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Flashcards in O&G facts to recall by the end of the day Deck (138):
1

'woody' uterus

placenta abrupta

2

whats the target of the diastolic blood pressure in pre-eclampsia

Administer intravenous labetalol with target diastolic blood pressure 80-100 mmHg

3

what is the highest risk for HG?

twin pregnancies, molar pregnacy

4

what should be used first line for HG?

antihistamines should be used first-line: Promethazine

5

what is the active management of labour?
What women should give to the patient?

Active management lasts less than 30 minutes and involves the following:
Uterotonic drugs
Deferred clamping and cutting of cord, over 1 minute after delivery but less then 5 minutes
Controlled cord traction after signs of placental separation

6

When ECV should be offered in nulliparous and multiparous women?

The RCOG recommend ECV should be offered from 36 weeks in nulliparous women and from 37 weeks in multiparous women

7

what are the recommendations for the labour induction?

Indications
prolonged pregnancy, e.g. > 12 days after estimated date of delivery
prelabour premature rupture of the membranes, where labour does not start
diabetic mother > 38 weeks
rhesus incompatibility

8

what is the management of PROM? (premature rupture of membranes)

Management
admission
regular observations to ensure chorioamnionitis is not developing
oral erythromycin should be given for 10 days
antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome
delivery should be considered at 34 weeks of gestation - there is a trade-off between increased risk of maternal chorioamnionitis with a decreased risk of respiratory distress syndrome as the pregnancy progresses

9

Pregnancy vaccinations - 2PS

Pertussis and Pneumoccous

10

Late deceleration. What do you do?

1) Fetal blood sampling - check for acidosis.
2) If there is fetal acidosis ph<2 prepare for the urgent delivery

11

When in pregnancy , the same day delivery would be the only option in sever pre-eclampsia?

After 34 weeks, same day delivery is an option.

12

what is the definition of proteinuria in pregnacy?

The pregnancy-induced hypertension in association with proteinuria (> 0.3g / 24 hours)

13

what's the name of the maneuver used for uterine inversion?

Johnson Maneuver

14

Perineal Tears

3a: less than 50% of EAS thickness torn
3b: more than 50% of EAS thickness torn
3c: IAS torn
fourth degree: injury to perineum involving the anal sphincter complex (EAS and

15

However, chorioamnionitis can also occur with intact membranes, and this appears to be especially common with the genital Mycoplasma species. Key clinical features of chorioamnionitis include uterine tenderness, rupture of the membranes with a foul odour of the amniotic fluid and maternal signs of infection (for example tachycardia, pyrexia, and leukocytosis). In this case, the criteria for systemic inflammatory response syndrome (SIRS) is met, and together with the clinical features a diagnosis of sepsis secondary to chorioamnionitis can be made.

THINK = if there is SIRS (systemic signs of the infection) this must be it.

16

The most common explanation for short episodes (< 40 minutes) of decreased variability on CTG is

fetus is sleeping

17

The classic triad of vasa praevia is

rupture of membranes followed by painless vaginal bleeding and fetal bradycardia.

18

What are the delivery methods for placenta previa?

final ultrasound at 36-37 weeks to determine method of delivery, Caesarean section for grades III/IV between 37-38 weeks. If grade I then vaginal delivery

19

Dilated pupils + hyperreflexia seen on physical examination point towards

cocaine abuse

20

Fatty liver of pregnancy would present with:

fatty liver of pregnancy as demonstrated by jaundice, mild pyrexia, hepatitis LFTs, raised WBC, coagulopathy and steatosis on imaging.

21

when you would prescribe antibiotics in suspected mastitis?

- nipple fissure
-symptoms have not improved within 24h after continued expression of the milk
-bacterial culture positive

22

when you would perform the emergency cesarean section?

Bradycardia or a single prolonged deceleration with baseline below 100/min for >3 minutes

23

How would olihohydroamino present?

Reduced pubic symphysis height

24

diagnosis of placenta previa could be confirmed by which test?

abdominal ultrasound

25

'To prevent cord compression what would you do?

'To prevent cord compression, it is recommended that the presenting part be elevated either manually or by filling the urinary bladder.'

26

Potentially sensitising events in pregnancy:

- Ectopic pregnancy
- Evacuation of retained products of conception and molar pregnancy
- Vaginal bleeding < 12 weeks, only if painful, heavy or persistent
- Vaginal bleeding > 12 weeks
- Chorionic villus sampling and amniocentesis
- Antepartum haemorrhage
- Abdominal trauma
- External cephalic version
- Intra-uterine death
- Post-delivery (if baby is RhD-positive)

27

what signs you would like to ellict in pre-eclampsia?

headache
visual disturbance
papilloedema
RUQ/epigastric pain
hypereflexia

28

Twin-to-twin transfusion syndrome (TTTS). what medication you would use. what else does it do?

Indomethacin to reduce fetal urine output

29

What sort of defects are associated with increased nuchal translucency?

Nuchal translucensy is associated with congenital defects such as defects in abdominal wall and cardiac defect.

30

What are the three main causes of the hyperechogenic bowel?

CMV, CF and Downs syndrome

31

pregnant is admitted to the maternity unit with heavy vaginal bleeding. She is Rhesus negative. what do you do?

One dose of Anti-D immunoglobulin followed by a Kleilkhauer test

32

Second screen for anaemia and atypical red cell alloantibodies

28 weeks

33

Anaemia in pregnancy is
first trimester Hb less than 110 g/l
second/third trimester

Hb less than 105 g/lpostpartum
Hb less than 110 g/l
Hb less than 100 g/l

34

APGAR score

Pulse
respiratory effort
colour
muscle tone
reflex irritability

35

what are layers that must go through cesarian section?

Superficial fascia
Deep fascia
Anterior rectus sheath
Rectus abdominis muscle
Transversalis fascia
Extraperitoneal connective tissue
Peritoneum
Uterus

36

what would you do if the endomtetritis is suspecteD?


if endometritis is suspected the patient should be referred to hospital for intravenous antibiotics
clindamycin and gentamycin







37

nausea + lethargy + plus jaundice

acute fatty liver of pregnancy

38

Examples of UKMEC 3

more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)

39

Examples of UKMEC 4 conditions include

more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation

40

Contraceptives - time until effective (if not first day period):

instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

41

Inducers of the P450 system include

antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John's Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)

42

If more than 3 hours late (i.e. more than 27 hours since the last pill was taken)
action needed - see below

Action required, if needed:
take the missed pill as soon as possible. If more than one pill has been missed just take one pill. Take the next pill at the usual time, which may mean taking two pills in one day
continue with rest of pack
extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours

43

Desogestrel-only pill mechanism of action

In women using the desogestrel-only pill up to 97% of cycles are anovulatory and inhibition of ovulation is the primary mode of action of these pills.

44

Examples of contraceptives that are unaffected by EIDs are:

Copper intrauterine device
Progesterone injection (Depo-provera)
Mirena intrauterine system

45

Cerazette (desogestrel)

If less than 12 hours late
no action required, continue as normal

If more than 12 hours late (i.e. more than 36 hours since the last pill was taken)
action needed - see below

46

contraception in post-menopausal women that should be stopped

Depo-Povera and COCP

47

Oral levonorgestrel (used as emergency contraception)
How does it work?

Inhibits ovulation

48

A 27-year-old female presents to her GP as she missed her desogestrel contraceptive pill (progestogen only) this morning and is unsure what to do. She normally takes the pill at around 0900 and it is now 1430. What advice should be given?

Take missed pill now and no further action needed

49

Tanya is admitted with abdominal pain 4 days following medical management of an ectopic pregnancy. What medication is used for this?


Methotrexate

50

Elpitha is an 18 year old lady with lower abdominal pain, no dysuria and a negative urine HCG-what is your most likely differential diagnosis?

PID

51

Amanda is admitted with vomiting and left sided abdominal pain-what is your most likely differential diagnosis?

Ovarian cyst torsion

52

Deirdre is a 95 year old lady who has come in from her care home with PV bleeding-what is the most likely diagnosis?

Atrophic vaginitis

53

Deirdre is a 95 year old lady who has come in from her care home with PV bleeding-what is the most likely diagnosis?

What is the risk of Deirdre having endometrial cancer? 10%

54

If Deirdre had a transvaginal USS that showed an endometrial thickness of 6mm-what would you say to her

Perform a pipelle biopsy

55

Georgina is 38/40 and her waters went 3 days ago. You notice that she has a GBS sticker in her notes-the midwives are asking how she should be managed?

current infection + rupture of membranes = start immediate induction of labour

56

Tanya is a 23 year old lady who has been diagnosed with PID. What antibiotics would you start?

IM Ceftriaxone, doxycycline and metronidazole 14/7

57

Sasha is an inpatient who is having medical management of her miscarriage. The nurses on the ward ask you to review her as she is having a heavy bleed, what is the most important thing you should do?

Perform a speculum examination

58

Verity had an anterior repair yesterday and is complaining of lower abdominal pain-what is the most likely diagnosis?

urinary retention

59

You are bleeped by the Labour Ward-Dominica has SROM’d and was 5cm dilated 4 hours ago. She is contracting 2:10, has just been re-examined and is 5cm-what should be done?

Start syntocinon

60

What is Mc.Roberts?

Hyperflexion of the maternal hips

61

The baby is delivered with Mc.Roberts. and is brought to the resuscitaire. You administer 5 inflation breath with good chest rising but the baby is still not breathing spontaneously-what would you do now?

Administer ventilation breaths over 30 seconds

62

Estelle comes in through maternity triage-she is a type 2 diabetic. When should she be scanned in this pregnancy?

Every 4/52 from 24/40

63

What is the dose of Magnesium sulphate?

4g over 5minutes

64

Gardasil - what 4 does it protect against?

Name the one from the list: Gardasil protects against HPV 6, 11, 16 & 18.

65

UTI in first trimester of pregnancy. What would be the safest and most effective treatment?

Nitrofurantoin
cefalexin
amoxicillin
Antibiotics should be given for 7 days

66

Amenorrhoea for 4 months - what do u do?

exclude pregnancy with urinary or serum bHCG
gonadotrophins: low levels indicate a hypothalamic cause where as raised levels suggest an ovarian problem (e.g. Premature ovarian failure)
prolactin
androgen levels: raised levels may be seen in PCOS
oestradiol
thyroid function tests

67

Girl with cystic ovaries on US and something else. What other symptom would be the best indicator of her having polycystic ovaries?

Amenorrhoea, Hirustuism, Infertility, and then Obesity, Acne

68

Woman with PCOS. Best medication to increase fertility

Clomifene inhibits estrogen receptors in the hypothalamus, thus prevents the release of FSH

69

Woman with signs of premature ovarian failure. What test would be best to confirm this diagnosis: Oestradiol, Testosterone

FSH, LH.
FSH is better single useful test according to BMJ best practice

70

premature ovarian failure, what are the features?

• infertility
• secondary amenorrhoea
• raised FSH, LH levels

71

Man with azoospermia. What would be the most likely cause?

Mumps

72

Post menopausal woman with a PV bleed. What ix should you do?

outpatient US with endometrial biopsy

73

Lady with cyclic pain 1 week before her period starts, trying for a baby for one year

endometriosis

74

Q) What is a 23 week USS useful for? At 23 weeks the scan is generally repeated when the baby is in the wrong position or the mum is overweight

prediciting the position of the placenta at term
What is a 23 week USS useful for? At 23 weeks the scan is generally repeated when the baby is in the wrong position or the mum is overweight

75

• 50% of significant abnormalities will be detected by the 20-week screening scan.
• To provide the parents with options - eg, termination, preparation, and appropriate care throughout the rest of the pregnancy and delivery.

• 50% of significant abnormalities will be detected by the 20-week screening scan.

76

What causes increased urinary volume and frequency in the first trimester? Increased

GFR

77

Effect of taking fluoxetine during pregnancy on baby?

Persistent pulmonary hypertension of the newborn, …

78

antidepressants recommended in pregnancy

then paroxetine or sertraline is normally recommended.

79

Woman with Nexplanon. Most likely reason for wanting to change contraceptive?

irregular/heavy bleeding is the main problem

80

Pregnant lady being domestically abused by husband and scared to go home.

call and arrange emergency accommodation

81

Fast growing painful lesion on the labia

Bartholini

82

Women who has gone through menopause, had a hysterectomy. Wants HRT mainly to prevent osteoporosis and treat her hot flushes. Doesn’t want to take tablets.

Transdermal oestrogen,

83

Swimmer wants to treat hot flushes, doesn’t want a patch

cyclical

84

Woman with premature ovarian failure, wants to have periods.

COCP

85

COCP

Bisphosphonates

86

Lady high White cell count, fever, and lump in breast:

abscess, if no lump it would rather be mastitis

87

General breast tenderness

left sided, breastfeeding: mastitis

88

SBA on cx of hyperemesis gravid.- choices were b12 def (shud b b1 thiamine),

• Wernicke’s encephalopathy (from vitamin B deficiency)
• Korsakoff’s syndrome (from vitamin B1, deficiency)
• Haematemesis (from Mallory–Weiss tear)
• Psychological – resentment towards the pregnancy and expression of desire to
• terminate the pregnancy
• VTE
• central pontine myelinolysis
• acute tubular necrosis
• fetal: small for gestational age, pre-term birth

89

SBA on what to do with a cord prolapsed

- elevate the presenting part
- push the fetus in
- the presenting part of the fetus may be pushed back into the uterus to avoid compression.
- Tocolytics may be used.
- If the cord is past the level of the introitus, it should be kept warm and moist but should not be pushed back inside. The patient is asked to go on 'all fours' until preparations for an immediate caesarian section have been carried out.

90

HIV in preggie -

Antiretroviral therapy
all pregnant women should be offered antiretroviral therapy regardless of whether they were taking it previously

Mode of delivery
vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
a zidovudine infusion should be started four hours before beginning the caesarean section

Neonatal antiretroviral therapy
zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml. Otherwise triple ART should be used. Therapy should be continued for 4-6 weeks.

91

14 year old primary amenorrhoea + ejection systolic murmur -

Turner’s

92

What do you test for in Hep B infection antenatal?

HBsAg

93

What is not a risk factor for primary PPH? I put beta thalassemia trait but not v sure
a.

B thalassemia trait, if intermedia then it would have consequences
b. Retained products
c. Sepsis
d. Vaginal tear
e. Grand Multiparty

94

At antenatal check, woman with BP 150/90, what would you do?

Admit and assess

95

Urogynae – leak urine when laughing and going up stairs, initial management?

Pelvic floor exercise

96

What is the treatment for a Bartholian abscess –

marsupialization

97

Women with previous GDM what is the best way to investigation her blood glucose

OGTT at 28w

98

Women with APH (spotting) otherwise well, what is the most important thing to rule out?

Ectopic pregnancy

99

1What type of contraception can increase risk of osteoporosis?

Depot injections, Dep-povera
Adverse effects
• irregular bleeding
• weight gain
• may potentially increased risk of osteoporosis: should only be used in adolescents if no other method of contraception is suitable

100

Women with excessive vomiting, under what circumstance would you admit her?

Ketonuria
Inpatient management should be considered if there is at least one of the following:
● continued nausea and vomiting and inability to keep down oral antiemetics
● continued nausea and vomiting associated with ketonuria and/or weight loss (greater than 5% of body weight), despite oral antiemetics
● confirmed or suspected comorbidity (such as urinary tract infection and inability to tolerate oral antibiotics).

101

1Which drug is likely to be teratogenic?

Sodium valproate

102

Intact uterus and amenorrhoea for more than 2 years

continuous combined HRT

103

Women with menopausal symptoms and has eczema, and bleeds free for less than 2 years

oral combined HRT

104

Blue dots on cervix –

nathobian cyst Nabothian follicles (blocked mucous glands)

105

Mother with stillborn baby, generalized oedematous when born, mother had fever at 18w with rash on trunk

chicken pox

106

Disease that requires rapid vaccination at birth/immunoglobulins if mother is highly infectious.

babies born to mothers who are chronically infected with hepatitis B or to mothers who've had acute hepatitis B during pregnancy should receive a complete course of vaccination + hepatitis B immunoglobulin

107

Disease that require C-section if mother has an outbreak at 34wks or later due to risk of transmission vaginally :

HSV

108

due to trans-placental spread from the mother. It causes a variety of effects to the unborn child including microcephaly, hydrocephalus, cerebral calcification and choroidoretinitis

toxoplasmosis

109


Skin lesions, lymphadenopathy, failure to thrive

syphilis

110

Smear comes back as moderate dyskaroysis

CIN2

111

76 year old had a single brown discharge –

endometrial cancer

112

Intermittent pain + vomiting

ovarian torsion

113

47yo women with menorrhagia + dysmenorrhea, US showed multiple fibroids

• symptomatic management with Mirena, other options include tranexamic acid, combined oral contraceptive pill etc
• GnRH agonists may reduce the size of the fibroid but are typically useful for short-term treatment
• surgery is sometimes needed: myomectomy, hysterscopic endometrial ablation, hysterectomy
• uterine artery embolization

114

32 yo has 2 children down with family, had COCOP before

mirena

115

Women going away for holiday and would like to delay her periods

COCP or norethiestrone

116

Mother being prepared for CS, sudden tingling around her mouth?

anaphylaxis

117

Mother had previous CS, sudden abdo pain and abnormal CTG

uterine rupture

118

dyskariosis

This term simply means abnormal nuclei -that is that the nuclei in the cells are different from normal cells, they are hyperchromatic and have irregular chromatin.

119

20 week antenatal scan. Which of the following is the best description.

Scan with biometry

120

Q) Lady has a diagnostic laparotomy. She has suprapubic pain that not even IV paracetamol is helping.
What is the likely reason?

Urinary retention

121

Somali lady comes in doesn’t speak much English says she' 42 weeks. Examination of abdomen suggests a 32 week uterus. What is next in management?

Admit her to ward for ANC tomorrow, do HIV test as HIV babies tend to be small, Induce her Labour now, do a transabdominal scan]

122

What is used ads screening for Down

the combined test: 11-13+6 nuchal translucency measurement + serum B-HCG + PAP A
14 wks: OHIA *oestriol, HCG, and inhibin-A AFP,
Low alpha fetoprotein (AFP)
Low oestriol
Low pregnancy-associated plasma protein A (PAPP-A)
Thickened nuchal translucency
High human chorionic gonadotrophin beta-subunit (-HCG
High Inhibit

123

anorexia investigations

Anorexia Nervosa:

124

PCOS investigations

Free androgen index

125

Menopause

FSH – premature menopause

126

twins are associated with twin to twin transfusion

Monoamniotic monozygotic

127

two fetal poles, one gestational sac

Monoaminotic

128

Dichorionic

two placentas

129

Booking bloods/urine

FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
hepatitis B, syphilis, rubella
HIV test is offered to all women
urine culture to detect asymptomatic bacteriuria

130

Drugs used in pre-eclampsia

a) Ranitidine
b) Prednisolone
c) Cyclizine
d) Thiamine

131

The risk factors for endometrial cancer are as follows*:

obesity
nulliparity
early menarche
late menopause
unopposed oestrogen.

132

Perinatal mortality rate as:

The number of stillbirths (of at least 22 completed weeks of gestation) plus the number of neonatal deaths within the first 7 days of life per 1000 births.

133

A 35-year old woman presents with secondary amenorrhea for 2 months

Serum beta-HCG

134

A 20-year old woman presents to the Gynaecology department having never menstruated. She has a short stature and ultrasound scan reveals ‘streak’ ovaries.

Karyotype testing

135

A 36-year old has an uncomplicated spontaneous vaginal delivery of her 3rd baby. Soon afterwards, the midwife pull the emergency buzzer as the patient has suddenly become unresponsive. Her pulse is 44bpm and her blood pressure is unmeasurable. Her estimated blood loss was 800ml. There is no active vaginal bleeding, the perineum appears intact and the placenta is complete

The degree of shock is disproportionate to the amount of the blood loss.

136

A midwife from the post-natal ward calls you to review a woman who is feeling increasingly unwell. She underwent an emergency caesarean section 2 days ago for failure to progress after an induction for prolonged rupture of membranes. On examination she appears clammy with a regular pulse of 122bm, blood pressure of 125/70, respiratory rate of 24, oxygen saturation of 99% on room air and temperature of 35.4C.

Septic shock

137

woman with polyhydramnios secondary to gestational diabetes mellitus is admitted for induction of labour. Soon after the midwife performs an artificial rupture of membranes, there is a fetal bradycardia which does not recover

cord prolapse

138

medroxyprogesterone is the same as X and whats its its side effect

- loss of bone mineral denisty
-Depropovera