MD3 ONG Flashcards
1
Q
Best way to estimate the duration of a pregnancy on palpation?
A
From Pubic symphysis to top of palpable uterus (fundus) - at 20 weeks fundus will be at belly button, at 40 weeks it will be just below the rib cage. Between them around 30 weeks.
2
Q
How can you tell if a baby is getting ready to come on palpation?
A
Head will descend (in non-breach) and will lose mobility.
3
Q
What is the normal number of weeks before labour and at what point after this period is the baby at risk?
A
37 to 42 weeks, a week after that, risk of stillbirth begins to rise.
4
Q
What actually is amniotic fluid?
A
Baby pee - marker of well hydrated and nourished baby.
5
Q
What is the cutoff for pre-eclampsia and which 3 areas of the body are uniquely at risk?
A
140/90.
Vessels - made stiff - leads to hypertension
Kidneys - hypertension/placental mystery molecules cause proteinuria
Brain - low threshold for seizures
6
Q
What is HELLP syndrome?
A
Think of it is a severe form of pre-eclampsia.
H - haemolysis
EL - elevated LFTs causes DIC as all coags are up.
LP - low platelets
7
Q
What is the medication given to raise seizure threshold in pre-eclampsia?
A
Magnesium sulphate - but makes patients feel like shit
8
Q
What is the only true cure for pre-eclampsia and what are some temporary measures?
A
true cure - remove placenta
in the meantime - atenolol, hydralazine, and mag sulph
9
Q
Define the following acronyms: EDD, GTT, PPH, LMP
A
Estimated date of delivery
Glucose tolerance test
Post partum haemorrhage
Last menstrual period
10
Q
Which two conditions are key to specifically touch on in past obstetric hx at the booking visit?
A
HTN and diabetes
11
Q
What is the tool to test for perinatal depression?
A
Edinburgh Post-natal depression score
12
Q
When does everyone do a GTT? What about if Hx of gestational diabetes?
A
28 week visit.
Earlier if PHx. (do twice)
13
Q
Mnemonic for Ix performed at initial antenatal visit?
A
FBI RUSHH (CVS)
FBE
Blood group and Rhesus
Iron
Rubella
Urine (MSU for UTI, consider STIs)
Syphilis
Hep B and C
HIV
Consider CVS - CST (opportunistic), varicella serology and scan (USS)
14
Q
Define primary and secondary PPH and major and minor PPH.
A
Primary = in first 24 hours after birth
secondary - 24hrs to 12 weeks after.
Minor = 500ml to 1000ml blood loss.
Major is over 1000 or signs of shock.
15
Q
What is 3rd stage of delivery?
A
between baby and placenta delivery.
16
Q
What is the main management difference between a minor and major PPH?
A
Major needs transfusion immediately, start O neg then switch, consider also FFP and cryoprecipitate (has fibrinogen that’s why).
17
Q
Describe these 3 major acute causes of PPH - uterine atony, placenta accreta, placenta previa.
A
atony - uterus not contracting, contraction squeezes blood vessels shut normally.
Accreta - placenta imbedded into uterine wall - doesnt detach with birth - bleeds heavily
previa - placenta covering cervix.
18
Q
One pharm and one surg Mx for uterine atony.
A
pharm - oxytocin
surg - balloon tamponade
19
Q
What medication may help prevent pre-eclampsia and when should it be ceased?
A
low dose aspirin to be ceased at 36 weeks.
20
Q
What is an ECV?
A
Extra cephalic version - palpate the baby away from breach position into better position
21
Q
3 major Ix/interventions performed at the 28 week appointment vs the 36 week?
A
28 - FBE, anti-D if needed, GTT
36 - FBE, anti-D if needed, GBS swab
22
Q
Who needs Anti-D?
A
Rho neg mums with + babies
23
Q
When are the two main USS done for most women?
A
12 and 20 weeks.
24
Q
Which complication does folic acid aim to avoid?
A
Spina bifida
25
Is warfarin safe for pregnancy?
No, it is teratogenic
26
List 4 key discussion topics for the initial pregnancy visit
1. confirm pregnancy/dates
2. folate
3. medication check
4. Lifestyle/diet tips
27
Approximately when do most pregnant women stop working?
Week 34
28
What are the main two complications to look for at each antenatal visit?
- pre-eclampsia (HTN)
- Poor growth (IUGR/placental insufficiency)
29
Are proteinuria and glucosuria common in pregnancy?
Yes both in small amounts
30
What is chorioamnionitis? Which complication is it closely linked with?
Infection of the chorion/amnion with vaginal flora. Closely linked with pre-term labour.
31
List some risk factors and signs of chorioamnionitis.
Risks - long labour and multiple examinations in labour
Signs - foul amnion, fever, tachycardia
32
Abx treatment for chorioamnionitis?
IV Amp + gent/ceft, and metranidazole or clindamycin for anaerobes.
33
Which bacteria typically causes post-partum sepsis?
Group A Strep (pyogenes)
34
Mx for positive GBS swab?
IV benpen prophylactically at delivery
35
CMV is associated with which fetal complication?
Deafness
36
When are the 4 doses of Hep B vaccine?
At birth, then at 2, 4 and 6 months.
37
Which medicine can be given as prophylaxis for HBV vertical transmission in a HBV + mum?
tenofovir (if viral load above 200,000)
38
If active HSV lesions are present during late term, what is the best mx?
Ceasar instead of vaginal birth
acyclovir for prophylaxis
39
What are the two biggest causes of maternal mortality in Australia?
Cardiac Disease and DVT.
40
What is the key physiological cardiac change during pregnancy and how does this impact the risk of associated pathologies?
cardiac output MUST rise during pregnancy. If there is an underlying pathology that is worsened by higher CO (eg. aneurysm) or that prevents a rise in CO (eg. a left sided stenotic valve) then this is DANGEROUS.
41
Which cardiovascular condition has the highest risk of maternal death in pregnancy?
Pulmonary Hypertension
42
What are the physiological changes to the respiratory system in pregnancy?
- airway edema common
- RR up
- diaphragm pushed up by uterus reduced functional residual capacity (FRC) which acts as an O2 storage.
43
Is breathlessness normal in pregnancy?
Yes very common but it is important to seperate it from a potential PE
44
List two physiological changes that put the airway at risk in pregnancy.
- laryngeal/airway swelling
- reduced osephageal sphinctre tone increasing reflux
45
How do sugar levels change in pregnancy and how might this impact a type 1 diabetic?
Pregnancy requires both hyperglycemia and hyperlipidemia to feed baby - T1DM will need more insulin during pregnancy.
46
How does pregnancy impact blood/plasma?
Levels greatly increase, causing haemodilution.
47
How are T and B cells impacted by pregnancy?
T cells usually inhibited to allow for fetal growth - this may mean autoimmune diseases flare less when pregnant.
B cells are unimpaired which is why vaccines still work during pregnancy.
48
Why does lying position impact pregnancy?
Aortocaval compression = compression of the IVC and aorta due to the position of the fetus.
Solution = left lateral tilt
49
Is it safe to defib while pregnant?
If a woman's heart is not working then the baby is in danger, it is safest to defib. The most unsafe thing for the baby is for the mother to die.
50
Can rubella and varicella vaccines be given during pregnancy?
These are live vaccines so cannot be given in pregnancy. Can be given in planning or afterward.
51
What is the mx for pregnant women with a clot risk?
- clexane subcut
- educate around DVT/PE signs and symptoms
52
Signs of pre-eclampsia?
Headaches, visual changes, swelling, N+V
53
When do fetal movements usually start for mum?
Around 17 weeks but everyone is different
54
What Ix would you order for reported reduction in fetal movements?
- CTG and USS
55
What is primigravid?
First pregnancy
56
What is a fetal station?
How far down the baby's head is in pelvis
57
What does an USS look for when looking for reduced fetal movements?
placental insufficiency as evidenced by DVP. Deepest vertical pocket of amniotic fluid. If less than 2cm = placental insufficiency.
58
What is macrosomia and what are the delivery options?
Big baby.
1. Watch and wait - risk of obstruction (ceasar) and risk of shoulder dystocia
2. Ceasar - bleeding risk and longer recovery (4-6 weeks)
3. Induction eg. balloon dilatation and ARM
59
What is a key medical thing to do for women moving forward after a stillbirth?
Lactation suppression
60
What is an amniotomy and what is syntocinon?
Amniotomy (ARM) = artifical rupture of membranes
syntocinon = synthetic oxytocin to force contractions
61
What is meconium and what does it mean if it is present in the amniotic fluid?
First poop of baby - sticky green bile stuff. If present in amniotic fluid it may be a sign of fetal distress or an overdue baby - CTG.
62
What are the 3 stages of delivery?
First phase - labour until full dilation
Second - full dilation to birth
Third - birth to placental delivery
63
What is station 0 for the fetus?
Head is at level of ischial spines
64
What is caput?
Swelling of the baby's head
65
What is crowning?
baby'd head no longer retreats after contractions.
66
Why is oxytocin given after baby is born?
To prevent PPH
67
How does pregnancy impact clotting factors?
They go up massively (800% up) to prep for delivery haemorrhage. DVT risk massive
68
How does delivery of the baby impact the cardiac system?
All of the fluid that was shunting into the placenta returns to the system - strain on heart.
69
What are the main two groups of medications used for analgesia in delivery?
- nitrous oxide for contractions
- opioids, typically morphine - 10mg IM 2-3 hourly.
70
How can an epidural help pre-eclampsia?
An epidural and spinal can cause hypotension due to shutting off the sympathetic mechanisms in the spine. This lowered BP can help in those with HTN.
71
Which combo of medications are given in an epidural?
Local anaesthetic: bupivicaine or ropivicaine
+ opioid - fentanyl
CAN DO IT AS A PCA
72
Why would you avoid GA in pregnancy?
Many reasons. Very risky in pregnancy due to airway risks, aorto-caval compression may not be recognised, hypoxia risk due to reduced FRC, and GA will cross to baby.
Plus partner cannot be in the room to be involved.
73
Explain gravida vs parity?
gravida = number of times pregnant
parity = birth of fetus over 20 weeks (live or stillbirth)
74
What is the average baby birth weight? (at 40 weeks)
3.5kg
75
Why might appendicitis be missed in pregnancy?
McBurney's point MOVES due to growth of abdomen and some symptoms may be similar to regular pregnancy symptoms eg. nausea
76
What pharm management can help in pre-eclampsia and in IUGR (intra uterine growth restriction)?
low dose aspirin
77
To really clarify someone's gestation period you can which two methods?
USS - 7 weeks sac + CRL + heart rate.
5 weeks just sac, 6 weeks just sac and CRL.
CRL often dates pregnancy.
Serial BHCG - should double every 48 hrs in successful pregnancy.
78
If BHCG is rising weirdly and not doubling every 48 hrs as expected, what might you consider?
ectopic
79
When is the NIPT done?
10 weeks
80
What is the chance of miscarriage on average before 3 months?
Around 30-40%
81
When to the first and second visits tend to be in pregnancy and what is done at these?
- first visit is the 'i am pregnant visit' around 6 weeks. Confirm pregnancy (BHCG) and discuss folate, discuss lifestyle changes, removing teratogenic meds.
- next visit = 12 weeks. Blood tests. FBI RUSHH (+varicella, CMV, etc depending on clinician). Combined first trimester screening = USS for nuchal translucency and then the triple blood test algorithm.
82
What blood tests are part of the triple blood test for the combined first trimester screening?
BHCG, alpha fetoprotein, PAPP-A
83
What are the two diagnostic tests for aneuploidy and what are their risk levels?
amniocentesis - 16 weeks - 0.5% risk
chorionic venous sampling - 13 weeks - 1% risk.
84
When is the 3rd major pregnancy visit? What is done?
20 weeks - morphology scan.
85
Describe the main tests done at the 28 and 36 week visits?
28 weeks - anti D if needed, FBE, iron, Ab test (always every fkn visit). GTT
36 weeks - GBS swab
86
What are some reasons for a planned ceasar?
- mum's choice
- active HSV
- breach
- giant baby
- transverse lie
- abnormal placenta (accreta, previa, vasoprevia)
87
Why does hardly anyone in the western world go beyond 41 weeks + 3?
Risk of stillbirth rises each day
88
What is the normal baby position on vaginal delivery?
occipital-anterior.
Occipital bone of baby against mum's anterior side (pubic symphisis)
89
What are the 3 stages of pregnancy?
1 = in labour but not fully dilated to 10cm
2 = fully dilated until birth
3 = post birth until placenta delivery
90
Which two injections are given to the baby within an hour of being born?
Hep B and Vit K
91
What 4 things are tested for on the fetal heelprick?
- PKU
- congenital hypothyroid
- cystic fibrosis
- congenital adrenal hyperplasia
92
What is the 'normal' timeline for physiological neonatal jaundice ?
Between 24hrs and 2 weeks jaundice is likely normal.
93
What is the cause of physiological jaundice in neonates?
Babies need high Hb (around 180) to deal with the hypoxic conditions of the womb and the delivery - once born they no longer need this Hb so the heme is broken down into bilirubin. Their inefficient livers are unable to conjugate this bilirubin leading to increased unconjugated bilirubin levels.
94
What is the validity of different oral contraceptive pills following pregnancy?
mini pill - no side effects. Safe once baby is born.
combined pill - estrogen will turn off lactation
95
What day is usually the peak of physiological jaundice?
Day 5 or so
96
What is the most common cause (by far) of pathological neonatal jaundice? What usually leads to this pathology?
Haemolysis. 99/100 says John Mills.
USUALLY this is due to iso-immunisation - i.e the crossing of maternal IgG across the placenta to target baby antigens. Nowadays this is typically ABO cross reactivity.
97
Which iso-immunisations are most common?
In the olden days Rhesus disease (Ab made by Rhesus neg mum in response to Rhesus positive baby following maternal sensitisation due to prior pregnancy or maternal fetal haemorrhage) was the most common cause of iso-immunisation and subsequent neonatal jaundice. Now we give anti-D.
Now the most common cause is ABO cross reactivity.
98
What percentage of women are rhesus negative and how does anti-D work?
15% are rhesus negative.
Anti-D mimics the maternal Ab that would be produced and mops up the fetal DNA that leaks across the placenta so that the mother herself does not mount an immune response and make her own Ab.
This is given before and after birth.
99
What is a dangerous complication of fetal anemia (ie due to haemolysis)?
hydrops fetalis
100
What six blood tests are done for jaundiced baby?
1. Bilirubin level (conjugated as well)
2. Baby blood group
3. Direct Antigen test (Coombs) tests for Ab in fetal circulation
4. Hb
5. G6PD - haemolysis due to oxidative stress
101
Which population is most likely to get G6PD and what are 3 main causes?
South East Asian.
Legumes (Flava beans), anti-TB drugs and sulphur antibiotics.
102
What is the main treatment for pathological neonatal jaundice to avoid bilirubin buildup leading to kernicterus? What is the second line in extreme cases?
Phototherapy.
If it is really bad: exchange blood transfusion - blood goes in and out at some time manually in 20ml aliquots.
103
If, more than 2 weeks post birth, a baby becomes jaundiced and bilirubin levels are largely conjugated, what would you suspect?
Obstruction - conjugated bilrubin is spilling out the liver into the blood instead of into the bowel. Query biliary atresia (non-formation of biliary system and gallbladder).
104
What are the key components of a post-natal checkup? (POSSIBLE OSCE)
- how is baby (but leave most of it for GP/peadiatrician)
- how is mum
- breastfeeding
- mood - edinburgh depression score
- bleeding, discharge (period)
- bowels/bladder
- lifestyle things like return to exercise
- CST
- contraception
- immunisations
+/- exam for scars/sutures
105
Jaundice after 2 weeks may be due to which common cause?
Breast milk jaundice - in some women a molecule in breast milk inhibits conjugation of bilirubin in liver
106
It’s important not to forget that _____ can cause pathological neonatal jaundice.
sepsis
107
What are the cut off values for the 3 stages of the oral GTT?
Fasting - should be below 5
after 1 hr - should be below 10
After 2 hrs - should be below 8.5
108
How often should women with gestational diabetes test their sugars?
4x a day, 1 first thing fasting and then 3x in the day 2 hours after each meal
109
What is the typical first line management for gestational diabetes?
Insulin
110
Which blood test may serve as an indicator of future pre-eclampsia?
PAPP-A (part of the combined first trimester blood screen) may indicate future pre-eclampsia if it is low
111
What is the realistic earliest point you can deliver a baby and it still lives normally (with assistance initially) ?
26 weeks though some may survive even at 22 weeks.
112
Why is fetal haemolysis such a risk ?
Haemolysis leads to anaemia which in the fetus can cause hydrops fetalis - cerebral palsy risk etc
113
List some causes of antepartum bleeding.
- Miscarriage
- Labour
- Placental abruption (maybe linked to pre eclampsia)
- Uterine rupture
- Placenta previa
- Placenta accreta
- Vaso previa (painless)
- Infection eg. chorio
- GYNAE causes: STI, fibroid, polyp, gynae cancer
114
What is the pain level in placenta accreta, previa and vasoprevia
usually all are painless
115
Which 3 questions do you ask all pregnant women regardless of gestation?
- pain
- bleeding/discharge
- fetal movements
116
Instructions for GTT?
Fast 8-12 hours before, so often light snack before bed because don’t want to be over fasted. Just water the morning of the procedure.
3 blood tests over 2 hours, drink the drink.
117
What is lichen sclerosis and what is the long term risk?
Vulval skin changes appearing like plaques - precursor to squamous cell carcinoma
118
Can you do CST and DTP vaccine antepartum?
Yes both!
DTP often given in third trimester and CST ‘anytime, anywhere’
119
What do the ovaries feel like on bimanual exam on a normal person?
Not palpable
120
What are the degrees of vaginal tears in labour?
(They build upon each other)
First degree - vaginal mucosa
Second - perineum
Third - anal sphincter
Fourth - anal mucosa/rectum
121
Non-pharm intrapartum mx for preventing tears?
Warm compress to vasodilate perineum
122
What is the most common side effect of ergometrin (used PPH and induction)?
Vomiting - most vomit
123
Defining features of pre-eclampsia? What is the difference to eclampsia?
- hypertension
- small baby
- proteinuria
- low PAPP-A
Real eclampsia = seizures
124
After 32 weeks, Lionel says you really have to check 3 things:
- size of the baby
- pre - eclampsia
- which way is the baby facing
125
What is a missed abortion?
Miscarriage with no fluid from the vagina, cervix still shut but baby has no heart beat.
126
Which hormone causes muscle aches in pregnancy?
Relaxin
127
What is the significance of a cervix length under 25mm?
Short cervix one ultrasound is increased risk of pre-term birth.
128
What is the risk of a low lying placenta?
Risk of placenta previa
129
What is the feared complication of congenital parvovirus?
Fetal anemia
130
Goal for a pre-eclamptic mum with a small baby at 31 weeks?
Must come out or it will die
131
Risk of vasoprevia, management?
In labour baby will descend and burst a vessel lying in the way of the uterus - very quick fetal death. Management is an early Caesar, can’t risk labour.
132
What are some causes for repeat miscarriages?
- coagulopathy
- SLE/anti-phospholipid
- chromosomal abnormality (worst one, no fix)
133
Advice for mums to avoid CMV?
Avoid little kids, under 2 are the biggest risk, don’t hate cutlery, kiss on the head not the mouth.
134
Initial mx for gestational diabetes?
Lifestyle + exercise
135
What is metaraminol?
Alpha 1 agonist (indirect) used to raised BP in spinal/epidural patients.
136
What is miscarriage risk of an 8 week embryo with normal CRL+HR on USS with healthy mum?
Below 5%
137
When do stop aspirin in pre-eclampsia risk
?
Stop 36 weeks
138
Difference between minor and major PPH and primary and secondary PPH?
Minor = 500 to 1000ml
Major = over 1000ml
Primary - within 24 hrs of birth
Secondary - between 24 hrs and 6 weeks after birth
139
What are the causes of a primary PPH?
The 4 T’s: (in this order)
- tone (uterine atony)
- tissue (retained intrauterine products)
- trauma (from birth eg, forceps)
- thrombus
140
Two main causes of secondary PPH?
- retained uterine products
- infection
141
List two causes of polyhydramnios and two causes of oligohydramnios:
Remember amniotic fluid is baby pee.
Oligo: placental issue (no nutrients for baby to make pee) OR kidney issue - baby can’t make pee
Poly: baby can’t swallow (producing pee but not swallowing it) and gestational diabetes
142
Some considerations for a First Nations/regional pregnant woman?
- Koori Maternal services
- fetal monitoring/scans can be done regionally
- telehealth for some visits is possible
- Birthing on country may be important to some
- placental rituals are common in First Nations groups
- can suggest relocating for a short time at the 34 week mark or so
143
Extra referral made antenatally for twins?
Lactation consultant - breastfeeding twins can be tough, best to prepare
144
What is AEDF?
Absent End Diastolic flow - on umbilical cord using doppler - sign of fetal distress
145
When is the usual cutoff for IV steroids to increase surfactant for baby?
Usually before 34 weeks.
146
Pharm Mx for chorio?
Gent, Amp, Clinda (or Metro)
For PROM - premature rupture of membranes (risk of chorio)
- add IV steroids for baby surfactant
147
How long ago must last period be to be defined as menopause?
12 months
148
What is ITP?
Immune thrombocytopenic purpura - low platelets
149
What is aplastic anaemia, how does it impact an FBE?
Autoimmune destruction of the bone marrow (can be cause by many things eg. radiation, chemo, infection, congenital etc). Virtually everything on FBE will be low - Hb, WBC, platelets, reticulocytes etc.
150
Vaginal bleeding in an obese, post-menopausal woman should ring alarm bells for?
Endometrial cancer - fat produces estrogen, and after menopause this unopposed estrogen is a risk for gynae cancers.
151
What is the likely management of a post-menopausal woman with endometrial cancer?
Likely a hysterectomy with bilateral oophorectomy due to no longer being fertile.
152
What is Asherman's syndrome?
intrauterine adhesions (often from past surgery) that may cause pelvic pain, amenorrhea, abnormal uterine bleeding or an inability to get and stay pregnant.
(SECONDARY AMENORRHEA)
153
What is fragile X and what are some key clinical findings?
Genetic cause of mental retardation.
Findings include long face, large ears, prominent jaw, macro-orchism, mitral prolapse
154
What is the Abx for pertussis?
Macrolide - azithro or erithro
155
What are the 3 diseases screened for in basic carrier screening?
CF, spinal muscular dystrophy and Fragile X.
156
157
3 key mx in urge incontinence:
1. Bladder diary
2. Retraining - pelvic physio
3. Pharm eg. Oxybutinin
158
Which two mechanisms allow progesterone only contraception to impair fertility?
- thins endometrium preventing implantation
- thickens cervical mucus prevent travel of sperm and egg
159
When is anti D given to rhesus negative mums?
28 and 34 weeks
160
What is the most effective emergency contraception?
Copper IUD
161
Syphilis pathogen?
Treponoma pallidum
162
What weeks is Anti-D given in?
28 and 34
163
When is GTT done?
28 weeks unless prior dx then first one is at around 14 weeks
164
When is GBs swab taken?
36 weeks
165
What is sulfasalazine?
DMARD
166
What is folic acid for in pregnancy?
reduces spina bifida risk
167
When to stop work in pregnancy?
Around 34 weeks
168
CMV congenital risk?
deafness
169
If mum is Hep B+ at birth?
Hb IG given to baby. (tenofovir given to mum beforehand prophylactically).
170
Active HSV lesions at time of labour mx?
ceasar
171
Which abx class is contraindicated in pregnancy?
tetracyclines (and obviously also trimethoprim).
172
How does pregnancy impact insulin requirements in T1DM?
need more
173
Which vaccines should not be given during pregnancy?
Live - varicella or MMR.
174
Signs of pre-eclampsia?
Headache, swelling, visual changes.
175
What is a Bishops score?
estimation of how successful an induction will be
176
Ix for decreased fetal movements>?
CTG and USS.
177
Meconium liquor is indicative of?
fetal distress
178
Tx for aorta-caval compression?
left lateral tilt
179
Analgesia in labour?
Morphine IM 10mg. 2-3 hrly.
Consider Nitrous oxide.
180
Spinal level aim epidural?
L3-4
181
List the 3 ligaments that must be passed through to do an epidural?
supraspinous, interspinous, ligamentum flavum.
182
Medicines used for epidural?
local eg. bupivicaine
and opioid - usually fentanyl.
183
when to re-check GTT in diabetics?
6 weeks post-partum
184
When is a CRL usually visible on USS?
6 weeks gestation
185
Risks for ectopic?
past ectopic, current IUD, surgery in pelvis, PID.
186
Dermoids are a risk for which condition?
ovarian torsion
187
Timeline for meconium passage in neonates?
Should pass it in 48 hrs
188
2 month vaccinations?
hexa - DTP, Hib, HBV, polio
pneumococcal
rotavirus
189
Tapeworm that causes liver cysts?
Echinococcus
190
White stool in neonate =
biliary atresia
191
Causes of primary PPH vs secondary PPH.
Primary 4T's:
Tone, tissue, trauma, thrombin.
Secondary:
retained products or infection
192
When does peri-natal depression peak?
4 weeks after pregnancy. Whereas post-partum blues in earlier.
193
When can a mirena be put in post-vaginal birth?
4-6 weeks.
194
Advice post-vasectomy?
Still fertile for 3 months.
195
Which medication can be given to increase lactation?
donperidone
196
white nipple with breastfeeding pain Dx and mx?
vasospasm - like raynauds.
heat application or nifedipine
197
mastitis abx?
oral fluclox
198
Ages for CST and mammogram screening?
CST - 25-74
Mammogram: 50-74
199
Insanely high bHCG suggests?
Molar pregnancy/trophoblastic disease
200
Agents used in hyperemesis gravidum?
promethazine, ondansetron, prochlorperazine, pyroxidine, STEROIDS
201
Brown/prune juice coloured antepartum bleed is classic for?
ectopic
202
How does molar pregnancy look on USS?
Bunch of grapes
203
Mx molar pregnancy?
D+C, treat as if regular birth tbh with oxytocin etc. Weekly BHCGs afterwards until normal.
204
Most ectopics are located where?
Ampulla (in the tube)
205
AMH hormone is tested for what purpose?
Anti-mullerian hormone tests how many eggs a woman has left.
206
Classic finding on USS for placental abruption?
retroplacental hematoma
207
When to give ante-natal steroids?
If baby being born before 35 weeks.
208
Sats aim with neonates on supplemental oxygen?
91-95%
209
use of caffeine in preemies?
prevents apneas
210
Signs of necrotizing enterocolitis in babies?
bilious vomits
PR bleed
abdo distension
211
Molecule with a high negative predictive value for risk of pre-term birth?
Fetal fibronectin
212
Medication to prevent pre-eclampsia?
low dose aspirin until about 36 weeks.
213
Swelling of neonate head that doesn't conform to suture lines = ?
subgaleal haemorrhage - emergency - can easily bleed out
214
one palmar crease in neonates is suggestive of?
trisomy 21
215
Where should saturation probe be placed for pre-ductal sats in neonate?
right hand
216
Findings on CXR for RDS?
- ground glass opacity
- air bronchograms
- underinflated lungs
217
How to test if discharge is amniotic fluid?
amnisure
218
HTN in pregnancy with clonus and brisk reflexes indicates?
severe pre-eclampsia
219
Ix for endometrial hyperplasia?
Urgent hysteroscopy D+C with biopsy
220
Tamoxifen moa and cancer risk?
Tx for breast cancer by reducing estrogen levels in the breast but increases estrogen levels in uterus - increased endometrial cancer risk.
221
First line PCOS tx?
COCP
222
How long should a period be?
No longer than 8 days
223
FSH level in ovarian insufficiency?
High
224
NOF exam findings?
Shortened leg and externally rotated
225
surgery for vaginal (recto or cysto-cele) prolpase?
Colporrhaphy
226
surgery for vaginal enterocele prolpase?
hysterectomy
227
Main endometrial cx type?
Endometrial (endometroid) carcinoma
228
Main type of cervical cx and finding on histo?
Squamous cell carcinoma - keratin swirls on histo.
229
Primary differential for dysmenorrhea?
endometriosis
230
Dysparaneuria is classically caused by?
endometriosis. Typically 'dee[ dysparanueuria'
231
'chocolate cyst' on laparascopy is typical of?
endometriosis - endometrioma
232
Bulky, tender uterus is a classic description of?
Adenomyosis
233
Role for screening in ovarian cx?
none
234
Risk reduction for ovarian cx?
OCP, Mirena, aspirin
235
Which cancers are at risk in Lynch syndrome patients?
bowel, endometrial, prostate, pancreas, ovarian.
236
Lynch syndrome best risk reduction in females?
hysterectomy with bilateral salpingooopherectomy
237
Peutz-jeghers syndrome is typically associated with with finding on examination?
Brown spots on lips, oral mucosa, fingers and nose. High cancer risk.
238
BRCA is largely indicated in which two big groups of cancers?
Breast and ovarian
239
Most common site for endometriosis?
Ovaries
240
Chemo for ovarian cx?
Carboplatin or new PARP drugs
241
Tumour markers for ovarian cancer?
CEA, CA19-9 and CA125.
242
Cutoff BP value for pre-eclampsia?
140/90
243
Normal baby head position in birth?
Occipito-anterior
244
Tests on heelprick?
- CF
- PKU
- hypothyroid
- CAH
245
How to check hypoxic threat to newborn baby?
Cord lactate, above 7 is a worry.
246
GTT cutoff scores?
fasting 5.1
1 hr 10
2 hr 8.5
247
Early GTT for high risk women date?
14-16 weeks then the normal one again 28 weeks.
248
Which HTN drugs are teratogenic?
ACEi
249
Blood test that may indicate risk of pre-eclampsia?
low PAPP-A
250
Hormone that causes the sore muscles/bones in pregnancy?
Relaxin
251
Safe cervix length?
over 25mm
252
Signs of cervical shock?
Hypotension + BRADYcardia (unlike other types of shock)
253
what is plaquinil?
hydroxychloroquine
254
What is a congenital diaphragmatic hernia?
Bowel in thorax on CXR. fucked.
255
What is PUPS?
Generalised itch in pregnancy
256
Uterus dermatome roots?
T10-12
257
Two key medications to give in PPROM?
Abx and steroids if under 35 weeks
258
Abx for bacterial vaginosis?
Metranidazole
259
LLETZ?
Large loop excision of trasnformation zone
260
Autoimmune fusing of vulva?
lichen sclerosis - steroids
261
What is Turner's syndrome?
XO chromosomes. Often amenorrhea.
262
Causes of secondary amenorrhea?
PCOS
prolactinoma
pregnancy
etc
263
Free fluid in the pouch of douglas in a suspected ectopic indicates?
rupture. It's blood.
264
'slow rising beta' is ONG code for?
ectopic
265
Single methotrexate dose side effects?
N+V and dizziness.
266
Ways to control vaginal bleeding:
- NSAIDS
- mefanamic acid (NSAID)
-tranexamic acid
- progesterone (takes a few days)
267
Classic cause of non-bleeding pain in young girls/women?
Ovulation pain
Ovarian cysts
268
if usual anti-emetics don't work in morning sickness - best tx is?
steroids
269
How long do you wait before reviewing an expectant option miscarriage?
2 weeks
270
Hypoglycemia cuttoff neonates?
2.6
271
Typical cause of early neonatal sepsis?
GBS (also listeria and e.coli)
272
First line for neonatal hypoglycemia?
40% dextrose gel
273
Main cause of seizures in neonates?
hypoxia.
(hypoglycemia can also cause but not as common)
274
Maple syrup urine in neonates suggests which group of illnesses?
amino acid disorder.
275
High LH:FSH ratio is typical in?
PCOS
276
Which blood molecule is tested in spina bifida?
Alpha fetoprotein (high)
277
naevus flammeus is also known as a ?
port wine stain
278
FSh and LH levels in Turner syndrome?
High. LH and FSh trying to stimulate shit ovaries.
279
active ingredient in Plan B?
levinorgestrel
280
Which form of progesterone only contraception is contraindicated in patients with current breast cancer?
implanon
281
Risks of IUD?
perforation
can cause PID if STI present at insertion.
282
Ergometrine use?
Good with syntocinin for PPH but not appropriate for augmenting labour.
283
TTN vs RDS timeline.
TTN - immediate, resolves within 24 hrs.
RDS - takes a few hours to appear. A week to resolve. Worst 72hrs.
284
Risks for neonatal sepsis?
GBS +
too many vaginal exams
maternal fever/infection
prolonged rupture of membranes
285
Abx for GBS prophylaxis?
IV Benpen
286
Main risk factor for necrotising enterocolitis?
pre-maturity
287
'high pitched cry' is a classic finding for which neonatal disease?
Meningitis
288
HSP can lead to which bowel complication?
intussiception
289
Histo findings in asthma:
- goblet cell hyperplasia
- hypersecretion of mucus
- smooth muscle proliferation
- wbc infiltration
290
