142
Q

How is placenta praevia diagnosed and graded?

A

USS - transvaginal

colour flow doppler

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143
Q

What should not be done before exluding placenta praevia?

A

Digital examination - could cause placenta to bleed

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144
Q

If low lying placenta on 16-20/40 scan, what is mx?

A

rescan at 34/40
limit activity/intercourse only IF they bleed
if present at 34/40 and grade 1/2 rescan every 2 weeks

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145
Q

If high presenting part/ abnormal lie at 37/40?

A

CS

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146
Q

If placenta praevia with bleeding - mx?

A

Admit
treat shock
cross-match blood
final USS 37/40

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147
Q

If final USS (placenta praevia) at 37/40 shows grades 3/4 - mx?

A

CS 37-38/40

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148
Q

If grade 1 placenta praevia - delivery method?

A

can be vaginal

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149
Q

28-yo g1p0 in labour for 11hrs; progressed through first stage without any issues. Midwife noted CTG abnormalities, able to palpate the umbilical cord. She immediately calls the obstetric registrar > checks CTG, variable decelerations. What is initial definitive mx for the cause of these decelerations?

A

place hand into vagina to elevate the presenting part

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150
Q

guidelines for mx cord prolapse

A

elevate presenting part - manually/filling bladder

Tocolysis - Terbutaline to prep for CS

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151
Q

define cord prolapse

A

umbilical cord descending ahead of the presenting part of fetus

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152
Q

risk factors cord prolapse

A 
prematurity
multiparity
polyhydramnios
twin pregnancy 
cephalopelvic disproportion 
abnormal presentations - breech/transverse lie 
placenta praevia
long umbilical cord
high fetal station
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153
Q

when do most cord prolapses occur?

A

ARM

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154
Q

During tocolysis and prep for CS, what position is mother encouraged to take?

A

All 4s

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155
Q

What are false labour pains common in 2/3 trimester known as?

A

Braxton-Hicks contractions

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156
Q

maternal cx post-term labour

A

increases need of forceps/CS

increases labour induction rates

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157
Q

neonatal cx post-term labour

A

reduced placental perfusion

oligohydramnios

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158
Q

what should be done with woman 41/40

A

induce

give her choice of expectant mx

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159
Q

uterine tenderness and brown foul smelling vaginal discharge along with fever, tachycardia in pregnant woman:

A

chorioamnionitis

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160
Q

if pregnant woman with dysuria, what should be an important differential?

A

Pyelonephritis

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161
Q

what is chorioamnionitis?

A

result of ascending bacterial infection into amniotic fluid/membranes/placenta

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162
Q

what is big risk with chorioamnionitis?

A

Prolonged premature ROM

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163
Q

Tx: chorioamnionitis?

A

prompt delivery of fetus, ?via CS

IV Abx

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164
Q

mastitis mx: no infection

A

continue breast feeding, simple analgesia, warm compress, send culture

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165
Q

mastitis mx: infection

A

continue breastfeeding +PO flucloxacillin

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166
Q

trimethoprim use in pregnancy: ok?

A

Not in first trimester!!

Folate antagonist

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167
Q

What terminology is used to describe the head in relation to the ischial spine?

A

Station

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168
Q

Heb B vaccine schedule in babies with high risk of developing HepB (mum has it)

A

If mum is surface antigen positive - 1st dose HepB vaccine + 0.5ml HBIG within 12 hours of birth
Further vaccination 1-2/12
Further vaccination 6/12

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169
Q

can HepB be transmitted via breast feeding?

A

no

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170
Q

what is vasa praevia?

A

fetal blood vessels cross/run near the os
vessels rupture when membranes rupture
>frank bleeding

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171
Q

classic triad of vasa praevia?

A

ROM
followed by painless bleeding
followed by fetal bradycardia

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172
Q

McRobert’s manouvre - used for?

A

Shoulder dystocia

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173
Q

What position must woman be in for McRobert’s manouvre?

A

suppine, hips flexed and abducted fully

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174
Q

continuous dribbling incontinence after prolonged labour in area of world with poor obstetrics care?

A

Vesicovaginal fistulae

from bldder to vagina

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175
Q

if large unilateral ovarian cyst in woman who wants to have children, what is next step of ix?

A

serum ca125, aFP, bHCG + elective cystectomy

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176
Q

tearing pain and haemodynamic compromise in woman of child bearing age:

A

Ectopic pregnancy

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177
Q

RUQ pain in PID cause?

A

perihepatic inflammation - Fitz Hugh Curtis Syndrome

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178
Q

mid cycle pain that subsides within 24-48hours - sharp onset, little systemic disturbance

A

Mittelschmerz

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179
Q

endometriosis

A

growth of ectopic endometrial tissue outside of the uterine cavity

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180
Q

clinical features of endometriosis?

A 
chronic pelvic pain
dysmenorrhoea - pain day before bleed
deep dyspareunia 
subfertility
urinary sx
frozen pelvis
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181
Q

Endometriosis Ix:

A

Laparoscopy is gold standard

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182
Q

Mx: endometriosis

A

NSAID/paracetamol is 1st line sx relief
COCP/medroxyprogesterone acetate
GnRH analogues

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183
Q

whirlpool sign in gynae:

A

ruptured ovarian cyst

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184
Q

USS ovarian rupture:

A

whirlpool sign
enlarged ovary in midline with free pelvic fluid
no ovarian venous flow/reversed diastolic flow

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185
Q

when invite women who have been treated for CIN1/2/3 back for repeat cervical screening?

A

6 months time - test of cure

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186
Q

if CIN1, what mx?

A

Test for HPV - if positive colposcopy
if -ve - return to routine call
if positive again after 1 yr - smear again in 12/12

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187
Q

wheelchair user requests contraception - what is CI?

A

COCP - immobility -> clots

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188
Q

most effective form of contaception (excluding abstinence)?

A

Contracpetive implant (Nexplanon)

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189
Q

How long does nexplanon implant take to work?

A

7 days

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190
Q

how long does implant last?

A

3 years

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191
Q

does implant contain estrogen?

A

no

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192
Q

how long can missed pill be taken if miss desorgestrel?

A

prog only. 12 hour window

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193
Q

if patient on enzyme inducing drug, what contraception method should be used?

A

Cu IUD commonly (no hormones)

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194
Q

in terms of contraception, how many years amenorrhoea for woman <50?

A

2 years

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195
Q

in terms of contraception, how many years amenorrhoea for woman 50

A

1 year

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196
Q

if past / current hx breast cancer - contracpetive?

A

Cu IUD

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197
Q

COCP MOA:

A

inhibits ovulation

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198
Q

Implant MOA (etonogestrel):

A

inhibits ovulation

All progestogen-only methods of contraception are safe to use as contraception alongside sequential HRT.

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199
Q

Cu IUD MOA:

A

decreases sperm motility and survival

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200
Q

multiparity
multiple pregnancy
embryos are more likely to implant on a lower segment scar from previous caesarean section

risk factors for:

A

placenta praevia

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201
Q

what is Bishop’s score used for?

A

predict whether induction of labour will be required

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202
Q

under which Bishop’s score predicts that labour is unlikely to start without induction?

A

5 or less

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203
Q

What tx given to woman with Bishop score <5 to induce labour and what does it do?

A

Prostaglandin E2 PV to ripen cervix

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204
Q

when in pregnancy can women develop any of the pregnancy related causes of HTN?

A

after 20 weeks until 6 weeks postpartum

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205
Q

after what dates should delivery be offered to a woman with pre-eclampsia?

A

34 weeks

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206
Q

mx moderate-severe depression in post-natal period (with no hx severe depression): first line tx:

A

CBT

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207
Q

when are ADs used in mx of PND and which type first?

A

after CBT not engaged with

SSRIs

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208
Q

can woman taking SSRIs breastfeed?

A

on sertraline/paroxetine ok to

not fluoxetine

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209
Q

what is lochia?

A

bleeding that presents in the first two weeks following birth
red blood>dark brown blood>stops

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210
Q

Mx:lochia

A

reassure, discharge

if vol increased/smells bad/won’t stop seek help

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211
Q

how long might lochia last after birth?

A

6 weeks

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212
Q

In woman 32/40 PROM, how mx:

A

admit for >48hours, Abx (erythromycin), steroids (neonatal RDS)

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213
Q

when should deliver in woman who has PROMed

A

34 weeks

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214
Q

In woman with severe asthma, how manage her pre-eclampsia?

A

Nifedipine first line

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215
Q

most frequent cause of severe early-onset (< 7 days) infection in newborn infants.

A

Group B septicaemia

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216
Q

GBS in pregnancy mx:

A

IV benpen IP

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217
Q

cord prolapse mx:

A
  1. tocolytics
  2. correct to avoid compression
  3. patient on all 4s
  4. cord should not be pushed back into uterus
  5. immediate CS
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218
Q

what can you do first in mx of cord prolapse?

A

push presenting part of fetus back into uterus to avoid compression

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219
Q

hyperemesis gravidarum dx criteria triad:

A

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

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220
Q

Rh sensitising events in pregnancy:

A
  • Ectopic pregnancy
  • Evacuation of retained products of conception and molar pregnancy
  • Vaginal bleeding < 12 weeks, only if painful, heavy or persistent
  • Vaginal bleeding > 12 weeks
  • Chorionic villus sampling and amniocentesis
  • Antepartum haemorrhage
  • Abdominal trauma
  • External cephalic version
  • Intra-uterine death
  • Post-delivery (if baby is RhD-positive)
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221
Q

which test determines proportion of fetal RBCs present?

A

Kleinhauer test

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222
Q

what may an affected Rh+ve fetus show:

A 
oedematous (hydrops fetalis, as liver devoted to RBC production albumin falls)
jaundice, anaemia, hepatosplenomegaly
heart failure
kernicterus
treatment: transfusions, UV phototherapy
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223
Q

Reduced urea, reduced creatinine, increased urinary protein loss

A

normal lab findings in pregnancy!

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224
Q

what can be used to classify the severity of nausea and vomiting in pregnancy?

A

The Pregnancy-Unique Quantification of Emesis (PUQE) score

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225
Q

hyperemesis gravidarum: mx

A
  1. antihistamines (promethazine, Cyclizine).
  2. ondansetron and metoclopramide
  3. ginger and P6 (wrist) acupressure: little evidence
  4. admission for IV hydration (severe)
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226
Q

hyperemesis gravidarum cx:

A 
Wernicke's encephalopathy
Mallory-Weiss tear
central pontine myelinolysis
acute tubular necrosis
fetal: small for gestational age, pre-term birth
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227
Q

when may hyperemesis gravidarum persist until?

A

20 weeks

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228
Q

what is related to hyperemesis gravidarum?

A

bHCG levels

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229
Q

how often is the depot provera (medroxyprogesterone acetate) injecton given

A

every 12 weeks

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230
Q

urinary incontinence: urge incontinence: first line tx

A

bladder retraining

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231
Q

urinary incontinence: stress incontinence: first line tx

A

pelvic floor training

2nd: duloxetine

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232
Q

In woman who has PROMed at 30/40, what should be given to her to prevent neonatal RDS?

A

Dexamethasone - steroid

233
Q

sudden onset unilateral pelvic pain precipitated by intercourse or strenuous activity

A

ruptured ovarian cyst

234
Q

women who have recently stopped breastfeeding and is due to occlusion of a lactiferous duct:

A

galactocele

no mx needed

235
Q

67-year-old woman presents with a heavy, dragging sensation in the suprapubic region. She also has frequency and urgency.

A

urogenital prolapse

236
Q

where is cervical excitation seen?

A

PID

ectopic pregancy

237
Q

mx shoulder dystocia labour:

A 
request senior help 
McRobert's manouvere
apply suprapubic pressure
episiotomy - internal manouveres (Wood's screw/ grasping posterior arm)
Symphisiotomy 
Zavanelli manouvere (incl CS)
238
Q

menorrhagia first line tx:

A

IUS mirena

lasts 5yrs

239
Q

menorrhagia : mx

A

IUS
COCP
Depot provera (progestogens)

240
Q

dysmenorrhoea if do not need contraception mx:

A

transamic acid / NSAIDS (mefanamic acid) first line

241
Q

eclampsia: first line tx

A

Mg sulfate

to both stop and prevent seizures

242
Q

35yof, trouble conceiving 8/12. periods have been heavier past year. Now unmanageable, episodes of flooding.
abdomen snt, but you palpate a supra-pubic mass.

A

Fibroids

243
Q

menorrhagia, subfertility and an abdominal mass in this patient points towards
uterus can feel bulky

A

fibroids

244
Q

first line fibroids tx:

A 
IUS
tranexamoc acid
COCP
nsaids
progestogens
sx - myomectomy, hysteroscopic ablation, UA embolisation
245
Q

measurement of the symphysis-fundal height in centimetres should???

A

closely match the gestational weeks from 20 weeks onwards within 1/2cm

246
Q

when is serum AFP raised?

A

in fetal abdominal wall defects eg. omphalocele

nerual tube defects

247
Q

when is serum AFP low?

A

Down’s syndrome,
maternal DM,
Edwards syndrome
maternal obesity

248
Q

33-year-old woman is investigated for infertility. Laparoscopy is essentially normal. Hysterosalpingography shows blocked fallopian tubes bilaterally. Dx:

A

PID

249
Q

classic ABC features of irritable bowel syndrome

A

ABdo pain
bloating
change in bowel habit

250
Q

26-year-old women develops sudden onset right iliac fossa pains whilst playing netball. She is nauseated and has vomited twice. On examination she is tender in the right iliac fossa.

A

Ovarian torsion

251
Q

primary PPH definition:

A

> 500mls blood loss within 24 hours of birth of baby

252
Q

risk factors for primary PPH:

A 
previous PPH
prolonged labour
pre-eclampsia
increased maternal age
polyhydramnios
emergency Caesarean section
placenta praevia, placenta accreta
macrosomia
ritodrine (a beta-2 adrenergic receptor agonist used for tocolysis)
253
Q

mx PPH

A

ABC including two peripheral cannulae, 14 gauge
(bimanual uterine compression)
IV syntocinon (oxytocin) 10u or IV ergometrine 500mcg
IM carboprost
Sx: IU balloon tamponade is 1. for when uterine atony
others: B-Lynch suture, ligation of the uterine arteries/internal iliac arteries
if severe, uncontrolled haemorrhage -hysterectomy

254
Q

secondary PPH until?

A

12 weeks

255
Q

when is first HPV vaccine given and to who and what ages?

A

12-13yo m+f

256
Q

which strains of HPV does vaccine protect vs?

A

16, 18

257
Q

Oliohydramnios causes?

A 
PROM
fetal renal problems e.g. renal agenesis
IUGR
post-term gestation
pre-eclampsia
258
Q

oligohydramnios definition?

A

<500ml at 32-36 weeks and an amniotic fluid index (AFI) < 5th percentile.

259
Q

is it legal to reinfibulate a woman with type 3 FGM after vaginal delivery?

A

no

260
Q

FGM type 1:

A

clitoridectomy

261
Q

FGM type 2:

A

Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision)

262
Q

FGM type 3:

A

Narrowing of the vaginal orifice with creation of a covering seal, with or without excision of the clitoris (infibulation)

263
Q

FGM type 4:

A

All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization

264
Q

what normally happens to BP during pregnancy?

A

falls in first half and then rises to pre-pregnancy levels before term

265
Q

what secretes HCG?

A

synchtiotrophoblasts

266
Q

what maintains the production of progesterone by the corpus luteum in early pregnancy?

A

HCG levels secreted by the synchtiotrophoblasts

267
Q

small (<35mm) unruptured ectopic pregnancy with no visible heartbeat, a serum B-hCG level of <1500 IU/L, no intrauterine pregnancy and no pain, then first line treatment should be:

A

Methotrexate

medical management

268
Q

when should laparoscopic salpingectomy (or salpingotomy where there is risk of infertility) in ectopic?

A

ectopic is larger than 35mm, is causing severe pain or if the B-hCG level is >1500

269
Q

medical mx miscarriage?

A

misoprostol

if expectant mx for >14/7

270
Q

if fetal breech at 34/40, what is mx?

A

wait til 36 weeks then offer external cephalic version

271
Q

heavy menstrual bleeding: initial ix:

A

FBC

272
Q

diagnosis of postpartum thyroiditis is based upon:

A

clinical manifestation and TFTs alone

(normal TSH, high T4) - propranolol

273
Q

premature ovarian failure (POM) is defined as:

A

cessation of menses for 1 year before the age of 40. It can, however, be preceded by irregular menstrual cycles. Common symptoms include hot flushes, vaginal dryness, vaginal atrophy, sleep disturbance, and irritability.

274
Q

hyperemesis gravidarum associations:

A 
multiple pregnancies
trophoblastic disease
hyperthyroidism
nulliparity
obesity
275
Q

if woman already treated for pre-eclampsia and comes in 37+1 with papilloedema and HTN, mx?

A

IV Mg Sulfate + plan immediate delivery

276
Q

18-yof discharge. New sexual partner, not using barrier protection. Thick cottage-cheese like discharge is visualised. She reports no other symptoms of note. What is the most likely diagnosis?

A

Candida albicans

277
Q

‘cottage cheese’, non-offensive discharge
vulvitis: dyspareunia, dysuria
itch
vulval erythema, fissuring, satellite lesions may be seen

A

candida albicans

278
Q

mx: candida albicans?

A

local - clotrimazole pessary (clotrimazole 500mg PV stat)

oral - itraconazole 200mg PO bd for 1 day/fluconazole 150mg PO stat

279
Q

Causes of an increased nuchal translucency include:

A

Down’s syndrome
congenital heart defects
abdominal wall defects

280
Q

Causes of hyperechogenic bowel:

A

cystic fibrosis
Down’s syndrome
cytomegalovirus infection

281
Q

urge incontinence: bladder training unsuccessful - what is next tx?

A

Tolterodine - antimuscarinic

282
Q

monochorionic twins: ultrasound monitoring performed between 16 and 24 weeks gestation aims to detect?

A

twin-twin transfusion syndrome

283
Q

Cocaine abuse, pre-eclampsia and HELLP syndrome are known causes of?

A

placental abruption

284
Q

what window of time is the Nexplanon inplant effective as immediate contraception if administered?

A

1-5 days

285
Q

Ix: after USS for endometrial ca:

A

hysteroscopy with endometrial biopsy

286
Q

What will transvaginal USS show for endometrial thickening if needs further ix:

A

> 4mm thickness-

high negative predicted value

287
Q

why should oxybutinin not be used in elderly population?

A

risk of falls

288
Q

what must happen re: all cases of FGM in UK?

A

reported to police

289
Q

what are CIs of Cu IUD?

A

pregnancy and PID

290
Q

how many days before day 1 does ovulation always occur?

A

14 days

291
Q

when can the mid-luteal progesterone levels best be measured?

A

7 days before day 1 (21 days)

292
Q

what bishop’s score indicates labour will likely start spontaneously?

A

> 9

293
Q

definitions anaemia in pregnancy: each trimester

A

first trimester Hb less than 110 g/l
second/third trimester Hb less than 105 g/l
postpartum Hb less than 100 g/l

294
Q

Pregnant patients with type 1 diabetes should monitor their blood glucose:

A

daily fasting, pre-meal, 1hour post meal, bedtime

295
Q

how long does active mx of 3rd stage of labour last?

A

<30 mins

296
Q

what is theactive mx of 3rd stage of labour?

A

Uterotonic drugs - oxytocin
clamping and cutting of cord, >1 min after delivery <5 mins
Controlled cord traction after signs of placental separation

297
Q

when should ergometrine not be used?

A

HTN

298
Q

when should Mg treatment be stopped in eclampsia?

A

either 24 hours after delivery or 24 hours after last seizure

299
Q

when is the deadline for attempting external cephalic version?

A

rupture of amniotic sac

300
Q

expectant management of an ectopic pregnancy can only be performed for:

A

1) An unruptured embryo
2) <30mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <200IU/L and declining

301
Q

when should ca125 be ix:

A 
50 years old +:
abdominal distension or 'bloating'
early satiety or loss of appetite
pelvic or abdominal pain
increased urinary urgency and/or frequency
302
Q

The definition of menorrhagia has changed

A

to reflect the woman’s subjective experience rather than mls blood loss

303
Q

incontinence (urinary) Ix:

A

bladder diaries should be completed for a minimum of 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

304
Q

The requirements for instrumental delivery can be easily remembered by the mnemonic FORCEPS

A

Fully dilated cervix
OA position preferably OP delivery is possible with Keillands forceps and ventouse.
Ruptured Membranes
Cephalic presentation
Engaged presenting part i.e. head at or below ischial spines the head must not be palpable abdominally
Pain relief
Sphincter (bladder) empty this will usually require catheterization

305
Q

Late decelerations and foetal bradycardia on cardiotocography (CTG) is a worrying sign and would justify??

A

emergency CS

306
Q

A high voiding detrusor pressure with a low peak flow rate on urodynamic testing:

A

bladder outlet obstruction

overflow incontinence

307
Q

what is used as pre-eclampsia prophylaxis during early pregnancy>

A

low dose aspirin

308
Q

do we have ovarian screening in UK>

A

no

309
Q

when is action required re: contraceptive patch (if patient doesn’t replace patch)

A

above 48 hours
emergency contraception if required
barrier protect for 7 days

310
Q

what type of contraception is the EVRA patch?

A

Combined

311
Q

how does contraceptive patch work?

A

for first 3 weeks wear patch everyday, change patch weekly

remove for week 4 - withdraw bleed

312
Q

what is the riskiest, but rare form of breech presentation?

A

footling at delivery

313
Q

A transvaginal ultrasound demonstrating a crown-rump length greater than 7mm with no cardiac activity

A

diagnostic of miscarriage - confirmed

314
Q

what effect will mirena have on periods?

A

initially irregular then followed by light menses or amenorrhoea

315
Q

when in cycle can Cu ID be inserted?

A

anytime

316
Q

risk for endometrial hyperplasia (drugs)

A

tamoxifen

317
Q

cervical screening in HIV patients:

A

cervical cytology annually

318
Q

what is measured in the combined test for Down’s?

A

nuchal translucency + bhCG + PAPPA

319
Q

triple test for Down’s?

A

AFP, unconjugated oestriol, hCG

320
Q

quadruple test for Down’s?

A

AFP, unconjugated oestriol, hCG, inhibin A

321
Q

which cancers are increased risk in COCP use:

A

breast and cervical

protects against ovarian, endometrial

322
Q

Infertility in PCOS: Tx

A

Clomifene>metformin

323
Q

mild dyskaryosis and negative HPV smear: when should she next be screened if 29yo

A

3 years

324
Q

if untreated GBS in pregnancy, and baby delivered, what is MX:

A

observe for 24 hours as risk of sepsis

325
Q

HNPCC/Lynch syndrome is a strong risk factor for?

A

endometrial cancer

326
Q

Women should be prescribed cyclical combined HRT if

A

LMP<1yr ago

327
Q

Women should be prescribed continuous combined HRT if

A

taken cyclical combined for at least 1 year or
it has been at least 1 year since their LMP or
it has been at least 2 years since their LMP, if they had premature menopause (menopause below the age of 40)

328
Q

Most common type of ovarian pathology associated with Meigs’ syndrome:

A

fibroma

329
Q

what is Meig’s syndrome?

A

benign ovarian tumour (usually fibroma) associated with ascites and pleural effusion

330
Q

Most common benign ovarian tumour in women under the age of 25 years

A

dermoid cyst

331
Q

The most common cause of ovarian enlargement in women of a reproductive age:

A

follicular cyst

332
Q

34-year-old woman presents to her GP for contraception advice three weeks after the delivery of her second child. She is currently breastfeeding. She has a body mass index of 28 kg/m^2. Her husband has a vasectomy booked for three months time:

A

POP

333
Q

atrophic vaginitis tx:

A

topical oestrogen

lubricants and moisturisers

334
Q

TOP medical mx:

A

mifepristone + prostaglandins

335
Q

TOP <9 weeks

A

medical mx - mifepristone and prostaglandins

336
Q

TOP <13 weeks

A

Surgical dilation + suction of uterine contents

337
Q

TOP >15 weeks:

A

surgical dilation + evacuation of uterine contents

or late medical abortion (mini-labour induced)

338
Q

where is Nexplanon implantation implanted?

A

subdermal, non-dominant arm

339
Q

medication of choice in suppressing lactation when breastfeeding cessation is indicated??

A

cabergoline

340
Q

most common identifiable cause of postcoital bleeding

A

cervical ectropion

341
Q

placenta accreta:

A

attachment of the placenta to the myometrium, due to a defective decidua basalis. As the placenta does not properly separate during labour there is a risk of post-partum haemorrhage.

342
Q

Risk factors for placenta accreta:

A

previous CS

Placenta praevia

343
Q

if delayed placental delivery in placenta accreta and major blood loss, definitive mx:

A

hysterectomy

344
Q

if mildly elevated BP, but no proteinuria or any other sx >20 weeks pregnancy, description of case?

A

gestational HTN

345
Q

ca125 measure for:

A

ovarian ca

346
Q

open myomectomy. Which of the following is a common complication following this operation?

A

ahdesions

347
Q

history of sudden collapse occurring soon after a rupture of membranes is suggestive of

A

amniotic fluid embolism

348
Q

if pt refuses hormonal tx for menopausal vasomotor sx, what can be prescribed?

A

SSRI

349
Q

contraceptive vaginal ring - what hormone(s)?

A

combined - oestrogen and progesterone

350
Q

are noacs ok in pregnancy?

A

no - must be swpped onto LMWH

351
Q

woman refusing screening as she is lesbian - advice?

A

cervical screening as normal

352
Q

thin, white homogenous discharge
clue cells on microscopy: stippled vaginal epithelial cells
vaginal pH > 4.5
positive whiff test (addition of potassium hydroxide results in fishy odour)

A

bacterial vaginosis

353
Q

tx: bacterial vaginosis;

A

Oral metronidazole

354
Q

offensive ‘musty’, frothy, green vaginal discharge. On examination you an erythematous cervix with pinpoint areas of exudation.

A

Trichomonas vaginalis

355
Q

Strawberry cervix - which infection?

A

Trichomonas vaginalis

356
Q

trichomonas vaginalis tx:

A

oral metronidazole

357
Q

thin, purulent, and mildly odorous vaginal discharge. She also complains of dysuria, intermenstrual bleeding and dyspareunia. A swab shows a Gram-negative diplococcus.

A

gonorrhoea

358
Q

gonorrhoea tx:

A

IM ceftriaxone+PO azithromycin

359
Q

sudden intense pain

free fluid in the pelvis - USS - Dx:

A

ruptured enometrioma

360
Q

MOA of metformin in PCOS?

A

increases peripheral insulin sensitivity so affects the HPA axis

361
Q

women with preterm-PROM with a triad of maternal pyrexia, maternal tachycardia, and fetal tachycardia

A

chorioamnionitis

362
Q

Epilepsy + pregnancy =

A

5mg Folic acid starting when planning preg

also in obese pregnant women first 12 weeks

363
Q

first line ix for ?endometrial ca

A

TVUSS

364
Q

if lochia > 6weeks - ix??

A

USS

365
Q

painless vaginal bleeding, excessive morning sickness and shortness of breath. Routine examination of the patient’s abdomen reveals a uterus which extends up to the umbilicus. Ultrasound revealed a solid collection of echoes with numerous small anechoic spaces.??

A

hydatiform mole

366
Q

CF: hydatifrom mole

A

painless vaginal bleeding in early pregnancy and a uterus which is large for dates.
Hyperemesis gravidarum severe
thyrotoxicosis

367
Q

USS : hydatifrom mole

A

solid collection of echoes with numerous small anechoic spaces which resembles a bunch of grapes (also known as ‘snow-storm’ appearance).

368
Q

Fibroid dx. waiting for myomectomy surgery, what drug given while awaiting sx?

A

GnRH analogue

369
Q

37yof 15/40 abdo pain. Gradually, progressively worse 3/7. n/v. 38.4ºC, 116/82 mmHg, 104bpm. The uterus is palpable just above the umbilicus and a fetal heart beat is heard via hand-held Doppler. cervix is closed, no blood. PMH: menorrhagia due to uterine fibroids. This is her first pregnancy. What is the most likely diagnosis?

A

fibroid degeneration
(red degeneration)
pain, fever, vom

370
Q 
anaemic 20 weeks gestation.
Hb 104
MCV 104
blood film shows hypersegmented NPs
explain:
A

macrocytic anaemia. The blood films suggests that the cause of the macrocytosis is a megaloblastic anaemia
-> folate or b12 deficiency

371
Q

COCP: If 2 pills missed in week 3,:

A

finish the pills in the current pack then start new pack immediately ommiting the pill-free interval

372
Q

microgynon ??

A

COCP

373
Q

cancer commonly ulcerated and can present on the labium majora.?

A

vulval carcinoma

374
Q

cancer tend to be white or plaque like?

A

Vulval intraepithelial neoplasia

375
Q

risk factors for vulval ca;

A

Human papilloma virus (HPV) infection
Vulval intraepithelial neoplasia (VIN)
Immunosuppression
Lichen sclerosus

376
Q

ovarian mass in post-menopausal woman - mx?

A

any maass - refer to gynae - needs ix

377
Q

late decells seen on CTG - mx?

A

fetal blood sampling

urgent delivery if fetal acidosis

378
Q

couples should have regular sexual intercourse for a period of ? before referring ?

A

12/12

379
Q

commonest risk in TOP?

A

infection (10%) - prophylactic Abx

380
Q

if called for smear during pregnancy - what is advice??

A

advise to go for smear >12/52 post-partum

381
Q

if previous smear abnormal and woman becomes pregnant - mx?

A

seek specialist advice

smear could be done mid-trimester

382
Q

which criteria for PCOS:

A

Rotterdam

383
Q

risk for pre-eclampsia:

moderate

A 
FHX
Primigrav
age 40 years or older
pregnancy interval of more than 10 years
body mass index (BMI) of 35 kg/m² or more at first visit
multiple pregnancy
384
Q

tx: moderate pre-eclampsia risk?

A

aspirin from 12 weeeks

385
Q

possible cause oligohydramnios?

A 
premature rupture of membranes
fetal renal problems e.g. renal agenesis
intrauterine growth restriction
post-term gestation
pre-eclampsia
386
Q

39 weeks pregnant comes to see you complaining of itching down below. She has thick white discharge.

A

thrush

Tx - clotrimazole pessary

387
Q

only definitive tx adenomyosis:

A

hysterectomy

388
Q

adenomyosis:

A

presence of endometrial tissue in the myometrium

389
Q

features: adenomyosis:

A

dysmenorrhoea
menorrhagia
enlarged, boggy uterus

390
Q

Mx: adenomyosis:

A

GnRH agonist

hysterectomy

391
Q

emergency contraception:

A

copper coil), an oral progesterone-only contraceptive (levonorgestrel) or a selective progesterone receptor modulator (ulipristal acetate) could be offered

392
Q

atypical endometrial hyperplasia. She is post-menopausal and otherwise fit and well. What is the ideal management of this condition?

A

total hysterectomy with bilateral salpingo-oophrectomy

393
Q

first-line treatment for magnesium sulphate induced respiratory depression?

A

Calcium gluconate

394
Q

commonest site of ectopic?

A

Ampulla of FTs

395
Q

most important aetiological factor for causing cervical cancer?

A

HPV 16, 18

396
Q

contraception: time til effective: IUS mirena, COCP, implant, injection:

A

7 days if not taken on first day of cycle

397
Q

time til POP effective as contraception if not day 1 cycle:

A

2 days

398
Q

time til IUD effective contraception if not day 1 cycle:

A

instantaneous

399
Q

blooking bloods: rubella undetected: advice??

A

advise to stay away from anyone who has rubella and advise of risks of rubella pregnancy

400
Q 
sensorineural deafness
congenital cataracts
congenital heart disease (e.g. patent ductus arteriosus)
growth retardation
hepatosplenomegaly
purpuric skin lesions
'salt and pepper' chorioretinitis
microphthalmia
cerebral palsy
A

congenital rubella syndrome

401
Q

can women have MMR during pregnancy?

A

no

402
Q

what is criteria for medical management of fibroid?

A

<3cm

not distorting uterine cavity

403
Q

long term complications of vaginal hysterectomy with antero-posterior repair:

A

enterocele and vaginal vault prolapse

404
Q

Bladder still palpable after urination, think

A

retention with urinary overflow

405
Q

raised FSH, LH levels

low oestrodiol levels

A

premature ovarian failure

406
Q

Woodscrew Manoeuvre?

shoulder dystocia

A

put your hand into the vagina and rotate the fetus 180 degrees

407
Q

best way to dx adenomyosis:

A

MRI pelvis

408
Q

emergency contraception. Last night the condom split. She does not use regular contraception and is on day 20 of a 28 day cycle. You discuss the intrauterine device but she declines. which option?

A

Levonorgestrel stat dose 1.5mg

409
Q

why should cooked liver be avoided in pregnancy?

A

high amounts of vit A - teratogen

410
Q

mx: breech delivery, fully dilated:

A

CS

411
Q

what test to confirm early menopause?

A

FSH - raised

412
Q

POP+Abx - any extra precautions?

A

no - continue as usual

413
Q

24yof to GP 8/7 giving birth. Persistent pink vaginal discharge, ‘smelly’. 90bpm, 38.2ºC diffuse suprapubic tenderness. Uterus feels generally tender. Urine dipstick shows blood ++. What is the most appropriate management?

A

Admit to hospital - IV Abx clindamycin and gentamicin until afebrile for greater than 24 hours
puerperal pyrexia
secondary to endometritis

414
Q

puerperal pyrexia:

A

temp > 38 in first 14/7 post-delivery

415
Q

puerperal pyrexia causes:

A 
endometritis: most common cause
urinary tract infection
wound infections (perineal tears + caesarean section)
mastitis
venous thromboembolism
416
Q

30yof 34/40 UTI - GBS, what mx going forward:

A

IP IV Benpen

417
Q

to prevent spina bifida, what dose of folic acid should be taken throughout the first 12 weeks pregnancy?

A

400mcg daily

418
Q

risk factors for spina bifida in baby:

A 
parental NTD
FHx NTD
prev pregnancy NTD
AEDS, coeliac, DM, thalassaemia
obesity
419
Q

23F, G2P1, 37/40 - fainting and has severe abdominal pain. BP 92/58 and HR 132. Cold and her fundal height is 37 cm; cervical os is closed and no vaginal bleeding. dx?

A

placental abruption

rf = cocaine

420
Q

which AED is recommended for pregnancy?

A

Lamotrigine

421
Q

17 year old girl presents with a history of amenorrhoea, having never started her period. On further questioning she has developed secondary sexual characteristics, such as growth of breast tissue and pubic hair. She also complains of pelvic pain and some bloating.
Which of the following is likely to be the cause?

A

imperforate hymen

422
Q

if woman has 2 inadequate smears in a row - mx??

A

refer to colposcopy

423
Q

25yof ED. Severe abdo pain. Started suddenly 3 hrs ago. She has not had periods for 7wks, currently sexually active. Hx PID 5yrs ago. Abdo ex: generalised guarding and signs of peritonism. An urgent USS showed free fluid in the pouch of Douglas, empty uterine cavity. Urine βhCG was positive.
Suddenly became very ill. BP 85/50 mmHg, HR 122/min, RR 20/min, O2 sats 94%.
likely dx:

A

ruptured ectopic pregnncy

424
Q

Mx of sudden deterioration in ?ruptured ectopic?

A

urgent laparotomy

425
Q

HIV pregnancy - advice re breastfeeding?

A

do not do it

426
Q

Mx of a HIV pregnancy?

A

anti-retroviral tx throughout
vaginal delivery if viral load < 50copies/ml 36/40
CS if viral load higher
zidovudine infusion 4hrs pre CS
if VL<50, zidovudine PO to neonate/4-6wks
if higher VL, ART 4-6wks

427
Q

woman with IUS first 6/12 - commonest sfx:

A

irregular bleeding

428
Q

UTI in breastfeeding woman: which Abx safe?

A

trimethoprim

429
Q

CTG: terminal bradycardia:

A

fetal HR<100 for >10mins

430
Q

CTG: terminal deccelerations: what does this mean?

A

fetal HR drops and does not recover >3mins

431
Q

If see pre-terminal CTG findings - mx?

A

emergency CS

432
Q

clinical features of hypertension, vomiting and abdominal pain support the diagnosis of which obstetric condition?

A

HELLP

433
Q

? case of rubella in pregnancy - who should you contact?

A

local health protection unit

434
Q

Assuming the Pearl Index of the combined oral contraceptive pill is 0.2, how will you explain the failure rate of this form of contraception if used correctly?

A

For every 1000 women on this contraception for 1 year, 2 will become pregnant

435
Q

what results would the testing for downs show?

A 
thickened nuchal translucency 
high bHCG
low oestrodiol
low PAPPA
low AFP
436
Q

5th day post partum. ED. husband noticed abrupt change in behaviour. Confused and restless. MSE: describes racing thoughts, low mood and suicidal ideation. Pressurised speech is also evident. What is the most likely diagnosis?

A

puerperal psychosis

437
Q

differentiating between puerperal psychosis and post natal depression in terms of onset?

A

puerperal psychosis is first 3 weeks

PND is 1 months after - 3 months

438
Q

need for contraception after the menopause:

over 50:

A

12 months LMP

439
Q

need for contraception in menopaise:

Under 50

A

24 months LMP

440
Q

how long after partum can women get pregnant

A

21 days

441
Q

what happens to urine pregnancy test after TOP?

A

can remain positive for up to 4 weeks post-TOP

442
Q

if pregnancy test positive after 4 weeks since TOP, what does this indicate?

A

incomplete abortion or

persistent trophoblast

443
Q

if woman with hyperemesis gravidarum presents 12/40, severe with diplopia and ataxia - what is wrong and what needed for mx?

A 
wernicke's encephalopathy
IV pabrinex (vit b and c)
444
Q

28-year-old woman presents because she has not had a period for the past 9 months. She also describes fluid leaking from her nipples.

A

prolactinoma

445
Q

26-year-old woman presents 3 months after giving birth to her first child. During labour she had a large post-partum haemorrage. She did not breastfeed but has not had a period since.

A

sheehan’s

446
Q

25-year-old woman presents 5 months after having dilation and curettage for a miscarriage. Since this procedure she has not had a period. A pregnancy test is negative. Hysteroscopy is performed which reveals the diagnosis.

A

asherman’s

447
Q

best test to confirm ovulation?

A

progesterone

448
Q

PCOS criteria (3)

A

oligomenorrhoea
hyperandrogenism (high T)
polycystic ovaries on USS or increased ov volume

449
Q

how many criteria need fulfilling for PCOS dx:

A

2/3

450
Q

risk factors for cervical cancer:

A 
HPV
smoking
HIV
early first intercourse, many partners
high parity
lower social status
cocp
451
Q

mechanism of HPV causing cervical cancer?

A

HPV 16 & 18 produces the oncogenes E6 and E7 genes respectively
E6 inhibits the p53 tumour suppressor gene
E7 inhibits RB suppressor gene

452
Q

missed 1 cocp - action?

A

take 2 following day - no further action

453
Q

34-year-old woman from Zimbabwe presents with continuous dribbling incontinence after having her 2nd child. Apart from prolonged labour the woman denies any complications related to her pregnancies. She is normally fit and well.

A

vesicovaginal fistulae

Ix - urinary dye studies

454
Q

56-year-old lady reports incontinence mainly when walking the dog. A bladder diary is inconclusive.
Ix?

A

urodynamic studies

455
Q

what condition is CI of epidural analgesia in labour?

A

coagulopathy

456
Q

which oral hypoglycaemic drug during breastfeeding is safe?

A

metformin

457
Q

what is fetal fibronectin (ffn)?

A

protein releasaed from the gestational sac

458
Q

what does high Ffn indicate?

A

increased likelyhood of early labour

459
Q

step-wise mx DM in pregnancy?

A

metformin
+ insulin
glibenclamide (if can’t tolerate metformin)

460
Q

if at 25/40, high FFP, what is mx?

A

admit for 2xdoses IM steroids,
monitor BMs closely
adjust insulin pump accordingly

461
Q

if woman presents with baby blues, mx?

A

reassure, explain

462
Q

methods of contraception is most associated with delayed return to fertility?

A

depo-provera

463
Q

molar preg 8 weeks after her last menstrual period. She complains of severe nausea, vomiting and vaginal spotting. - bloods (bhcg, tsh, thyroxine)??

A

high bhcg,
low tsh
high thyroxine

464
Q

For women taking phenytoin,carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine:
UKMEC 3:

A

POP, COCP

465
Q

amenorrhoea, abdominal pain and vaginal bleeding in combination with shoulder tip pain suggesting peritoneal bleeding - dx?

A

ruptured ectopic

466
Q

miscarriage with evidence of infection or increased risk of haemorrhage - mx:

A

surgical mx

expectant inappropriate

467
Q

23-year-old woman complains of anorexia, vomiting, fever and abdominal pain. The pain was initially periumbilical but is now worse in the lower abdomen.

A

appendicitis

468
Q

28-year-old woman complains of a two year history of bad period pains which are not controlled by NSAIDs or the combined contraceptive pill. She also reports significant pains during intercourse.

A

endometriosis

pelvic pain, dysmenorrhoea, dyspareunia and subfertility

469
Q

31-year-old woman complains of intermittent pain in the left iliac fossa for the past 3 months. The pain is often worse during intercourse. She also reports urinary frequency and feeling bloated. There is no dysuria or change in her menstrual bleeding

A

ovarian cyst

470
Q

25-year-old woman is to have an elective laparoscopic cholecystectomy in 8 weeks time. She takes no medications other than the combined oral contraceptive pill. What should be done with regards to her pill and her upcoming surgery?

A

stop pill 4 weeks before and restart 2 weeks after

VTE risk

471
Q

COCP: If 2 pills are missed in week 1,

A

emergency contraception if she had unprotected sex during the pill-free interval or week 1 and then take 2 pills today then back to normal

472
Q

common cause of menorrhagia and abdominal pain in a menstruating female?

A

fibroids (leiomyoma)

473
Q

woman mentions to her midwife that she has been previously diagnosed with immune thrombocytopenic purpura (ITP). Which procedure carries the greatest risk of haemorrhage in the newborn?

A

prolonged ventouse delivery

474
Q

14-year-old daughter. She is concerned as her daughter has not yet started her periods although suffers cyclical pain.

A

imperforate hymen

475
Q

19-yo GP 14 weeks into her second pregnancy. Her pregnancy has been progressing normally so far, including a normal dating scan at 10 weeks.
She visited 24 hours ago due to excessive nausea and vomiting and was started on oral cyclizine 50mg TDS. However, she is still unable to tolerate any oral intake, including fluids. Her urine dip is positive for ketones.

What is the most appropriate next step?

A

admit for iv fluids

if wt loss or ketonuria admit

476
Q

fetal head: optimum position?

A

OA

477
Q

when will women experience earlier urge to push - oa or op head?

A

OP head

478
Q

first line non-hormonal tx for menorrhagia?

A

tranexamic acid

479
Q

cholestatic picture of liver function tests (LFTs) :

A

high ALP and GGT, with a lesser rise in ALT

480
Q

hepatic picture would be expected on LFTs, with a rise in ALT/AST greater than that of ALP, a raised white cell count and potential clotting abnormalities in which condition?

A

acute fatty liver of pregnancy

481
Q

vomiting, dry skin, tiredness and raised B-hCG may point towards

A

molar pregnancy

482
Q

classic finding on US in molar pregnancy:

A

Large for dates uterus

483
Q

only effective treatment for large fibroids causing problems with fertility is??

A

myomectomy if woman wants to conceive

484
Q

levonorgestrel: how long can wait for emergency contraception:

A

72 hours (96 but decreases over time)

485
Q

ulipristal acitate: how long can wait for emergency contraception:

A

120 hours

CI in asthma

486
Q

ov ca stage 1:

A

confined to ovary

487
Q

ov ca stage 2:

A

outside ovary but in pelvis

488
Q

ov ca stage 3:

A

outside pelvis but in abdo

489
Q

ov ca stage 4:

A

distant metastasis

490
Q

Ix: jaundice of pregnancy?

A

LFTs

491
Q

first line tx: dysmenorrhoea

A

NSAIDs

492
Q

which gene predisposes to ovarian cancer (especially if hx in 1 degree relatives)

A

BRCA1

493
Q

signs during a cardiac examination would not be considered normal and prompt referral for further evaluation?

A

pulmonary oedema

494
Q

in women above 50, which contraception should be stopped?

A

depo-provera

495
Q

layers of abdomen to get to fetus in CS:

A 
Superficial fascia
Deep fascia
Anterior rectus sheath
Rectus abdominis muscle (not cut, rather pushed laterally following incision of the linea alba)
Transversalis fascia
Extraperitoneal connective tissue
Peritoneum
Uterus
496
Q

15-year-old girl reports heavy menstrual bleeding since menarche when she was 14. When she was younger, she frequently suffered from heavy nosebleeds. What is the most important next step after normal examination and ultrasound? Ix?

A

coagulation screen

497
Q

moderate dyskaryosis:

A

urgent referral for colposcopy 2ww

498
Q

after 24 weeks how much should fundal height grow per week?

A

1cm

499
Q

when is combined test for downs done?

A

11-13.6 weeks

500
Q

if women present later than 14 weeks which downs antenatal tests should be done and when?

A

triple/quadruple tests - between 15-20 weeks

501
Q

when is CVS (downs) done in pregnancy?

A

11-14 weeks

<15 weeks

502
Q

when is amniocentesis testing done in pregnancy?

A

15-20 weeks

>15 weeks

503
Q

infertility investigations if looking for tubal patency?

A

hysterosalpingogram
laparoscopy
check BMI

504
Q

lifestyle mx infertility:

A

sex, stress, sleep, weight

505
Q

lab investigations for infertility:

A

progesterone 21/28
LH, FSH
semen analysis - if abnormal repeat 3/12

506
Q

how to measure gestational age in first trimester?

A

crown-rump length

507
Q

twin-twin transfusion more likely in which type of twins?

A

monozygotic, monochorionic, diamniotic

508
Q

placenta increta?

A

invasion of the myometrial wall (80%) - no further than the wall

509
Q

Herpes viral labia infection in pregnancy mx:

A

CS before term

510
Q

tx for white penile discharge:

A

PO azithromycin

511
Q

PCOS: mx:

A

weight loss first line!

512
Q

Normal birth weight:

A

2.5-4kg at term

513
Q

oligohydramnios definition:

A

AFI < 5 cm at term or below 5th percentile for gest age

514
Q

polyhydramnios definition:

A

defined sonographically as a total amniotic fluid volume >2 L, a single vertical pocket ≥10 cm, or an AFI >20 cm at term or >95th percentile for gestational age.

515
Q

Small for dates / gestational age: definition:

A

birth weight < 10th centile

severe < 3rd centile

516
Q

how is fetal small for dates measured?

A

Estimated fetal weight/abdo circumferance<10th centile

517
Q

IUGR definition:

A

pathological restricted genetic growth potential leading to oligohydramnios

518
Q

risk factors for IUGR:

A 
age>40
smoking
prev SGA
mat/pat SGA
prev stillbirth 
cocaine use
vigorous exercise in preg
DM/HTN
heavy bleeding
low PAPPA
519
Q

ix: IUGR?

A

USS - ratio of head circumferance:abdo circumferance

Also anatomical USS
infection screen

520
Q

if HC:AC symmetrical on USS - what does this indicate?

A

constitutional small baby

521
Q

If HC:AC asymmetrical on USS - what does this suggest?

A

placental insufficiency ->renal failure -> oligohydramnios

Due to ‘brain-sparing’ effect

522
Q

Mx: IUGR:

A

Uterine artery doppler - absent/reverse end-diastolic flow -> CS
Middle cerebral artery doppler - abnormal - induce by 37/40
Normal findings - induce at 37/40

523
Q

pre-eclampsia: treat above what BP?

A

160/110

severe over 170/110

524
Q

Large for dates/LGA:

A

weight, length, SFH or head circumferance >90th centile

525
Q

causes of Large for dates baby:

A 
obesity 
polyhydramnios 
DM
infection - cmv
previous LGA babies
genetic abnormalities/syndromes
526
Q

cx LGA baby:

A 
hypoglycaemia
polycythaemia
birth defects - shoulder dystocia 
malpresentation
lung problems
meconium aspiration
PPH
perinatal asphyxia 
low APGAR
527
Q

Ix: LGA?

A

Uterine ex
USS
UA doppler
TORCH screen

528
Q

failure to progress in labour:

A

<2cm dilation in 4 hours

arrested descent or protracted

529
Q

failure to progress in labour causes:

A

unborn baby can’t fit through mum’s pelvis
baby not in right position
weak contractions/too far apart
(Power passage passenger)

530
Q

treatment for failure to progress in labour?

A

ARM
Oxytocin
instrumental
C-S

531
Q

in failure to progress - factors that make you consider mode of delivery?

A

fetal distress

maternal risk

532
Q

effacement:

A

cervical ripening/thinness - NOT SAME AS DILATED

533
Q

what does meconium stained liqor indicate:

A

fetal distress (also increased risk of aspiration)

534
Q

malpresentation Ix:

A

USS

uterine examination

535
Q

if face or brow presentation - Mx?

A

CS

536
Q

Bishops score - what are you examining and where?

A 
vaginal exam:
effacement
position
consistency
dilation
537
Q

commonest cause of recurrent miscarriage in first trimester?

A

antiphospholipid syndrome

538
Q

absolute contraindication for vaginal delivery following previous cesarean section?

A

vertical (classical) CS scar

539
Q

mx for vaginal vault prolapse?

A

sacrocolpopexy

540
Q

27 year-old lady is day 1 post emergency caesarean section for failure to progress in the first stage. She has been complaining of pain and heavy vaginal bleeding since delivery and in the morning was noted to have heavy, offensive lochia and a boggy poorly contracted uterus above the umbilicus.

A

retained products - examine under anaesthesia

541
Q

ovarian torsion can show what on USS?

A

whirlpool sign

542
Q

Intrahepatic cholestasis of pregnancy planning?

A

induction of labour at 37/40

543
Q

At which week should you refer to an obstetrician for lack of fetal movements??

A

24/40

544
Q

cervical ca FIGO stage 1a mx?

A

cone biopsy with follow up if they wish to maintain fertility
hysterectomy +/- LN clearance option but infertile

545
Q

HRT most likely to cause breast cancer?

A

Combined HRT

adding a progestogen increases breast cancer risk

546
Q

Chickenpox exposure in pregnancy > 20 weeks (if not immune):

A

antivirals or VZIG should be given within 7-14/7 post-exposure

547
Q

If after 28/40 weeks, if a woman reports reduced fetal movements and no heart is detected with handheld Doppler- next step?

A

USS scan

548
Q

patients with secondary dysmenorrhoea?

A

refer all to gynae

pelvic inflammatory disease, endometriosis, adenomyosis, and fibroids

549
Q

Cervical cancer screening: if smear inadequate then?

A

repeat within 3/12

550
Q

When investigating suspected PPROM, if there is no fluid in the posterior vaginal vault on speculum exam then?

A

USS for oligohydramnios

551
Q

Management of placental abruption when the fetus is alive, <36 weeks and not showing signs of distress?

A

admit and give steroids

552
Q

PCOS ix: gHs?

A

normogonadotropic normoestrogenic anovulation

553
Q

CI for depo-provera injectable prog only pill?

A

current breast cancer

554
Q

If at the time of diagnosis of gestational diabetes, the fasting glucose level is >= 7 mmol/l immediate?

A

insulin +/- metformin should be started

can also dx GDM if 2h glucose >7.7

555
Q

Pregnant women ≥ 20 weeks who develop chickenpox are generally treated how if present in <24h OF rash?

A

oral aciclovir

556
Q

Premenstrual syndrome: mx?

A

new generation COCP - drospirenone containing COCP continuous
or SSRI either continuously or during luteal phase

557
Q

For transgender males, testosterone therapy does not provide protection against pregnancy - mx?

A

copper IUD

- CI in menorrhagia

558
Q

ix of choice first line in ?ectopic?

A

transvaginal uss

559
Q

A 34-year-old woman presents to the GP asking about contraception. She is 4 weeks post-partum. When is lactational amenorrhoea a reliable form of contraception?

A

amenorrhoeic, baby <6/12, breastfeeding exclusively

560
Q

If a breastfed baby loses > 10% of birth weight in the first week of life then?

A

refer to midwife-led breastfeeding clinic

561
Q

The recurrence rate of postnatal psychosis is?

A

25-50%

562
Q

Women who have a positive pregnancy test and either abdominal, pelvic or cervical motion tenderness should

A

refer immediately to early pregnancy assessment unit

563
Q

HRT with lowest VTE risk?

A

transdermal

564
Q

If a patient vomits within 3 hours of taking the levonorgestrel>

A

take a second dose

565
Q

For patients assigned male at birth treated with oestradiol, GNRH analogs, finasteride or cyproterone, contraception mx?

A

barrier - cannot be 100% sure

566
Q

from down’s combined screening - which 2 syndromes give similar results?

A

Edward’s (tri 18) and Patau’s (tri 13)

PAPPA tends to be lower than downs

567
Q

emergency contraception if it is inserted within 5 days of UPSI, or up to 5 days after the likely ovulation date.???

A

copper IUD

568
Q

A 32-year-old female requests emergency contraception. She had unprotected sexual intercourse 28 hours ago and is not using any regular contraception. She has a diagnosis of obesity, severe asthma and uterine fibroids with distortion of the uterine cavity. mx?

A

levonorgestrel - double dose

double dose if BMI>26 / wt>70kg

569
Q

if abnormal exam findings, pelvic pain, intermenstrual or postcoital bleeding- ix?

A

TVUSS

570
Q

safest contraception in BRCA carrier?

A

copper IUD

571
Q

48F perimenopausal symptoms. Apart from suffering from migraines with aura, she does not have any relevant medical history. She has a family history of deep vein thrombosis (DVT). The patient’s last menstrual periods are irregular, the last one being 3 months ago. She is not currently on any contraception.
tx?

A

topical combined cyclical HRT

572
Q

A 49-year-old patient presents with hot flushes and mood swings. She has no previous medical history or family history. She has been amenorrheic since her Mirena (levonorgestrel) coil was placed 2 years ago. She would like to consider HRT with the least side effects. tx?

A

oestrogen patch

573
Q

Pregnant women who are < 6 weeks gestation and present with vaginal bleeding and no pain - mx?

A

expectantly
retake preg test in 7 days - if negative = miscarriage
if + or continued sx -> EPAU

574
Q

If two pills are missed, between days 8-14 of the cycle,??

A

no emergency contraception required as long as 7 pills previously taken correctly
7 days of additional precaution

575
Q

28F hirsutism affecting her face, upper arms and chest. It is affecting her self-esteem and she is keen on further treatment for this symptom. She also has irregular menstrual cycles which vary between 19 and 45 days in length. She has no other medical problems and does not smoke. She has a BMI of 29 kg/m2 and blood pressure of 136/88 mmHg. Her HbA1c is normal. She does not wish to get pregnant at this time. rx?

A

COCP

576
Q

A 35-year-old woman has irregular periods, acne and hirsutism. She has also been trying to conceive with her partner for 6 months but has been unsuccessful. A pelvic ultrasound scan has confirmed the presence of polycystic ovaries. She has tried losing weight and her current BMI is 28 kg/m2. Her HbA1c is normal.
mx?

A

refer to fertility services

577
Q

Maria, a 33-year-old woman, attends the infertility clinic after failing to conceive naturally for the last 18 months. Investigations have diagnosed her with polycystic ovarian syndrome (PCOS) and she would like to discuss initial options for managing her infertility.
tx?

A

letrozole first line to stimulate ovulation

578
Q

Increased risk of placental abruption is associated with>

A

age, multiparity, maternal trauma

3a (7 decks)

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