GOSH Flashcards
(156 cards)
1
Q
What is the most common cause of reduced variability on CTG (short term)
A
Sleeping fetus
We worry if decreased variability for longer than 40 mins
2
Q
When should u be careful about ABX on contraception
A
If you ar taking an enzyme inducing Abx e.g rifampicin during the pill free period then you need to use condos for 7 days
3
Q
When can you take the COCP post-partum
A
UKMEC4 if BF<6weeks
UKMEC2 if BF 6wks-6months PP
Also shouldn’t be used in first 21 days PP at all
If started after day 21 additional contraception is needed for first 7 days
4
Q
What week can pregnant women not fly from
A
32 weeks
5
Q
When do you do a fetal blood sampling after CTG interpretation vs emergency C-section
A
I think mostly go for c-section
Fetal blood sampling can be useful in a non-reassuring CTG (vs abrnomal CTG) but often delivery is prioritized
6
Q
What in a history would stop you giving labetalol in a pregnant lady for hypertension in pre-eclampsia
What do y give instead
A
Asthma!
Give nifedipine instead (ccb)
7
Q
When do you get a tender cervix
A
PID most commonly
Also in ectopic, endometriosis, appendicitis, ovarian torsion
I guess anything that inflames the peritoneal area
No tender cervix in a miscarriage
8
Q
Exaggerated symptoms of pregnancy e.g. excessive vomiting plus bleeding plus large fetus
A
Hydatiform mole
9
Q
When is surgical Mx indicated over medical in ectopic
A
Symptoms (pain)
Over 35mm
Visible fetal heartbeat
HCG over 5000
10
Q
Step wise approach to managing PPH
A
ABCDE
Warmed Crystalloid infusion (fluids)
Mechanical= rubbing up the fundus, catheter
Medical= IV oxytocin
Surgical= IU balloon tamponade
11
Q
What is Sheehan’s syndrome
A
Necrosis of the pituitary gland following hypovolaemic shock as part of PPH
12
Q
What do you give in magnesium sulphate induced respiratory depression
A
Calcium gluconate
13
Q
What is HELLP syndrome
A
Haemolysis
Elevated Liver enzymes
Low Platelets
14
Q
What blood test results in Edwards
A
Everything low
Same tests as downs which is high hCG and high inhibin
15
Q
Stepwise investigations for reduced fetal movements
A
Handheld Doppler
If no HB then USS
If HB then CTG for at least 20 mins
16
Q
First line in infertility in PCOS after weight loss advice
A
Clomifene
Anti-oestrogen
17
Q
Drugs In an MTOP
A
mifepristone followed by prostaglandins after 36-48hrs e.g. misoprostol
18
Q
What makes you do LSCS over external cephalic version
A
Breech but waters ruptured
19
Q
Cutoffs for Hb levels
A
- First trimester= 110
- Second or third trimester= 105
- PP= 100
20
Q
When does pregnancy increase blood pressure
A
After 20 weeks
21
Q
Skin tears after birth Tx
A
Category 1= involving skin only- no repair needed
Category 2= skin and perineal muscle- repair on maternity ward
Category 3= skin, perineal muscle and anal sphincter complex- repair in theatre
Category 4= skin, perineal muscle, anal sphincter, rectal mucosa- repair in theatre
22
Q
How do you treat thrush in pregnancy
A
Clotrimazole pessary, not oral fluconazole as it is associated with congenital abnormalities
23
Q
How do you investigate duchenne muscular dystrophy got confirm the diagnosis
A
Genetic analysis
Creatinine kinase is also a strong indicator
24
Q
What do you give in urge incontinence when oxybutinin is contraindicated
A
Mirabegron
CI as fall risk I’m elderly
25
When do you induce labor in cholestasis of pregnancy and why
37
Increased risk of stillbirth
26
How do you deliver the next baby with a classical c-section scar
C-section
Vaginal birth is contraindicated
27
What are the 2 indications for big dose of folic acid (5mg)
anti-epileptic medication
Obese (>30 BMI)
28
Medical Mx of MTOP
Oral mifepristone
AND
Vaginal prostaglandins (e.g. Misoprostol)
29
What do you do if a woman has a temp of >38 in labor anf why
Give prophylactic benzylpenecillin to prevent GBS infection
30
How much weight needs to be lost PP for midwife referral
10 %
31
Breathlessness and sudden abdomen increase in size, presenting between weeks 16 and 26
Twin to twin transfusion syndrome
1 foetus is a donor which recieves less nutrients and the other becomes fluid overloaded
On USS one foetus will have empty bladder
32
2 stages of stage 1 of labor
Latent= 0-3cm dilation
Active= 3-10cm
33
How long can you forget your patch change before consequences
48 hours
Same as COCP
34
What happens if 2 COC pills are missed in week 3
Omit pill free period
35
Does hormonal contraception increase risk of breast cancer
Yes
36
What is the difference between partial and complete hydatiform mole
Complete is when 2 sperm fertilize an empty ovum
Partial is when 2 sperm fertilize a functional ovum
37
Enlarged and boggy uterus gonad
Adenomyosis
Endometrial tissue growth in muscular wall (myometrium)
38
Do you get dysmenorrhea in PID and endometriosis
Yes in endometriosis
No in PID
Good way to distinguish
39
What do you give pregnant women with thrush
Clotrimazole pessary
Oral fluconazole is CI due to risk of congenital abnormality
40
Which hormone is the best evidence of ovulation
Progesterone
Peaks at day 21
41
Which blood disease is a CI for expectant Mx of a miscarriage
Von Willebrand Disease
Give misoprostol PV
42
What’s the best form of contraception for someone taking anti-epileptic drugs
Copper coil
43
Which contraception is linked with weight loss
Depo injection
Definitely more common to gain weight with it tho
44
What is the classic presentation of placental abruption vs placenta praevia
Constant lower abdominal pain
woman may be more shocked than is expected by visible blood loss
Tender, tense uterus* with normal lie and presentation.
Fetal heart may be distressed
Placenta praevia= Vaginal bleeding, no pain. Non-tender uterus* but lie and presentation may be abnormal
45
How do you manage fibroids
Manage the symptoms e.g. if menorrhagia treat the pain
If really big and lots of symptoms consider surgical removal
Consider GnRH analogues to reduce hormonal effects
46
What is the smear regime if you are HIV positive
Smear every year
47
Snow storm appearance on obs USS
Complete hydatiform mole
48
What cancer risks come with COCP
Increases risk of cervical and breast cancer (ones we screen for)
Decreases risk of uterine and ovarian cancer
49
What is the first line medication for hyeremesis gravidarum
Cyclizine
50
Which Abx do you prescribe in preterm PROM
Erythromycin
51
Do you give aspirin in pregnancy
Usually avoided but given in pre-eclampsia
Avoid in breastfeeding
52
what are the indications for emergency C-section in placenta praevia
active labor
refractory life-threatening maternal hemorrhage
a category III fetal heart rate tracing
significant vaginal bleeding at ≥34+0 weeks of gestation.
53
How do you manage placenta praevia in outpatients after a bleeding episode
Counseling:
- Avoid excess physical activity, including sexual intercourse
- call their provider promptly if bleeding or labor occurs.
A course of antenatal corticosteroid therapy is administered.
Anti-D immune globulin is administered to RhD-negative patients
Planned C-section at 36/37
54
What is first line meds in HG and what drug class is it
Promethazine
Antihistamines are first-line in the management of nausea & vomiting in pregnancy/hyperemesis gravidarum
55
MMR vaccine schedule
1234
12 months, 3-4 years
56
Loose stool following gastroenteritis
Transient lactose intolerance is a common complication of viral gastroenteritis
57
How to manage someone on NOACs e.g. apixaban in pregnancy
Switch to heparin e.g enoxaparin
LMWH does not cross the blood brain barrier so is safe in preg
58
What is the organism that causes GBS
Streptococcus agalacticae is the bacterium which causes Group B Streptococcal disease (GBS)
59
Breast and endometrial cancer risk in oestrogen and combined HRT
HRT- increased risk of breast cancer
increased by the addition of a progestogen
the risk of breast cancer begins to decline when HRT is stopped and by 5 years it reaches the same level as in women who have never taken HRT
increased risk of endometrial cancer
oestrogen by itself should not be given as HRT to women with a womb
reduced by the addition of a progestogen but not eliminated completely
the BNF states that the additional risk is eliminated if a progestogen is given continuously
60
Breast, endometrial and ovarian cancer risk in combined/ oestrogen-only HRT
Breast:
- combined= increased risk. Risk reduces when you stop and increases the more you take it
-oestrogen only= slightly increased risk (less than combined), reduces
Ovarian:
- both slightly increase the risk, reduces
Endometrial:
- combined has no effect
- oestrogen only increases the risk (only given when patient has had a hysterectomy)
61
Specific requirement to be eligible for oestrogen only HRT
Has to have had a hysterectomy
62
COCP Breast, cervical, ovarian, endometrial cancer risks
Increased risk of breast and cervical cancer (ten years after stopping the risk is back to baseline)
Decreased risk of ovarian and endometrial cancer (stays when stop taking)
63
POP breast, cervical, endometrial cancer risk
Less well known that COCP
Breast: slightly increased risk (similar to combined pill)
Cervical: unsure
Endometrial: unsure but think it reduces like COCP
64
Which hormone is rasised significantly in menopausal people
FSH
65
Which hormones does the nexplanon contain
Progesterone
66
Breech in labour?
LSCS within 75 mins
You can’t do external cephalon version once waters have broken as u need the water to help turn
67
How do u diagnose BV
Thin white fishy discharge
Clue cells on microscopy
PH more than 4.5
history, vaginal examination and microscopic examination. Microscopy is the preferred method for diagnosis whereby a high vaginal smear (HVS) is gram stained and evaluated for: The presence of 'clue cells' – vaginal epithelial cells studded with Gram variable coccobacilli.
68
Which infection gives a strawberry cervix
Trichomonas vaginalis
69
How to treat gonorrhoea
IM ceftriaxone 1g stat
Presents with discharge , IMB, dypareunia, dysuria
Gram negative diplodocus
70
Which UKMEC is wheelchair use
3
71
Which organism causes scarlet fever
Streptococcus pyogenes
72
What size foetal sac for surgical management of ectopic
35
73
What HCG level for wxtopic surgical management
5000
74
Which female cancer is hereditary non-polyps is colorectal carcinoma (HNPCC)/ Lynch syndrome a strong risk factor for
Endometrial cancer
75
How do you describe the baby’s head orientation during labour
Left or right OCCIPUT anterior or posterior
Look where the occiput is when looking up at the mother lying on her back
If the baby’s head is on your left then its left occiput anterior/posterior
76
What non hormonal treatment can you give in vasomotor symptoms of menopause
SSRIs e.g. fluoxetine
77
Hb cut offs in preg
115 for non-pregnant women, 110 in early pregnancy, 105 in later pregnancy, and 100 after childbirth.
78
Ondansetron in pregnancy ?
there is an association with a small increased risk of cleft lip/palate in the newborn if used in the first trimester
Discuss before use
79
How logn does it take for the POP to be effective
2 days
80
6 risk factors for shoulder dystocia
Large for Gestational Age
Diabetes
Maternal BMI
Slow progress in second stage of labour
Assisted delivery e.g. forceps, ventouse
Previous shoulder dystocia
81
What can you do positionally for the mum in shoulder dystocia
McRobert’s manouvre
Legs extended then flexed onto her chest
82
4 risk factors for cord prolapse
When membranes are ruptured artificially (ARM)
PROM
Pre-term baby
Non-longitudinal (position of the baby)
83
How do you manage cord prolapse
LSCS
Don’t touch the cord as it causes more vasospasm
Can lift baby’s head up so its not touching the cord
If SVD is quicker than predicted time for LSCS then continue with SVD
84
Name 4 drugs given to manage PPH and what they do
Syntocinon relaxes vascular smooth muscle
Ergometrine causes strong uterine contractions
Carboprost and Misoprostol are synthetic prostaglandins which also causes uterine contractions (think MTOP)
85
First line antiemetic in vomiting in pregnancy
Promethazine
86
Drug management for postpartum thyroid it is
Propranolol
87
Fasting glucose threshold for insulin vs lifestyle modifications
7 mmol/L
You can plus or minus add metformin
88
What is the main drug management for hypertension in pregnancy
Labetalol
Nifedipine if it is unsuitable
Only give if BP is persistently above 140/90
89
What do all the hormones do in the menstrual cycle
FSH causes the maturation of an egg in the ovary
LH stimulates the release of the egg (stimulates ovulation)
oestrogen is involved in repairing and thickening the uterus lining,
progesterone maintains the uterine lining
In regnancy HCG maintains the corpus luteum which secrets progesterone keeping the lining thick
90
In which paeds rash is the palms and soles typically spared
Scarlet fever
Treat with Oral Pen V for 10 days
Safe to return to school after 24 hours
91
Which Abx for GBS prophylaxis
Benzylpenecillij
92
What is the hormonal level changes in turners
increased FSH and LH
In primary amenorrhoea to compensate for lack of oestrogen and progesterone
93
Can you breastfeed if u have hepatitis b
Yepatitis B
94
What is gold standard for diagnosing Hirschsprungs
Rectal biopsy
Lack of ganglion in nerve cells
95
Which organism causes PID most commonly
Chlamydia
96
Is smoking a risk factor for pre-eclampsia
No
Neither for HG
97
How to manage someone with moderate - high risk of pre-eclampsia
Give aspirin 75-150mg daily from 12 weeks until delivery
98
Pregnancy flying advice
If carrying twins don’t fly after 32 weeks
37 weeks for one child pregnancy
99
Medical Mx of missed miscarriage
Oral mifepristone + 48 hours later, misoprostol (vaginal, oral or sublingual) unless the gestational sac has already been passed
For an incomplete misacarriage you can give a single dose of misopsrostol
100
Complications of surgical management of miscarriage
Complications include intrauterine infection (3%), damage to the cervix/trauma, haemorrhage and retained products (5%).
101
Complications of medical management of miscarriage
Can be complicated by heavy bleeding and moderate abdominal pain. There is a 5% incidence of retained products/failure of treatment.
102
How to manage an incomplete miscarriage medically
Misoprostol
Antiemetics and analgesia
No need for mifepristone, used in missed miscarriage
103
4 indications for surgical
mx of ectopic
Significant pain.
Adnexal mass of 35 mm or larger.
Fetal heartbeat visible on an ultrasound scan.
Serum hCG level of 5000 IU/L or more.
104
medical Mx of ectopic,
MTOP drugs,
missed and incomplete miscarriage drugs
methotrexate for ectopic
MTOP= misoprostol and mifepristone
incomplete MC= just misoprostol
missed MC= Oral mifepristone + 48 hours later, misoprostol (vaginal, oral or sublingual)
105
when do you do surgical termination
by choice- no indication for either
vacuuming up until 14 weeks
after 14 weeks dilation and evacuation
also do it if medical doesnt work
106
medical termination before and after 10 weeks
oral mifepristone
48 hours later give misoprostol
if after 10 weeks more likely to have to give a second dose of misoprostol
107
Ondansetron pregnancy
In first trimester small risk of cleft palate / lip
Cyclising or promethazine are first line in vom in pregnancy
108
Medical Mx of eclampsia
an IV bolus of MgSo4
4g over 5-10 minutes should be given followed by an infusion of 1g / hour
treatment should continue for 24 hours after last seizure or delivery (around 40% of seizures occur post-partum)
109
How long do you give after MTOP for negative pregnancy test
4 weeks
If still positive after that then refer
110
How do you investigate and manage preterm prelabour rupture of membranes
STERILE speculum to look for pooling of amniotic fluid (don’t do bimanual)
Can swab using Amnisure if can’t tell
Admit them and CTG them
Oral erythromycin for 10days
Anetnatal corticosteroids give to reduce risk of respiratory distress syndrome
Longer you wai5 for delivery = increased risk of chorioamnionitis but low risk of RDS
111
How to treat gonorrhoea
Ceftriaxone 1g IM stat
Chlamydia is doxy 100mg BD for a week or azith if pregnancy
Syphillis is IM benzathine benzylpenecillin stat
112
How to treat syphillis
Syphillis is IM benzathine benzylpenecillin stat
113
How to treat chlamydia
Chlamydia is doxycycline 100mg BD for a week or azith if pregnancy
114
When is the booking clinic and what happens
Usually between 8-12 weeks
Ideally before 10 weeks
Baseline assessment and plan pregnancy:
- booking bloods: sickle cell and thalassaemia screen, blood group and rhesus D status, FBC for anaemia, infections (HIV, Hep B, Syphilis)
- pre-eclampsia screen- risks and symptoms
- general check e.g. height and weight
Prophylactic meds may be given e.g. aspirin for pre-ec, LMWH for VTE
115
What bloods are taken at the booking appt (8-12 weeks ideally before 10 weeks)
- FBC for anaemia
- group and save for blood group
- Rhesus D status
- screening for thalassaemia and sickle cell
- screening for infectious diseases (HIV, Hep B, Syphillis)
- potentially screening for downs if after 11 weeks (combined test)
116
What is Rhesus status and why is it important in pregnancy
Everyone is either Rh+ or Rh-. If you are Rh- you don’t have Rh antigens on your blood cells. Therefore if you encounter blood that is Rh+ then you create antibodies to attack it.
If you are Rh- and your unborn baby is Rh+ then if your blood were to mix (e.g. during birth, bumps etc) then you would become sensitized and have antibodies saved up.
If you were then to become pregnant again with a Rh+ baby then it can harm the baby and cause Rhesus disease (hemolytic disease of the fetus and newborn (HDFN)) which can potentially be life threatening
So anti-D prophylaxis is given to stop this response to Rh- women
117
When do they screen for Down’s, Edwards and Patau’s syndrome
Between 11-14 weeks
So just after booking scan which is 8-12 weeks
Combined USS (for nuchal translucency) and maternal blood tests
downs causes increase nuchal translucency and PAPP-A but high HCG
If they can’t do the USS then they do a triple/quad blood test between 15-20 weeks
118
When is the dating scan and how does it work
Between 10 and 14 weeks
So hopefully just after booking clinic (8-12) and ?same time as down’s/edwards/pataus screening (11-14 weeks)
Calculates gestational age using the Crown-Rump Length
Also identifies twins
119
How do blood group compatibilities work
If you are A blood group then you have antibodies vs B group
If you are B blood group then you have antibodies vs A group of
If you are AB blood group then you have no antibodies vs anything (can receive any)
If you are O blood group then you have antibodies vs both A and B so can’t receive any (apart from O) but you can give to anyone
If you are Rh-ve you wont be able to accept from Rh+ve but you can give to anyone as you will develop antibodies vs Rh+ve blood
If you are Rh+ve then you can receive from anyone but wont be able to give to Rh-ve people
120
When are anti-D injections given to Rh-ve women
28 weeks
Birth
This is to prevent Rh-ve women becoming sensitized to a potentially Rh+ve baby- this could cause serious effects in future pregnancies (Rh disease)
121
When is the anomaly scan and what is it
Usually 20 weeks (between 18-21)
Detailed USS which looks for 11 conditions (fetal anomalies) e.g. heart conditions, exomphalos, spina bifida, Edwards/ Pataus
May also be able to find out gender of baby
122
Vaginal delivery after C-section
Yes after one
No after 2
123
Risks/ disadvantages of C-section
More pain
More bleeding
Risk of infection
Risk of harm to surrounding organs
Small risk of cutting baby if pressed up against womb
Longer recovery in hospital (3- days)
124
Advantages of HRT
Reduction in vasomotor symptoms
Improved mood
Improvement of urogenital symptoms
Reduces the risk of developing osteoporosis
Cardiovascular protection
125
Which two vaccines are offered to all pregnant women
Whooping cough (16 weeks onwards)
Influenza during autumn/ winter
126
How do you assess BBV risk during a sexual history
Sexual contact with HIV positive person
Sexual activities with MSM
Sexual activities with someone outside the UK
IV drug use
Paying/ being paid for sex
Blood transfusions/ tattoos/ piercings abroad
127
How do you counsel someone with an STI
Treat the infection (in pregnancy chlamydia is oral azithromycin 1g orally for one day then 500mg orally for 2 days)
Encourage to go to SH clinic for screening for other STIs
Partner notification- SH clinic will be able to help with that (anyone slept with in last few months)
Offer follow up to check Sx/ partner notification/ re-check for infection
128
What would you seek specialist advice for in UTI in pregnancy
Catheter-associated UTI
Recurrent UTI (refer to obs)
Underlying urinary tract abnormality
Suspected serious underlying cause
129
Which Abx UTI in pregnancy
CKS SAYS NITROFURANTOIN 100mg BD for 7 days
Nitro for first 2 trimesters
?trimethoprim for last (decreases folate in first tri)
Avoid nitro in third tri as it can reduce RBC around delivery time
130
Syntometrine contraindications
Hypertension
Increases blood pressure
Causes uterine contractions
131
Which antibiotics are CI in pregnancy
Trimethoprim in 1st trimester
Nitro in 3rd trimester
Tetracyclines cause neonatal tooth discoloration
Co-amoxiclav increases risk of NEC
132
How do you treat chorioamnionitis
Cefuroxime 1.5g TDS IV
And
Metronidazole 500mg TDS IV
133
How to treat endometritis
Co-amoxicillin 1.2g I TDS
Or
Clindamycin and Metronidazole if penicillin allergic
134
How to calculate fetal engagement
Palpate the presenting part of the fetus (usually the head)- this mean closest to the vagina
If it is the head and you can feel the whole head then it is five fifths palpable and so not engaged
If you can’t feel the head at all then it is zero fifths palpable and fully engaged
135
How to twll between placenta praevia and placental abrupt ion
Placental abruption is painful uterus with bleeding
Placenta praevia is painless bleeding
136
How to manage uterine inversion
When the fundus of the uterus falls into the vagina turning it inside out
Johnsons maneuvre- pushing the uterus back up in to the abdomen
If that fails then hydrostatic pressure methods- filling the vagina up with water
If they both fail then surgery
137
How to manage uterine inversion
When the fundus of the uterus falls into the vagina turning it inside out
Johnsons maneuvre- pushing the uterus back up in to the abdomen
If that fails then hydrostatic pressure methods- filling the vagina up with water
If they both fail then surgery
138
Most common tocolytics given to stop Labour
Nifedipine (ca channel blocker)
Indomethacin (NSAID)
B2 agonist e.g. terbutaline
139
What steroid, dose and frequency in premature labour
Betamethasone 12mg IM x 2 doses, 24h apart
140
What dose of Enoxaparin as a prophylactic and therapeutic regime in pregnant women VTE
Prophylactic= 0.5mg/kg/day
Therapeutic= 2mg/kg/day
141
RCOG guidelines for PPH stepwise approach
Non-pharmaceutical first e.g. uterine compression, catheter with balloon
Then Syntocinon 5 units IV infusion
then ergometrine
Then Carboprost
Then misoprostol 1000micrograms rectally
Then surgical intervention
142
RCOG guidelines for PPH stepwise approach
Non-pharmaceutical first e.g. uterine compression, catheter with balloon
Then Syntocinon 5 units IV infusion
then ergometrine
Then Carboprost
Then misoprostol 1000micrograms rectally
Then surgical intervention
143
CI of ergometine
Hypertension
144
CI of Carboprost
Asthm
145
How to treat lichen sclerosis of the vulva
Potent topical steroid e.g. dermovate
Prevents scarring and reduces the risk of vulval cancer
146
What is the most common type of ovarian cancer in different demographics
Epithelial is the mst common type overall, much more common in post-menopausal women
Germ cell is the most common type in younger women around <40 (around 10% of all OC)
147
COCP and VTE contraindicated?
COCP is contraindicated when there has been a first degree relative who has had VTE under the age of 45
148
How to treat Trichomoniasis
Metronidazole either 2g oral stat or 7 day 500mg BD
149
Previous GBS management
Give mum intrapartum prophylactic Abx (Benzylpenecillin)
150
Gram negative diplococci which organism
Neisseria gonorrhoea
Treat with ceftriaxone
151
When to refer for no fetal movements
24 weeks
152
Whirlpool sign on USS
Ovarian torsion
153
Hyper echoic mass on pelvis USS
Fibroids
154
Need for contraception after the menopause rules
12 months after the last period in women > 50 years
24 months after the last period in women < 50 years
155
Reactive arthiritis typical presentation
1 to 4 weeks following a genitourinary or gastrointestinal infection
The classic triad of symptoms is:
- conjunctivitis- can’t see
- urethritis- can’t pee
- arthritis- cant climb a tree
156
How long does it take for IUS to be effective
7 days
Same as COCP and implant
