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MRCOG part 1 > CLINICAL MANAGEMENT > Flashcards

CLINICAL MANAGEMENT Flashcards

1
Q

Incidence of choriocarcinoma in the UK

A

1 in 50,000 pregnancies

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2
Q

How many pregnancies are twins?
How many of special care inits are twin babies?

A

3%

15%

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3
Q

How many twins are born <37 weeks and <32 weeks?

A

50%

10%

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4
Q

Is there evidence for cervical cerclage or progesterone to prevent pre-term delivery

A

NO

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5
Q

What is perinatal mortality like for twins in comparison to non-twin babies

A

3 times greater perinatal mortality

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6
Q

What type of drug is clavulinic acid

A

beta-lactamase inhibitor. Without this a lot of penicillins can be broken down by beta-lactamase.

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7
Q

Which anti-epileptic drugs are STRONG/mild inducers of cytochrome P450

A

STRONG:

phenytoin
carbamazepine
phenobarbital

MILD:

topiramate

NO EFFECT:

sodium valproate
lamotrigine
keppra
pregabalin/gabapentin
benzos

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8
Q

What are the changes in the blood during pregnancy?

A

Increased coagulability
Reduced platelets
Increased fibrinogen
Increased ESR

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9
Q

What is the leading cause of direct maternal death in pregnancy

A

PE

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10
Q

What is the leading cause of indirect maternal death in pregnancy?

A

Cardiovascular disease.

BIGGEST CAUSE OVER ALL. Accounts for >25%

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11
Q

What is the incidence of PE in pregnancy?

absolute risk?

A

1.3/1000

1-2/1000

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12
Q

How much of VTE in pregnancy is PE vs DVT

A

PE = 10-20%, the rest are DVT

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13
Q

If you are pregnant vs non-pregnant, how much more likely to get a VTE are you?

A

4-6 times more likely

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14
Q

How many women who get a VTE in pregnancy have an inherited thrombophilia?

A

40%

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15
Q

Which anti-epileptic has the worst teratogenic profile. Especially in which trimester?

A

sodium valproate

First trimester

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16
Q

How many pregnancies does gestational diabetes occur in?

A

2-5% of all pregnancies

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17
Q

If a patient has had chemo - when can she start to try and conceive agin?

A

After 1 year

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18
Q

Give the percentages of how likely the following would progress into cancer:
endometrial hyperplasia without atypia (simple and complex)

with atypia

A

Without overall - <5%

Simple EH without atypia 1%

Complex EH without atypia 4%

WITH atypia = 40%

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19
Q

Risk factors for endometrial Ca

A

obesity
prolonged oestrogen - early menarchy, late menopause, unopposed oestrogen HRT
nulliparity
PCOS
tamoxifen
Immunosuppression

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20
Q

For EH without atypia: how is it treated? Surveillance?

A

Progestogens:

IUS first line. Oral alternative but not as good.

Conservative treatment means less liekly to regress

surveillance = every 6 months

Can do hysterectomy if treatment doesn’t work

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21
Q

What to do is patients with EH with atypia decline surgery

A

can do IUS/progesterone PO

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22
Q

Which infections do we screen for antenatally

A

hepB
HIV
syphilis

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23
Q

In whom is cell salvage recommended

A

where >1500ml blood loss is anticipated

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24
Q

In whom is recombinant EPO recommended

A

end-stage renal failure

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25
Q

How to manage a non-haematinic deficiency anaemia in pregnancy

A

transfusion.

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26
Q

How long can patients with PCOS be treated with clomifene

A

max 6 months

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27
Q

What are the grades of ovulation disorders?

A

1 = stress, low BMI, high exercise

2 = PCOS

3 = ovarian failure

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28
Q

How is ovulation disorder 1 managed?

A

Reduce exercise, BMI >19, can pulse gonadotrophins with LH surge

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29
Q

How is ovulation disorder 2 managed?

A

First line = clomifene or metformin or both

Second line = laparoscopic drilling, gonadotrophins

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30
Q

How is ovulation disorder 3 managed?

A

IVF with egg donation

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31
Q

What is the diagnostic criteria for GDM

A

Fasting glucose = >5.6
2 hour glucose = >7.8

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32
Q

What is the advice regarding hba1c for those planning to get pregnant

A

aim for <48

if >86 - pregnancy not advised!!

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33
Q

Which contraceptive pill can be used for acne?

A

Needs to be combined.

Should aim to be anti-androgenic rather than androgenic.

Norethisterone = ANDROGENIC

ethinylestradiol is the oestrogen.

A good choice would be ethinylestradiol/desogestrel

desogestrel is what is in the POP cerazette

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34
Q

What are the MC criteria for COCP?

A

MEC 1 = no restriction
MEC 4 = absolute contraindication

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35
Q

Give examples of MEC 4 criteria for COCP

A

BMI >35
Age >35 and active smoker >15/day
Current breast Ca
Previous VTE
<6 weeks postpartum (breast feeding)
<3 weeks post-partum (not breastfeeding)
Systolic BP >160
Diastolic BP >100
Stroke
IHD
Vascular surgery
Significant cadio abnormalities eg ToF
Cardiomyopathy with impaired cardiac function
Positive antiphospholidid antibodies
Abnormal clotting e.g. factor 5 leiden
Hepatocellular carcinoma
Migraine with aura
AF

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36
Q

What stimulates milk ejection in response to suckling

A

oxytocin

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37
Q

what maintains galactopoesis

A

prolactin

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38
Q

What stimulates lactogenesis

A

prolactin

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39
Q

What stimulates alveolar development in the breast?

A

prolactin, progesterone, oestrogen, HPL

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40
Q

Contraindications for atrificial rupture of membranes

A

Known HIV
High presenting part (risk of cord prolapse)
caution if presenting part isn’t the head or there is polyhydramnios
placenta previa
vasa previa
preterm labour

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41
Q

What is a primary and secondary PPH and what are the grades?

A

Primary - >500ml within 24h

Secondary - >500ml 24h-12 weeks post partum

Mild = 500-1000ml
Moderate = 1000ml-2000ml
Severe = >2000ml

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42
Q

Describe which fluid/blood products you might give in PPH

A

Initially up to 2L crystalloid whilst waiting for blood

WITH NO BLOOD RESULTS:
Initially 4 units PRC
Followed by considering 4 units FFP if haemostasis not achieved

WITH BLOOD RESULTS:
If prolonged APTT/PT and ongoing haemorrhage then give 12-15ml/kg of FFP

If APTT/PT >1.5x normal then may need to give more FFP

Platelets - give if <75 and still bleeding (1 pool)

Fibrinogen - trigger level of 2 - if below this give cryoprecipitate

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43
Q

Are most RF for PPH known?

A

No

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44
Q

Who gets oxytocin and how in birth

A

vaginal delivery - 5-10 units IM

C-section 5 units IV

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45
Q

How much do prophylactic oxytocics reduce risk of PPH by

A

60%

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46
Q

What percentage of patients who are allergic to penicillin are also allergic to cephalosporins

A

0.5-6.5%

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47
Q

Examples of macrolides, how do they work?

A

erythromycin, azithromycin

Peptidyltransferase inhibitor

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48
Q

Examples of quinolones, how do they work?

A

ciprofloxacin
DNA gyrase inhibitor

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49
Q

Examples of tetracyclines

A

doxycycline

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50
Q

After birth how long does it take for the cervix to constrict again?

A

7 days

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51
Q

After birth how long does it take for the uterus to involve again?

A

4-6 weeks

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52
Q

After birth how long does it take for the vagina to gain tone again?

A

4-6 weeks

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53
Q

After birth how long does it take for the lochia flow to cease?

A

3-6 weeks

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54
Q

After birth how long can you get after pains for?

A

2-3 days

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55
Q

Describe the staging of cervical Ca

A

1A:
1a1 = stromal invasion of <3mm
1a2 = stromal invasion of <5mm

1B:
1B1 = stromal invasion >5mm but whole tumour <2cm
1B2 = stromal invasion >5mm but whole tumour <4cm
1B3 = stromal invasion >5mm but whole tumour >4cm

2A: Invades upper 2/3 vagina with no parametrial involvement
2A1 = <4cm dimension
2A2 = >4cm dimension

3B: With parametrial involvement but not up to pelvic side wall

3A: Involves lower vagina but no pelvic side wall

3B: extension to pelvic wall and/or hydronephrosis/kidney damage

3C: para-aortic or pelvic lymph node involvement
3C1 = pelvic only
3C2 = para-aortic

4A = local organ invasion

4B = distant organ invasion

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56
Q

Treatment for 1a1 cervical Ca

A

LLETZ +- hysterectomy. AS LONG AS THERE IS NO LVSI

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57
Q

Treatment for 1a2 cervical Ca

A

Risk of lymph node spread so radical hysterectomy + pelvic node dissection

If want to preserve fertility can do:
- radical trachelectomy
- LLETZ and lymph node dissection

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58
Q

Definition of hyperemesis

A

Pregnancy weight loss of 5% with metabolic disturbance (ketones/urea)

Usually starts before week 12 HAS to start before week 22

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59
Q

What are signs of shoulder dystocia

A

Prolonged second stage
Fetal head retracting when tight against the vulva (turtle-neck sign)
Difficult delivery of the face and neck
Failure of restitution of the fetal head

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60
Q

Describe the stages of the birthing process

A

Engagement - when the largest diameter of fetal head passes through the largest diameter of the pelvis - head in OCCIPITO-TRANSVERSE position

Descent - presenting part moves inferiorly due to pelvic contractions

Flexion - when head makes contact with the pelvis the neck flexes allowing for the presenting part to become smaller

Rotation - head rotates to occipito-anterior for delivery of the head

Crowning - when the head no longer retracts during contractions

External rotation - when head is out and then rotates 90 degrees so that shoulders are in an anterior-posterior position

Downward traction - to help delivery of anterior shoulder

Upward traction - to help delivery of posterior shoulder

Restitution = rotation of the shoulders to be align with the head when head is external

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61
Q

Management of shoulder dystocia

A

Help!

Legs - McRoberts manouver = legs to chest

Pressure - suprapubic pressure

Consider episiotomy

Rotational manouvers - corkscrew OR remove posterior arm

Roll patient to hands and knees

Consider zavanelli or pubic symphisiotomy

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62
Q

What is the worry with shoulder dystocia?

A

Brachial plexus injury - Erb’s palsy

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63
Q

When can women restart COCP after child birth? Transdermal patch?

A

after 3 weeks ( due to risk of clots) if not breast feeding

6 weeks if they are breast feeding

after 4 weeks

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64
Q

What type of cancer are most vaginal cancers

A

Squamous cell carcinoma

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65
Q

How does tranexamic acid work

A

Inhibits plasminogen activator - this inhibits the ending of thrombosis and fibrin. Can reduce flow by 50%

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66
Q

How does mefanamic acid work

A

Inhibits prostaglandins. Can reduce flow by up to 25% in 3/4 women

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67
Q

How does heparin work

A

Activates antithrombin III, inhibits factor Xa

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68
Q

Treatent of mennhoragia?

A

1st = IUS (levonorgestrel) where >12 months use anticipated

2nd = COCP OR tranexamic acid OR mefanamic acid

3rd = other progesterone only contraception

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69
Q

If menhorragia + dysmennhoria - what treatment?

A

mefanamic acid rather than tranexamic acid

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70
Q

When can endometrial ablation be used in menhorragia?

A

Significant impact on life

When fibroids <3cm. Also only if no future pregnancies planned.

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71
Q

When can UAE/myomectomy/hysterectomy be used in menhorragia?

A

Significant impact on life

When fibroids >3cm. Also only if no future pregnancies planned.

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72
Q

If a patient has high prolactin but low FSH and LH and progesterone and cannot get pregnant what is going on and what is the treatment?

A

Hyperprolactinaemia.

Causing negative feedback to pituitary and hypothalamus.

Needs investigation for ?pituitary adenoma but drug would be a dopamine agonist like bromocriptine

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73
Q

What effect does dopamine have on prolactin

A

dopamine reduces prolactin. When there is lots of prolactin that causes dopamine release which negatively feeds back to prolactin release

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74
Q

What is recommended with pre-menopausal women with simple cyst of 5-7cm

A

Follow up USS in 1 year

NO CA125

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75
Q

Who falls into the high risk catagory for 5mg folic acid

A

T1DM
Sickle cell
Taking methotrexate
Women on anti-epilpetics
FHx of NTD or previous preg NTD
coeliac disease

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76
Q

What type of of tumour is a fibroid

A

leiomyoma

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77
Q

What are risk factors for fibroids

A

obesity
black ethnicity
early periods
age

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78
Q

What are protective factors for fibroids

A

pregnancy
increasing number of pregnancies

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79
Q

What are the histological features of lichen sclerosis

A

epidermal thinning
degredation of the basal layer
dermal inflammation

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80
Q

What is the appearance/symptoms of lichen sclerosis?

Who is it most common in?

A

white atrophic areas
purpura
fissuring
Narrowinf introitus
dyspareunia

post-menopausal women

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81
Q

What are the features of lichen simplex - symptoms and histological

A

symptoms = fissuring, erosion, thick scaly skin (lichenification), excoriation

histological = epidermal thickening, increased mitosis at basal layer and prikle layer

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82
Q

What are the features of lichen planus?

A

violacious plaques with Reticular white bits on top - Wickham’s striae

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83
Q

What are the features of VIN?

Histological

A

lumps and bumps can be white or pigmented.

histological? atypical nuclei of cells in epithelial layer. increased mitosis. loss of surface differentiation.

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84
Q

When is CVS performed?

A

11 weeks-13+6 weeks

ABSOLUTELY NOT BEFORE 10 weeks

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85
Q

What is the first line for hirsuitism in PCOS for those <19 years or >19 years

A

<19 years = COCP - co-cyprindiol. This should be stopped 3-4 months after hirsuitism resolves

> 19 years = topical eflorithine

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86
Q

Describe the stagin system of endometrial Ca

A

1a <50% of myometrium
1b >50% of myometrium

2 invasion cervix but no extension beyond uterus

3a invasion of adnexas/serosa
3b invasion of vagina or parametrium
3c nodal involvement - pelvis (3c1) or paraaortic (3c2)

4a local invasion of other organs e.g. bladder
4b distant invasion of organs or inguinal lymph nodes

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87
Q

What are the survival 5 year % for endometrial Ca stage 1/2/3/4

A

1 = 85-90%

2 = 65%

3 = 45-60%

4 = 15%

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88
Q

What is the lifetime prevalence of fibroids?

A

30%

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89
Q

How many white women and black women have had a fibroid by age 50?

A

70% white women, 80% black women

90
Q

Peak incidence of fibroids

A

age 40

91
Q

How many women older than 30 get fibroids

A

20-50%

92
Q

What is the gas inflation needed prior to inserting the primary trochar

A

20-25 mmHg

93
Q

What is the distension pressure required after trochar inserted

A

12-15mmHg

94
Q

What is risk of serious complication in laparoscopy

A

2/1000

95
Q

Which criteria is used to diagnose PCOS

A

rotterdam

96
Q

Diagnostic criteria for PCOS?

A

2/3 of:

hirsuitism (physical or biochemical - testosterone
oligomenorrhoea
cytic appearance of ovaries on USS - 12 or more primary follicles or total ovarian volume >10cm3

97
Q

Does LH or FSH tend to be high in PCOS?

A

LH

LH:FSH >2

98
Q

What are the risk factors for acute fatty liver of pregnancy?

A

multipregnancy
nulliparity

99
Q

What are the signs and symptoms and bloods of acute fatty liver of pregnancy?

A

janudice, abdo pain, fatigue, obesity, male fetus

bloods - LFTs derranged, coagulopathy, hypoglyaemia, hypouricaemia

100
Q

What are the GDM diagnostic values for: NICE, WHO and modified who

A

2 hour glucose = ALWAYS 7.8

fasting glucose:
5.6 (NICE)
6.1 (un-modified WHO)
7.1 (modified WHO)

101
Q

What type of bacteria is gonnorhoea

A

gram negative diplococcus

102
Q

When do mothers typically start to feel fetal movements?

A

18-20 weeks

103
Q

How to manage RFM in >28 weeks

A

CTG

If CTG normal but RFM persists - USS

104
Q

How to manage RFM in <28 weeks

A

USS to assess size
doppler to locate fetal heart

105
Q

At what gestation does the fetus start swallowing

A

12 weeks

106
Q

When does the fetus start peeing

A

8-11 weeks (800ml/day by term)

107
Q

How much surfactant does the fetus produce per day by 2nd trimester

A

300ml

108
Q

What happens to ovarian size in menopause

A

<2cm2

109
Q

What is the half-life of oxytocin

A

5 minutes

110
Q

What is the half-life of ergometrine

A

30-120 minutes

111
Q

What type of receptors does oxytocin bind to?

A

G-protein-coupled receptors

112
Q

Treatment of hyperthyroid in pregnancy?

How common is it?

A

Propylthiouracil - crosses placenta less

NO RADIOIODINE

2/1000 pregnancies

113
Q

What is saint anthony’s fire

A

side effect of ergometrine

Ergometrine is an Ergot alkaloid.

St Anthony’s fire = gangrene and convulsive symptoms

114
Q

Staging of vulval Ca

A

1 - confined to peroneum

1A = <2cm tumour with <1mm stromal depth
1B = >2cm tumour OR >1mm stromal depth

2 - spread to adjacent structures with no nodes - 1/3 vagina, 1/3 urethra

3 - inguinofemoral nodes

3A - one node >5mm OR 2 <5mm
3B - 2 nodes >5mm OR 3 nodes <5mm
3C - 3 nodes >5mm OR erodes outwith capsule of node

4 - local or distant structures

4A - ulcerated inguinofemoral nodes, bladder, rectum, upper urethra, upper vagina
4B - pelvic lymph nodes or distant mets

115
Q

Which of the LFTs rises in pregnancy

A

ALP can triple in third trimester

116
Q

How many pregnancies experience itching

A

23%

117
Q

What is the cause of acute fatty liver of pregnancy

A

FETAL deficiency of long-chain-3-hydroxy-coA-dehydrogenase

this then leads to an accumulation of toxic liver product that accumulate in the maternal circulation

118
Q

What is polymorphic eruption of pregnancy

A

Rash that starts typically in 3rd trimester in first pregnancies.

Papules and plaques appear within striae

119
Q

How common is a dry mouth with antimuscarinics

A

1/10

120
Q

Summarise the treatment for OAB

A

Before antimuscarinics:
- bladder training
- desmopressin if nocturia
- vaginal oestrogen to treat atrophy

Muscarinics 1st line:
- oxybutynin (1st)
- tolterodone (2nd)

2nd line:
- transdermal anticholinergic
- mirabegron

Adjuvant:
- consider duloxetine for those not wanting surgery

121
Q

Summarise the treatment for OAB

A

Before antimuscarinics:
- bladder training
- desmopressin if nocturia
- vaginal oestrogen to treat atrophy

Muscarinics 1st line:
- oxybutynin (1st)
- tolterodone (2nd)

2nd line:
- transdermal anticholinergic
- mirabegron

Adjuvant:
- consider duloxetine for those not wanting surgery

122
Q

Who do we not give anticholinergics to and why?

A

Elderly and frail.

Because anticholinergics complete centrally as well as peripherally and therefore can cause confusion/delirium

123
Q

How does trimethoprim work

A

dihydrofolate reductase inhibitor

124
Q

How do tetracyclines work

A

Bind to 30S subunit of ribosomes to block the binding of amino-actyl TRNA to the site A of ribosomes

125
Q

Which cancer spreads lymphatically? What is the exception?

A

carcinoma

Renal cell carcinoma spreads haematogenously

126
Q

Which cancer spread haematogenously

A

RCC
choriocarcinoma
sarcoma

127
Q

Which cancer spreads transcoelomically? What does this mean?

A

Ovarian

Spreads scross a body cavity by penetrating walls such as peritoneum

128
Q

what is implantation/transplantation spread of cancer?

A

During surgery/procedure

129
Q

What is the average blood loss across one menstrual cycle?

A

35-40ml

130
Q

What is the maximum ‘normal’ blood loss in one menstrual cycle?

A

80ml

131
Q

Incidence of vascular injury in laparoscopy

A

0.2/1000

132
Q

Incidence of bowel injury in laparoscopy

A

0.4/1000

133
Q

Define delay of 2nd stage labour in nulliparous and parous women?

A

Nulliparous:
- suspect at 1 hour
- diagnose delay at 2 hours

Parous:
- suspect at 30 minutes
- diagnose at 1 hour

134
Q

What to do if delay suspected at second stage labour
?

A

ARM

135
Q

What to do if delay confirmed at second stage labour
?

A

C-section

136
Q

In how many patients with trichomoniais vaginalis do you see a straeberry cervix?

A

2%

137
Q

Treatment of TV?

A

metronidazole 400-500mg BD - duration depends on sx

138
Q

Investigation of TV

A

swab for PCR or wet smear microscopy

139
Q

Symptoms of TV

A

Up to 50% have no symptoms
up to 70% have discharge - white frothy in only approx 20%

dyspareunia
vaginal soreness
itching

140
Q

Contact tracing for men/women with chlamydia

A

Symptomatic men - last 4 weeks

ALL women or asymptomatic men - 6 months. OR if last sexual partner >6 month ago then just them

141
Q

How many women and men are asymptomatic with chalmydia

A

women - 80%
men - 50%

142
Q

When can COCP be started after abortion or miscarriage?

A

Immediately

143
Q

Who should get anti-D if aborting

A

Rhesus negative women >10 weeks pregnant

For women <10 weeks with SURGICAL abortion - consider anti-D

144
Q

Who gets antibiotics with abortion

A

can offer it for surgical abortions:

Doxycycline BD 3/7 or metronidazole 800mg PO

145
Q

What lactate level indicates tissue hypoperfusion

A

> 4

146
Q

Incidence of OASIS (obstetric and sphincter injury) in multips and nullips and overall

A

Nullips - 6%
Multips - 1.7%

Overall - 3%

147
Q

Follow up, examination, drug treatment of OASIS

A

follow up in 6-12 weeks

PR following repair or following birth of those at risk of OASIS

broad spectrum abx

148
Q

When starting methotrexate how often do FBC?

A

every 1-2 weeks

When established can do 2-3 months

Needs to do FBC, renal and liver function (risk of cirrosis, and also can lower cell proliferation so lead to neutropenia and thrombocytopenia)

149
Q

Treatment of molar pregnancy

A

methotrexate

150
Q

What is the max increase in Na over 24h

A

8-10

151
Q

What are the compositions of fat/protein/sugar in breast milk?

What about colostrum

A

Fat 4%, protein 1%, sugar 7%

Colostrum has much higher protein and low sugar

152
Q

Who should metolopramide not be given to

A

Those under 19 due to risk of oculogyric crisus

153
Q

What is an antepartum haemorrhage vs miscarriage

A

Bleeding >24+0 weeks

miscarriage must happen before 24 weeks

154
Q

How many miscarriages are in the first trimester

A

85%

155
Q

How many women with gonorrhoea will develop PID

A

15%

156
Q

What does neutrophil count do during pregnancy

A

drop

157
Q

With cholestatic jaundice - how many days post natally would you test LFTs

A

10 days

158
Q

How common is obstetric cholesiasis

A

0.7% pregnancies

159
Q

What defines obstetric cholestasis

A

itching with NO rash and derranged LFTs

160
Q

How is OC investigated

A

LFTs every 1-2 weeks and 10 days postnatally

161
Q

What if your patient has an itch but with normal LFTs

Treat the itch?

A

repeat LFTs in 1-2 weeks as the itch can preceed the abnormal bloods

Ursodeoxycholic acid

162
Q

What can OC lead to

A

premature delivery, passage of meconium, PPH, fetal distress

163
Q

Which is the most common type of ovarian cancer?

A

EPITHELIAL with highest occurance first:
serous
clear cell
endometrioid
mucinous

Other non-eithelial types: germ cell, sex cord

164
Q

5 year survival of ovarian Ca

A

43%

165
Q

How is ovarian mass assessed?

A

RMI - risk of malignancy index

Uses: USS appearance, menopausal status and Ca125 to assess risk of malignancy

166
Q

What are the ultrasound features looked at for RMI

A

Ascites, multilocular cyst, solid areas, intra-abdominal mets

167
Q

What is used for the diagnosis of BV

A

Amsel or nugent criteria

NOT gardnerella vaginalis

168
Q

What are the stages and symptoms of syphilis

A

Primary - chancre and lymphadenopathy
Secondary - rash on soles and palms, warts on genetalia
Latent - early <1 year after second stage, late >2 year after second stage
Tertiary - neurosyphilis, cardiosyphilis, gummas

169
Q

What is the appropriate dose of radiation for breast tissue in CTPA

A

10-20 mGy

170
Q

What type of cancers are most bladder Ca

A

Transitional

171
Q

What is the treatment of pueperal sepsis

A

Tazocin

172
Q

Risk factors for pueperal sepsis

A

obesity
GDM
immunocompromised
cervical cerclage
amniocentesis
C-section

173
Q

Treatment of gonnorrhoea in prengnancy?

A

1g IM ceftriaxone OR spectinomycin 2g IM or azithromycin 2g PO

174
Q

Treatment of gonorrhoea outwith pregnancy?

A

1g IM ceftriaxone OR ciprofloxacin 500mg PO

175
Q

Treatment of PID with gonorrhoea OUTPATIENT

A

doxycycline 100mg BD 14/7
metronidazole 400mg BD 14/7

1g ceftriaxone once off

176
Q

Inpatient management of PID

A

2g IM ceftriaxone OD until clinical improvement

doxycycline 100mg BD 14/7
metronidazole 400mg BD 14/7

177
Q

What are the levels of anaemia in prenancy

A

2nd trimester <110
3rd trimester <105
Post-partum <100

178
Q

Which organism causes most UTIs in pregnancy

A

e.coli

179
Q

Which antibiotics for UTI in pregnancy?

A

1st trimester - NO TRIMETHOPRIM

3rd trimester - NO NITROFURANTOIN

180
Q

What are the two histological features typical of serous and mucinous ovarian tumours?

A

Serous - Psammoma bodies

Mucinous - Mucin vaculoles

181
Q

Features of turners

A

Short
No menarchy
Short neck
Broad chest and widely spaced nipples
Teeth problems
Nails that turn upwards

182
Q

What is the risk that VIN will turn into vulval carcinoma

A

15%

183
Q

Describe the various methods of laparoscopic entry

A

palmers - RUQ - avoids suspected adhesions in the midline. Can be used in any weight

Varess needle - only used for normal weight patients due to difficulty (obese) and risk of vascular injury (very thin)

Hassan - Dissection and blunt insertion of trochar. Can be used in any weight

184
Q

What is pre eclampsia

A

BP >140 with 1 of the following:

  • proteinuria (2+ dipstick) or P:C >30
  • renal involvement
  • liver involvement - LFT >40
  • low platelets
  • convulsioms
  • ureteroplacental dysfunction such as IUGR/stillbirth
185
Q

Features of severe pre-eclampsia requiring admission

A

severe hypertension >160 or >110 diastolic

ALT >70

Creatinine rise >90

Platelet drop <150

Signs of PE/pulmonary oedema

Fetal compromise

186
Q

Drug tx for hypertension in prengnacy

A

1st - labetalol
2nd - nifedipine
3rd - methyldopa

187
Q

What is polymorphic eruption of pregnancy associated with

A

multiple gestation pregnancies
rhesus positive
obesity

188
Q

In which swab infection do you see ‘clue cells’

A

BV

189
Q

Which bacteria causes BV?

Type of bacteria?

What change does it cause for the environment?

A

Gardnerella Vaginalis

Gram-intermediate bacteria

Anaerobic

Causes environment to become alkali

190
Q

Treatment of BV

A

7/7 metronidazole

191
Q

What is the tubal factor infertility rate following single episode PID VS 3 episodes PID

A

12.5%

50%

192
Q

Incidence rate and mortality rate of vulval Ca

A

roughly:

INCIDENCE - 4/100,000

MORTALITY - 1/100,000

193
Q

How many vulval cancers are SCC

A

85%

194
Q

Mean presentation of vulval Ca

A
  1. Rare under age 50
195
Q

What is the first clinical sign of ureteric injury?

Other symptoms?

A

anuria

flank pain
haematuria
fever
vaginal urine discharge

Raised creatinine

196
Q

Overall complication risk in hysterectomy?

Haemorrhage risk?

Bowel injury risk?

Ureter/bladder injury risk?

A

4%

2.3%

0.04%

1%

197
Q

When is screening for GDM recommended for PCOS patients that are overweight?

Do all patients with PCOS get screened?

A

24-28 weeks

No, only those over weight or with another RF

198
Q

What is a tocolytic?

Examples?

A

Delays delivery

NSAIDs - Nifedipine

Oxytocin antagonists - atosiban

199
Q

Risk of vulval Ca with lichen sclerosis?

A

<5% - slightly higher risk

200
Q

Which gestation can you do a CTG if presenting with RFM?

A

> 28 weeks

201
Q

What is risk of serious neonatal infection?

What about if they have prelabour ROM?

A

0.5%

1%

202
Q

How to manage PROM if >34 weeks

A

If PROM >24h then induce if labour hasn’t started

203
Q

How to manage PROM if <34 weeks

A

Don’t induce unless clinically indicated such as infection

204
Q

Gold standard test for Chlamydia

A

NAAT

205
Q

Incidence of accreta (including per/in)

A

1.7/10,000

206
Q

Risk of accreta with 1/2/3/4/5 previous C-section

Other RF?

A

3%, 11%, 40%, 61%, 67%

previous accreta, praevia, asherman’s, previous ablation, previous uterine surgery

207
Q

Most common type of vaginal Ca

A

SCC

90% of cases

208
Q

Percentage of patients asymptomatically colonised by candida with pregnancy and non-pregnant women

A

40%

20%

209
Q

Tx of candida in pregnancy

A

topical Imidazole

210
Q

Most common pathogen in fitz/hugh/curtis syndrome?

What is it?

What can it cause in the neonate?

A

Chlamydia

Complication of PID - causes a hepatitis

OPthalmia neonatorum

211
Q

Azoospermia in tall skinny male with scant pubic hair and small balls?

A

Kleinfelters

212
Q

Infertility rate in endometriosis

A

40%

213
Q

Grading system for endometriosis?

A

American society for Reproductive Medicine

1 - superficial and firm lesions
2 - deep lesions at cul-de-sac
3 - ovarian endometriomas
4 - extensive adhesions

214
Q

What is the relative risk for someone with factor V leiden for VTE in pregnancy

A

80x more likely than non factor 5 leiden.

80/1000 pregnancies

215
Q

How do you classify thrombophilias

Which tend to be more severe?

A

Type 1 = deficiency of anticoag factors

Type 2 = excess of coag factors

TYPE 1 MORE SEVERE

216
Q

What is factor V leiden?

How many caucasians have it?

How many people with VTE have it?

A

coagulation factor V resists breakdown = TYPE 2

5% of caucasians

up to 30% of VTE

217
Q

What are some type 1 thrombophilias

A

Protein S deficiency, protein C deficiency, antithrombin deficiency

218
Q

Most common thrombophilia

2nd most common?

A

Factor V leiden

prothrombin G20210A

219
Q

Which complication doesnt need to be mentioned with laparoscopy

A

uterine injury

220
Q

Who is recombinant EPO used in in pregnancy?

Is it harmful?

A

those with anaemia of end stage renal failure

No evidence that it is harmful to fetus/neonate/mother

221
Q

Why do men with CF have azoospermia

A

Congenital absence of the vas deferens - this is because thick secretions due to mutation in chloride channels cause destruction in utero

MRCOG part 1 (3 decks)

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