July 2024 Flashcards by Dania b

shoulder dystocia: using McRoberts and suprapubic pressure what is the
percentage success rate of SD?

> 90%

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All-fours’ technique success rate

83%

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What is the difference in risk between
vaginal birth and c/s birth in peripartum
hysterectomy outcomes

65 per 100,000

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What is the difference in risk between
vaginal birth and c/s birth in neonatal
mortality

28 per 100,000

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What is the difference in risk between
vaginal birth and c/s birth in maternal death

20 per 100,000

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What is the difference in risk between
vaginal birth and c/s birth in placenta accreta

42 per 100,000

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What is the difference in risk between
vaginal birth and c/s birth in uterine rupture

185 per 100,000

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What is the difference in risk between
vaginal birth and c/s birth in asthma

309 per 100,000 children

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What is the marker for anaphylaxis

mast cell tryptase

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treatment for anaphylaxis

1:1000 adrenaline 500 micrograms IM

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max dose of lidocaine

3mg/kg without adrenaline
7mg/kg with adrenaline

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how does lidocaine work and what is the half life

blocks fast voltage gated sodium channels
half life 2 hours

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most reliable indicator of disseminated intravascular coagulation (DIC)?

Fibrin Degradation Products (FDPs) and platelets

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what is decreased in DIC

decreased platelets, fibrinogen, clotting factors, protein C and anti-thrombin III levels

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adrenaline indication and dose in cardiac arrest

1mg 1:10,000 IV or IO
assytole or PEA

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reversal of opioid toxicity

IV naloxone (onset 30s to 2min) typically at 0.4-2mg IV

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11-Post op 75yrs for ovarian CA with omentectomy. History of benign brain
tumour and liver disease. Post op day 4 abdomen distended tender BS sluggish
positive. Urine output 400/24hrs, 750 input
NEWS were stable

CTAP

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A 65-year-old had a hysterectomy for endometrial cancer. She recovered well
but complained of dribbling urine 2 days later and was given a course of antibiotics for a presumed UTI. On review at 4 weeks she complains of continued urinary incontinence. She has no dysuria, no sensation of urgency, needs to wear a pad at night, and intermittently voids good volumes of urine with normal flow. Urinalysis is negative. What the most likely diagnosis?

fistula

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Most common major complication of
laparoscopy

bowel injury: 0.4/1000

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overall risk of serious complication laparoscopy

2/1000

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risk of vascular injury from laparoscopy

0.2/1000

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risk of death in 100,000 from laparoscopy

5 in 100,000

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after vaginal disimpaction what is the next step with fetal head impaction

breech extraction
consider inverted T or J incision

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antihypertensive treatment for postnatal

enalapril - monitor renal functino and matneral serum potassium

or black = nifedipine or amlodipine

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bladder syndrome pharmacological treatments:

oral amitriptyline or cimetidine (not licensed fpr BPS)

What is the most appropriate Post op c/section pain relief for a patient who has had a spinal anaesthetic and is currently vomiting in recovery

IV morphine consider PCA if GA - routine monitoring until 2 hours after

syphilis treatment (early disease primary/secondary) in third trimester

Benzathin penicillin 2.4 MU IM weekly for 2 weeks

syphilis treatment (early disease primary/secondary) in first or second trimester

Benzathin penicillin 2.4 MU IM single dose

syphilis treatment late disease/unknown duration

Benzathin penicillin 2.4 MU IM weekly for 3 weeks

recurrent miscarriage testing

1. acquired thrombophilia especially lupus anticoagulant and anticardiolipin antibodis 2. cytogenetic analysis on pregnancy tissue of third+ miscarriage

when is parental peripheral blood karyotyping offered in recurrent miscarriage

parental perpheral blood karyotyping when pregnancy tissue reports unbalanced structural chromosomal abnormality OR if the cytogenetic analysis is unsuccesful

follow-up for complete molar pregnancy

if hCG has reverted to normal within 56 days of the pregnancy event then follow-up will be for 6 months from the date of uterine removal. OR 6 months from normalisation if after 56 days

f/u for partial molar pregnancy

concluded once the hCG has returned to normal on two samples, at least 4 weeks apart.

PUL sub-optimal hcg rise

pregnancy test in 14 days

first step in PPH

massage uterus/bimanual compression and repair perineal tears and catheterise

A PG delivers a healthy baby vaginally. She has a background of an aortic root dilatation measuring 4.5cm. Which uterotonic is contraindicated?

ergoemtrine (risk of hypertension induced aortic dissection or rupture)

A woman presents with 9 weeks of amenorrhoea and new lower abdominal pain. An ultrasound scan shows an intrauterine pregnancy with a fetal heart beat. There is a left sided complex adnexal mass, with free fluid in the pouch of Douglas. What is the most likely diagnosis?

heterotopic pregnancy

What is the rate of persistent trophoblast after salpingostomy for tubal ectopic pregnancy?

up to 1 in 5 women may need further treatment after salpingotomy (20%)

A patient at 38/40 presented with bilateral sensory weakness on the anterior and lateral thigh. There was no motor involvement. Which nerve is most likely to be affected?

lateral cutaneous nerve

A patient presented for review on maternity triage. She underwent a forceps delivery of a 4.1kg baby three days ago. She complained of foot drop. On examination she was found to have weakness of knee flexion and hip abduction. Which is the most likely affected nerve?

lumbosacral trunk

An 18 year old woman presents to gynaecology clinic with primary amenorrhoea. On examination she has Tanner stage 2 breast development and stage 2 pubic hair. Internal examination reveals a blind end vagina. What is the most likely diagnosis?

Complete androgen insensitivity syndrome: 46XY - normal puberty then primary amenorrhoea

A woman presents with primary amenorrhoea, ataxia and cataracts. What is the most likely diagnosis

Galactosemia

A primigravida presents to antenatal clinic at 20 weeks gestation. She is suffering from recurrent candida infection and has been on clotrimazole for the last 12 months. A HVS shows candida, which is sensitive to azoles. What is the most appropriate management?

Clotrimazole 500mg PV once weekly

A couple are undergoing primary fertility investigations. The female partner’s investigations are all normal. The male is found to have azoospermia with a low FSH. What is the most likely underlying cause?

Kallmans syndrome low FSH = kallmans, prader willi, charge

endometrial hyperplasia without atypia - risk of progression to endometrial cancer after 20 years, if left untreated?

1-5%

throbbing headache associated with nausea, blurred vision and photophobia. Neurological examination is normal, but fundoscopy reveals papilledema with an inward squint of the eye. Her BP is 127/85. What is the most likely underlying diagnosis?

idiopathic intracranial hypertension

greatest risk of cerebral venous thrombosis

third trimester and first 4 weeks postpartum

A primigravida with a BMI of 38 presents to the clinic at 16 weeks gestation. She is complaining of a gradual onset headache, that is particularly worse when she is coughing or straining. What is the most appropriate investigation to reach a diagnosis?

lumbar puncture

A 32-year-old woman undergoes surgical evacuation of products of conception. Histological diagnosis reveals a partial molar pregnancy. What is the genetic basis of a partial molar pregnancy?

Two sets of paternal chromosomes and one set of maternal chromosomes

A 44-year-old lady is referred to the GOPD by her GP to discuss sterilization. She had a copper IUD for the last 4 years and was under the impression that she can keep it until menopause. However, recent cervical cytology has grown actinomyces, and she has been advised that the IUD will need removal. She denies any symptoms. What contraception would you advise for her?

continue copper IUD - asymptomatic individuals with positive actinomyces on cervical cytology are more likely to be colonised than infected

A 33-year-old woman is referred to the GOPD to discuss contraception. She was considering sterilisation but is unsure whether her family is complete. She takes topiramate and has a bicornuate uterus. She does not want to undergo any procedures. What is the most appropriate contraceptive for her?

Depot medroxyprogesterone acetate progesterone injectable

Which is the contraceptive with the least failure rate from both typical and perfect use?

Etonogestrel implant

A patient asks you about which contraceptive choice would be most appropriate for her. She is HIV positive and is taking Efavirenz. What is the most effective contraception for her?

Depot medroxyprogesterone acetate

A patient reported having unprotected sexual intercourse last night with an unusual partner. The condom had split during the intercourse. She takes the COCP but reports forgetting to take a pill yesterday. She is in week two of her pack. What would be the most appropriate advice for her?

Enquire about STIs, take the missed pill now (even if it means two pills in one day) and continue the pack as scheduled

A patient with a history of 2 previous caesarean sections and diet-controlled gestational diabetes mellitus (GDM) is carrying a fetus weighing 3.1 kg. She is keen for a vaginal delivery (VD). What is the most appropriate management?

Offer C/S at 39 weeks

A diabetic pregnant woman presents at 33 weeks gestation, unwell with vomiting and fever. She is hyperglycaemic on assessment with urinary ketones 3+. Serum potassium levels are 3. What is the most appropriate initial management?

0.9% NaCl with 40 mmol KCl over 4 hours

A 65-year-old patient with a background of atrial fibrillation is due to undergo hysteroscopic polypectomy under general anaesthetic today. She usually takes warfarin but she stopped this a week ago in anticipation of the surgery. Her INR today is 1.6. What is the most appropriate action?

if INR>1.5 pre op, give vitamin K (phytomenadione)

A 50-year-old woman has a mechanical heart valve and takes Warfarin. She weighs 60kg. She is due to undergo a bilateral salpingo-oophrectomy. How would you manage her anticoagulation pre-operatively, in terms of bridging?

Stop warfarin five days before the procedure and start Enoxaparin (a LMWH) at 90mg S/C OD. Take last enoxaparin dose 24 hours before planned surgery.

A patient undergoes a vulval biopsy in GOPD, following presentation with narrowing of the clitoral hood. Biopsy has found squamous-cell carcinoma. Which is the most likely associated precursor?

Differentiated VIN (dVIN)

A pregnant patient with diabetes insipidus is started on desmopressin (DDAVP). What test should be monitored during pregnancy?

Urea and electrolytes check for hypernatraemia - weakness, confusion, seizure, coma

A 38-year-old woman is reviewed in GOPD, complaining of post-coital bleeding. On speculum examination there is a mass involving the anterior and posterior fornices of the vagina and invading into the upper third of the vagina. MRI abdomen and pelvis do not report any further abnormalities. What stage of cervical cancer does the patient have?

stage 2

Which inherited thrombophilia is most often associated with recurrent pregnancy loss?

Prothrombin gene mutation Lupus anticoagulant has the strongest associaion with recurrent miscarriage

Which inherited thrombophilia is most often associated with first and particularly second trimester recurrent miscarriage

Factor V Leiden

40 weeks 2.5kg - most common cause of stillbirth

placental cause 28w - 1.2kg, 30- 1.6kg, 32w - 2kg

previous pre-eclampsia delivered at 32 weeks - risk of recurrence?

33%

how much isotonic fluid is overload?

more than 2500mL using isotonic more than 1000mL using hypotonic

lacy rash cause?

parvovirus B19

commonest cause of pancreatitis

gallstones

in ART, when is the highest risk of VTE?

first trimester

increased risk of miscarriage with which uterine aomalies

septate and bicornuate

positive ascites or washings - what stage ovarian cancer

1C3

raised HbA2 (>3.5) indicates what?

beta thalassaemia - avoid iron unless ferritin is low.

gold standard for LAM avulsion

transperineal ultrasound 3d/4D

Most commonly injured vessel at laparoscopy

Inferior epigastric

patient at 14weeks with 3 prev preterm deliveries at 27,28,29 weeks. Next step of management

History indicated cervical cerclage

Woman had no antenatal care, from Africa (Zambia), delivered 3 weeks ago. Baby is unwell and has blocked nose, hyperpigmented macular rash on body and rash on soles of feet. Has hepatosplenomegally.

syphilis

July 2024 Flashcards

(77 cards)