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MCCQE1 > Obstetrics & Gynaecology > Flashcards

Obstetrics & Gynaecology Flashcards

1
Q

Treating Herpes Simplex, including pregnant and immunocompromised pts

A

Acyclovir 400mg TDS 7-10d first ep, 3-4 days recurrent episodes.

Fine in pregnancy.

Valcyclovir- more expensive. Both reduce viral shedding. Reduce symptoms. Also shorten viral excretion time and the duration of illness.

Immunocompromised pts require IV acyclovir

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2
Q

Complications of PCOS

A
  • NIDDM
  • Endometrial cancer
  • Nonalcoholic steatohepatitis
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3
Q

Maternal and fetal complications of shoulder dystocia

A

Fetal

1) hypoxic ischaemic encephalopathy (chest compression by vagina or cord compression by pelvis can lead to hypoxia)
2) brachial plexus injury (Erb’s palsy: C5-C7; Klumpke’s palsy: C8-T1), 90% resolve within 6 mo
3) fracture (clavicle, humerus, and cervical spine)
4) death

Maternal

1) perineal injury
2) PPH (uterine atony)

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4
Q

The window for antenatal treatment with corticosteroids

A

23-34 weeks

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5
Q

Risk factors for ovarian torsion

A
  • Women of repro age in 20s and 30s
  • Pregnancy
  • Anything involving induction of ovulation
  • Ovarian tumours (benign) (usually dermoid cysts)
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6
Q

Management of endometrial polyps

A

dx: pelvic ultrasound and treatment is d/c + bx to exclude cancer

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7
Q

Risk factors for amniotic fluid embolus

A

placental abruption

rapid labour

multiparity

uterine rupture

uterine manipulation

induction medication and procedures

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8
Q

Endometrial cancer risk factors

A
  • Oestrogen exposure
  • Nulliparity (2-3x increase)
  • Early menarche Late menopause
  • Unopposed menopausal oestrogen use
  • PCOS (relative risk of 3)
  • Diabetes
  • Oestrogen producing ovarian tumours
  • Obesity (2-3x increase in risk)
  • High doses of tamoxifen
  • Hypertension
  • Thyroid disease
  • Gallbladder disease
  • Caucasian
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9
Q

Management of placenta previa

A

Two categories of management: Not ready to deliver eg fetal immaturity. Stabilise the patient. Give a tocolytic to suppress labour. It buys time. Then give corticosteroids to promote fetal lung development. Deliver by caesarean if you have mature lungs. Fetal distress is a good reason.

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10
Q

How to treat acute pyelonephritis in pregnancy

A

Acute pyelonephritis in pregnancy is treated in hospital with ivabx (Ceftriaxone) until the pt is afebrile for 24-48h and symptomatically improved

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11
Q

Complications of uterine rupture

A

Maternal death 1-10%

1) maternal hemorrhage, shock, DIC
2) amniotic fluid embolus
3) hysterectomy if uncontrollable hemorrhage
4) fetal distress, associated with infant mortality as high as 15%

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12
Q

Shoulder dystocia- risk to fetus of long term disability

A

1%

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13
Q

Name a specific maternal contraindication to antenatal corticosteroids

A

Active TB

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14
Q

atrophic vaginitis tx

A

topical estrogen

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15
Q

Gardnerella vaginalis is the cause of what? And with which other organism is it commonly associated?

A

Bacterial vaginosis

Associated frequently with Mycoplasma Hominis

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16
Q

Management of seizures in eclampsia

A

Loading dose of magnesium sulphate 4-6g followed by an infusion 2g/hr.

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17
Q

Treatment of endometritis

A

Tx clindamycin + gentamicin

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18
Q

Complications of bacterial vaginosis

A
  • second and third trimester premature labour and birth
  • Post natal endometritis
  • Sometimes PID
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19
Q

Risk factors for placental abruption

A
  • Trauma
  • Cocaine
  • Polyhydramnios
  • Chronic hypertension
  • Pre-eclampsia Eclampsia
  • PROM- prolonged
  • Chorioamnionitis
  • Previous ischaemic placental disease (IUGR)
  • Maternal age
  • Parity
  • Smoking
  • Male infant
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20
Q

Name the condition:

Agalactorrhea, post-partum amenorrhea, secondary hypothyroidism, adrenalinsufficiency

A

Sheehan’s syndrome

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21
Q

Definition of post partum haemorrhage

A

Blood loss >500mls after the third stage of labour

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22
Q

Name the most common STI in Canada

A

Chlamydia

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23
Q

Indications for the induction of labour

A

Pre-eclampsia

Bad fetal signs

Placental abruption

Preg is 42w or more

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24
Q

Sites of endometriosis

A

Ovaries 60%

Broad ligament

Vesicoperitoneal fold

Cul de sac

Rectosigmoid colon + appendix

Also reported in liver, brain, lung & old scars

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25
Q

Physical examination in endometriosis

A

Physical exam: uterosacral nodularity on rectovaginal exam, fixed retroverted uterus

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26
Q

The drug of choice for chlamydia when a) not pregnant b) pregnant

A

a) Doxycycline b) Azithromycin

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27
Q

Definitive diagnosis of endometriosis

A

Laparoscopy

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28
Q

Drug of choice to reduce blood pressure in eclampsia

A

Labetolol

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29
Q

Defining characteristics of pre-term labour

A

Regular contractions (2 in 10 mins)

cervix >2cm

>80% effaced prior to term (20-37w)

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30
Q

What is colpitis macularis (strawberry cervix) associated with?

A

Trichomonas infection

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31
Q

Risk factors for placenta previa

A
  • Mutiparity
  • Prior caesarian
  • Fibroids + uterine abnormalities
  • Smoking + cocaine use
  • Multifetal pregnancy
  • Advanced maternal age
  • Infertility Rx
  • Previous uterine surgery
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32
Q

Management of uncomplicated UTI in pregnancy

A

First line: amoxicillin (250-500 mg PO q8h x 7 d)

alternatives: nitrofurantoin (100 mg PO bid x 7 d) or cephalosporins follow with monthly urine cultures

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33
Q

Treatment of syphilis

A

Penicillin G 2.4 million IU IM x 1 dose if early syphilis

(3 doses if late syphilis)

Monitor VDRL monthly

If penicillin G allergic: clindamycin 900 mg IV q8h

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34
Q

What is the significance of acanthosis nigricans?

A

It indicates insulin resistance

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35
Q

What’s the drug of choice for trichomoniasis?

A

Metronidazole

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36
Q

Indications to hospitalise a patient with pelvic inflammatory disease

A

Pregnant

Lack of response or tolerance of oral meds

Can’t take oral meds/ vomiting

Severe illness

Pelvic abscess incl tubo-ovarian abscess

Non-compliance

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37
Q

Complications of placenta previa

A

Placenta accreta. It attaches to the myometrium.

Placenta increta- invades the myometrium

Placenta percreta- perforates the myometrium

Pre-term delivery

IUGR

Prem rupture of membranes

Congenital anomalies

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38
Q

Contraindications to medically managing an ectopic pregnancy

A
  • Hemodynamically unstable
  • Signs of impending or actual ectopic mass rupture
  • Size larger than 3.5cm or fetal heart rate activity
  • Immunodeficiency, active pulmonary disease, peptic ulcer disease
  • Coexisting intrauterine pregnancy
  • Non-compliance risk
  • Breast-feeding
  • Hypersensitivity to methotrexate
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39
Q

Chlamydia complications

A
  • PID
  • Infertility
  • Ectopics
  • Reactive arthritis
  • Perinatal infection
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40
Q

Investigation of choice for suspected ovarian torsion

A

Do a transvaginal and abdominal US as a first measure Differentiate it from a ruptured ovarian cyst by the absence of peritoneal fluid on US

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41
Q

Chancroid organism

A

Haemophilus ducreyi

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42
Q

Causes of postpartum haemorrhage

A

The four Ts

Uterine atony- loss of strength of uterine muscle causes failure of contraction and retraction of the uterus. Caused by over distended uterus - fetal macrosomia, twins etc. Most common cause of PPH

Tissue- placenta not properly expelled after delivery

Trauma- during delivery. Incl uterine rupture

Thrombosis. Ay kind. Eg thrombocytopenia, low platelets

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43
Q

Ectopic pregnancy risk factors

A
  • Age >35
  • Prev ectopic (15% chance of recurrence)
  • Hx PID (scarring fallopian tube)
  • Tubal pathology and surgery
  • IUD
  • Multiple sexual partners (dt risk of PID)
  • Smoking due to impaired immunity in smokers
  • Prior induced abortion
  • In utero diethylstilbestrol exposure
  • Infertility (tubal abnormalities)
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44
Q

Management of mild and moderate placental abruption at term

A

Mild- You can try a vaginal delivery if there is no fetal compromise Moderate- deliver urgently regardless of gestational age

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45
Q

Diagnosis of PCOS

A

The Rotterdam criteria, 2/3

Oligomenorrhoea/irreg periods for 6m

Hyperandrogenism

Polycystic ovaries on US

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46
Q

The AMSEL criteria for diagnosis of bacterial vaginosis

A

Whiff test (fishy odour KOH) and clue cells.

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47
Q

Cause of pain associated with fibroids

A

fibroid outgrows blood supply

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48
Q

Typical presentation of endometrial polyps

A

vaginal bleeding between periods

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49
Q

Definition of uterine hyperstimulation

A

Defined as contractions that are 2mins in length or less.

So more than 5 in ten minutes

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50
Q

Diagnosis and treatment of chancroid

A

Dx “school of fish” on Gram stain → Tx azithromycin or ceftriaxone

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51
Q

Breastfeeding contraindications

A

Active herpetic breast lesions

Active TB

Untreated brucellosis

After radioactive isotopes

Chemotherapy

Recreational drugs

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52
Q

Causes of vulvar/ vaginal itching

A
  1. Bacterial vaginosis
  2. Vaginal/vulvar candidiasis
  3. Trichomonas vaginalis
  4. Chemical vaginitis
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53
Q

Commonest sites of ectopic pregnancies

A

ampullary (70%), isthmic (12%), fimbrial (11%)

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54
Q

Any woman presenting with abdominal pain, vaginal bleeding and amenorrhea is what until proven otherwise?

A

An ectopic pregnancy

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55
Q

Teratogenic antibiotics

A

Tetracyclines Fluoroquinolones Aminogylcasides Sulfonamides

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56
Q

A patient failing to lactate after a delivery with heavy blood loss

A

Sheehan syndrome

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57
Q

Uterine bleeding at 18 weeks. No products expelled. Os is open.

A

Inevitable abortion

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58
Q

Uterine bleeding at 18 weeks. No products expelled. Os is closed.

A

Threatened abortion

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59
Q

Most common cause of amenorrhea

A

Pregnancy

60
Q

The term for heavy bleeding during and between menstrual periods

A

Menometrorrhagia

61
Q

Therapy for PCOS

A

Weight Loss and OCPs. Consider metformin.

62
Q

Laparoscopic findings in endometriosis

A

Powder burns and chocolate cysts

63
Q

Most common location for an ectopic pregnancy

A

The AMPULLA of the oviduct

64
Q

Patient has increased vaginal discharge and petechial patches in the upper vagina and cervix

A

Trichomonal vaginitis

65
Q

Most common cause of bloody nipple discharge

A

intraductal papilloma

66
Q

Breast malignancy presenting as itching, burning and erosion of the nipple

A

Paget disease

67
Q

Annual screening for women with a strong family Hx of ovarian cancer

A

CA-125 and transvaginal ultrasonography

68
Q

Non-surgical options for stress incontinence

A

Kegel exercises

Estrogen

Pessaries for stress incontinence

69
Q

Lab values suggestive of menopause

A

Increased FSH

70
Q

Most common cause of female infertility

A
  1. Ovulation disorders
  2. Endometriosis
71
Q

Molar pregnancy containing fetal tissue

A

Partial mole

72
Q

Typical Abx for GBS prophylaxis

A

IV penicillin or ampicillin

73
Q

Investigation of choice in a woman w postmenopausal bleeding

A

Hysteroscopy. Not US

74
Q

Difference between a total and a radical hysterectomy

A

A total hysterectomy removes the whole uterus and cervix.

In a radical hysterectomy, a surgeon removes the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina. Radical hysterectomy is generally only done when cancer is present.

75
Q

Rx if endometrial cancer is confined to the uterus:

A

Total extrafascial abdominal hysterectomy w bilateral salpingo-oophorectomy + pelvic + para-aortic LN dissection, with CA-125 as a marker for F/U

76
Q

Rx if endometrial cancer is beyond stage II

A

Hysterectomy, bilateral slapingo-oophorectomy, and if it’s stage II or greater do radiotherapy

77
Q

Rx for a vaginal recurrence of endometrial cancer

A

Transvaginal brachytherapy

78
Q

First line treatment abnormal uterine bleeding

A

Ibuprofen

Fibrinolytics

COCP (but not in a smoker >35, thromboembolism). Note that oestrogen therapy on it’s own would make it worse

Progestins on days 10-14

Mirena coil

Danazil

79
Q

Causes of post-coital bleeding

A

Cervical malignancy (squamous cell 95%, adeno 5%)

Polyps

Vaginal atrophy

80
Q

Clinical examination findings in endometriosis

A

Fixed, retroverted uterus, nodular ligaments, firm adnexal mass (endometrioma)

81
Q

Sites of endometriosis (in descending order)

A
  1. Ovaries 60%
  2. Broad ligament
  3. Vesicoperitoneal fold
  4. Cul de sac
  5. Rectosigmoid colon + appendix
  6. Also reported in liver, brain, lung + old scars
82
Q

Treatment options for endometriosis

A

NSAIDs for mild sx

OCPs help the vast majority by preventing ovulation which leads to thinning of the endometrium

GnRH agonist- Leuprolide (US: Lupron), suppresses O production

Excision directly or by lasers to preserve fertility

Hysterectomy

83
Q

Initial work up PCOS

A

Serum testosterone

Prolactin

17-OH progesterone

17 hydroxyprogesterone

17 OHP LH, FSH, oestradiol DHEAS TSH

84
Q

Effect of pregnancy on thyroid hormones

A

Total T4 ↑bcs of ↑ THBG

85
Q

Effect of pregnancy on creatinine

A

Creatinine ↓bcs of the increased GFR

86
Q

Effect of pregnancy on GFR

A

GFR ↑ by 50%, this can lead to glycosuria which is not abnormal

87
Q

The cure for eclampsia

A

Delivery

88
Q

Risk of eclampsia in future pregnancies

A

Increased risk in future pregs, 25-50% increase in risk

Higher future risk if you have it at less than 34w gestation, or another preg <2 or >10y

89
Q

Should a woman with Hep B breastfeed

A

Yes apparently benefits outweigh risks

90
Q

Rx for hot flashes of menopause

A

SSRIs. Fluoxetine, paroxetine, sertraline. Also SNRIs- venlafaxine

91
Q

Herpes simplex- what kind of virus?

A

Large DNA virus

92
Q

Painless red vaginal bleeding in pregnancy which stops spontaneously w a soft non tender uterus.

A

Placenta previa

93
Q

Typical timing of placenta previa

A

After 20w, usu 29/30 weeks

94
Q

Management of painless red vaginal bleeding in pregnancy which stops spontaneously w a soft non tender uterus, presenting at 20 weeks

A

If someone presents early arrange a US between 28-36w to determine placental location. In the absence of any other comps you don’t need to keep repeating the sonography.

95
Q

Pregnant woman with Pain Vaginal bleeding (but bleeding might be concealed) Uterine hypertonus

A

Placental abruption

96
Q

Placental abruption- diagnosis

A

Clinical

97
Q

Management of placenta accreta

A

Hysterectomy

98
Q

Lower abdo pain, adnexal tenderness, cervical motion tenderness, not pregnant

A

PID

99
Q

Turner’s syndrome abnormal lab tests

A

Gonadal dysgenesis will result in low oestrogen. FSH & LH increase oestrogen. These will both be high in Turner’s syndrome.

100
Q

Treatment for Turner’s syndrome to achieve adult height

A

Early Rx w GH is the DOC for helping pmts gain adult height. Giving oestrogen too early can lead to closure of epiphyseal plates so this starts at 12

101
Q

80% of pyelonephritis is caused by which bug

A

E Coli

102
Q

What’s different about the pain from appendicitis vs ovarian torsion?

A

The latter is sudden onset

103
Q

Diagnosis of gonorrhoea

A

Urethral discharge - culture + gram stain.

Characteristic gram - diplococci

Nucleic acid amplification test (NAAT)

104
Q

Diagnosis of chlamydia

A

Tissue culture. You can’t see it on a gram stain

105
Q

Complications of shoulder dystocia

A

hypoxic ischemic encephalopathy (chest compression by vagina or cord compression by pelvis can lead to hypoxia)

brachial plexus injury (Erb’s palsy: C5-C7; Klumpke’s palsy: C8-T1), 90% resolve within 6 mo

fracture (clavicle, humerus, and cervical spine)

death

106
Q

Antiretroviral triple therapy in pregnancy reduces HIV transmission to what?

A

reduces transmission to <1%

107
Q

First line Rx UTI of pregnancy

A

First line: amoxicillin (250-500 mg PO q8h x 7 d)

108
Q

Pre-term labour- purpose of tocolytics

A

The primary purpose of tocolytic therapy is to delay delivery for 48 hours to allow the maximum benefit of glucocorticoids to decrease the incidence of RDS.

109
Q

Do tocolytics delay delivery?

A

No

110
Q

Maternal contraindications to tocolysis

A
  • Bleeding (placenta previa or abruption)
  • maternal disease (HTN, DM, heart disease)
  • preeclampsia or eclampsia,
  • chorioamnionitis
111
Q

Fetal contraindications to tocolysis

A
  • erythroblastosis fetalis
  • severe congenital anomalies
  • fetal distress/demise
  • IUGR
  • multiple gestation (relative)
112
Q

Antenatal ultrasound (fetal biophysical profile)- what it looks at

A

Fetal breathing: considered abnormal if there is absent breathing or no breathing episode for ≥20 seconds within a 30 minute lapse

Fetal tone: considered abnormal if there is slow extension with return to partial flexion or absent fetal movement

Fetal movement (gross body movement): considered abnormal if there is <2 episodes of body/limb movements within a 30 minute lapse

Amniotic fluid volume: considered abnormal if the largest pocket is <2 x 2 cm

113
Q

Absolute contras to the COCP

A

< 6 wks postpartum

  • smoker > 35 (>15 cigs day)
  • hypertension
  • current or past hx of venous thromboembolism (VTE)
  • ischemic heart disease
  • hx of cerebrovascular accident
  • complicated valvular heart disease (pulmonary –hypertension, AF, hx subacute bact endocarditis)
  • migraine headache w focal neurology
  • breast cancer (current)
  • diabetes with retinopathy/nephropathy/neuropathy
  • severe cirrhosis
  • liver tumour (adenoma or hepatoma)
114
Q

Sacral backache with menses and deep dyspareunia

A

Endometriosis

115
Q

Commonest cause of pregnancy loss in a) the first trimester b) the second trimester

A

a) chromosomal abnormality
b) cervical insufficiency, often secondary to a hx of cervical trauma

116
Q

Natural history of genital warts

A

50% disappear in four months without Rx, and 75% in 2 years they recur with treatment

117
Q

Rx for genital warts with the lowest rate of recurrence

A

Surgical excision

118
Q

Causes of galactorrhea

A
  • Hypothalamic or infundibular lesions
  • Tumors Craniopharyngioma Germinoma Meningioma
  • Infiltrative disorders Histiocytosis Sarcoidosis
  • Rathke’s cleft cysts
  • Pituitary lesions Prolactinoma Acromegaly
  • Breast surgery
  • Burns
  • Herpes zoster
  • Spinal cord injury
  • Trauma
  • Hypothyroidism
  • Renal insufficiency
  • Medication-induced hyperprolactinemia
  • Idiopathic hyperprolactinemia
119
Q

The risk factor for endometrial cancer with the highest relative risk

A

Postmenopausal estrogen (2-10)

PCOS next (3)

120
Q

What are the two types of hydatidiform mole and how do they differ?

A

Complete. Contains no fetal tissue, it is made of abnormal placental tissue. They are DIPLOID (androgenic 46XX or biparental 46XY)

Incomplete, contains fetal tissue, the placenta grows abnormally into molar tissue. They are triploid 69XXX or 69XXY

121
Q

Contraceptive effects of levonorgestrel IUD (Mirena)

A
  • Mucous thickening preventing sperm entering uterus
  • inhibits sperm motility
  • sometimes prevents ovulation
122
Q

The most likely cause of postpartum fever after caesarian delivery

A

Endometritis.

Usually day 2.

Fever, foul smelling discharge, leukocytosis

123
Q

What is lochia?

A

The vaginal discharge in the puerperal period. Lasts 4-6 weeks, not offensive smelling.

124
Q

Mechanism of action of a copper IUD

A

Spermicidal environment

125
Q

Management of uterine inversion

A
  1. The Johnson manœuvre- fist to reposition uterus
  2. Hydrostatic reduction (following sublingual GTN)- with warm saline (the O’Sullivan technique)
126
Q

Young woman with aysmptomatic small ovarian cyst <5cm- management

A

Repeat US 12 weeks

127
Q

Factors associated with poor outcome in TOLAC (trial of labour after caesarian)

A

High BMI >40

Hx or 2 or more caesarians

>35 years maternal age

Fetus >4kg

Induction of labour

128
Q

Preferred anticoagulant for venous thrombosis a) in pregnancy b) breastfeeding

A

a) LMW heparin b) Warfarin

129
Q

Single most important risk factor for endometritis

A

Caesarian section

130
Q

The Pap smear is better at detecting which type of cervical cancer?

A

Squamous > adeno

131
Q

When does the Canadian cervical screening programme start?

A

Age 25 for women with a hx of sexual activity, with three yearly smears

132
Q

Higher rates of cervical metaplasia are associated with which types of HPV?

A

HPV 16 and 18

133
Q

At risk groups for cervical cancer in Canada

A

immigrant Canadians

First Nations Canadians

geographically-isolated Canadians

sex-trade workers l

ow socioeconomic status Canadians

134
Q

Low-grade squamous intraepithelial lesion (LSIL)- potential options

A

Colposcopy or repeat cytology in 6/12 (if negative, repeat again in 6/12, if negative for a second time revert to routine 3 yearly screening)

135
Q

High-grade squamous intraepithelial lesion (HSIL)- potential options

A

Colposcopy

136
Q

The Jarisch–Herxheimer reaction is traditionally associated with what?

A

Treatment of syphilis

137
Q

What is The Jarisch–Herxheimer reaction?

A

It occurs after initiation of antibacterials when treating Gram-negative infections such as E coli, syphilis and louse- and tick-borne infections. It usually manifests 1–3 hours after the first dose of Abx as fever, chills, rigor, hypotension, headache, tachycardia, hyperventilation, vasodilation with flushing, myalgia (muscle pain), exacerbation of skin lesions and anxiety. The intensity of the reaction indicates the severity of inflammation. Reaction commonly occurs within two hours of drug administration, but is usually self-limiting.

138
Q

Management of transverse lie in labour

A

Emergency caesarian section

139
Q

Definition of prolonged PROM

A

24 hours

140
Q

Definition of retained placenta

A

Failure to deliver the placenta within 30 minutes of birth

141
Q

Management of molar pregnancy associated hyperthyroidism

A

It usually resolves with the treatment of the gestational trophoblastic disease. Some pts will require antithyroid medication. Tachycardia and hypertension can be managed with propranolol ***

142
Q

Management options for missed, incomplete or inevitable abortion

A

Expectant- wait, F/U with US, serial beta-hcgs

Medical- mifeprostone followed by misoprostol or misoprostol alone

Surgical- D+C

***

143
Q

Sudden frop in fetal heart rate during premature labour after PROM at 32 weeks. Fetus is in transverse lie. What is most likely cause?

A

Cord prolapse.

Should be considered with any sudden drop in fetal heart rate or sudden change in the fetal trace. It is most common in preterm pregnancies where there is unstable lie and spontaneous ROM has occurred.

***

144
Q

Breastfeeding when HIV+?

A

No

***

145
Q

Signs of magnesium sulphate toxicity

A

Loss of patellar tendon reflexes

Hot/ flushed

Muscular paralysis

Respiratory depression

Death

***

MCCQE1 (20 decks)

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