early pregnancy

Question 1

common early pregnancy symptoms

Answer 1

N+V, tiredness, MSK pain

Question 2

differentials for bleeding in the first trimester

Answer 2

miscarriage // ectopic // implantation bleeding // ectropion, vaginitis, trauma, polyps

Question 3

immediate referral criteria for ectopic

Answer 3

+ive pregnancy plus one of: pain and abdo tenderness // pelvic tenderness // cervical motion tenderness

Question 4

invx + mx bleeding if <6 weeks pregnant

Answer 4

if NO pain or RF for ectopic –> manage expectantly (repeat pregnancy test in 7-10 days and return if positive)

Question 5

invx if >6 weeks pregnant and bleeding

Answer 5

TVUS (location, fetal pole, HB)

Question 6

where do most ectopic pregnancues occur

Answer 6

tubal- ampulla!!!!

Question 7

where is most dangerous location for ectopic

Answer 7

isthmus

Question 8

progression of ectopic

Answer 8

absorption or ruptured

Question 9

what is an ectopic

Answer 9

implantation of fertilised ovum outside uterus

Question 10

RF ectopic pregnancy

Answer 10

PID, surgery // previous ectopic // endometriosis // IUD // POP // IVF

Question 11

symptoms ectopic

Answer 11

lower abdo pain (1st symptom, may be unilat) / vaginal bleeding (dark) // amenorrhoea for 6-8 weeks // shoulder tip or pain on bowels // dizzy, syncope

Question 12

o/e ectopic

Answer 12

abdo tenderness // cervical motion tenderness // adnexal mass (do NOT examine as may rupture

Question 13

invx ectopic

Answer 13

bHCG > 1500 // TVUS for ectopic = best

Question 14

when can expectant mx for ectopic be suitable

Answer 14

<35mm // unruptured + asymptomatic // no HB // hCG <1000

Question 15

when can medical mx for ectopic be suitable

Answer 15

same as expectant (eg <35, uruptured, no Hb) // + some pain, hCG <1500 (not if twins)

Question 16

mx for medical management

Answer 16

methotrexate + follow up

Question 17

indication surgical ectopic mx

Answer 17

> 35mm // ruptured // pain // fotal Hb present // hCG >5000

Question 18

mx surgical ectopic

Answer 18

1 = salpingectomy (if no infertility issues) // 2 = salpingotomy (if RF for infertility eg contralateral tube damage)

Question 19

complication salpingotomy

Answer 19

1/5 need further treatment (eg methotrexate or salpingectomy)

Question 20

what type of diseases is a molar pregnancy

Answer 20

trophoblastic

Question 21

symptoms mole

Answer 21

extreme pregnancy eg hyperemesis, hyperthyroid // vaginal bleeding,

Question 22

o/e molar pregnancy

Answer 22

uterus greater than expected age

Question 23

invx molar pregnancy

Answer 23

v high hCG // USS = snowstorm

Question 24

what is a complete mole

Answer 24

sperm joins with egg that has no DNA –> 46 chromosomes of paternal DNA

Question 25

complication complete mole

Answer 25

choriocarcinoma (mets to lung and liver)

Question 26

what is a partial mole

Answer 26

egg fertilised by 2 sperm (or 1 duplicated sperm) --> 69XXY

Question 27

mx molar pregnancy

Answer 27

urgent referral // need birth control for 12 months after

Question 28

RF hyperemesis gravidarum

Answer 28

increased bHCG, multiple pregnancies, trophoblastic disease, nullpartity, obesity, history of HG

Question 29

what decreases risk of HG

Answer 29

smoking

Question 29

what decreases risk of HG

Answer 29

smoking

Question 30

who needs admitted with HG

Answer 30

cant keep down fluids or meds // ketonuria or weight loss (5%) despite meds

Question 31

triad of HG

Answer 31

5% pre-pregnancy weight loss // dehydrated // electrolyte imbalance

Question 32

scoring symptoms for severity N+V in pregnancy

Answer 32

pregnancy unique quantification of emesis

Question 33

1st line meds HG

Answer 33

antihistamine (cyclizine, promethazine) // proclorperazine, chlorpromazine // pyroxidine dual therapy

Question 34

2nd line meds for HG

Answer 34

ondesatron // metoclopramide (5 days only) or domperidone

Question 35

SE ondasetron

Answer 35

cleft lip in 1st trimester

Question 36

SE metoclopramide

Answer 36

EPSE - 5 days max