o&g Flashcards

Question

Syphilis

Answer 1

takes 3/12 weeks treponamel pallidum dark field - dark ground appearance of chancres under microscopy Jarish-herxheimer - give steroids before benzatheine-pen IM stat in 1st, 2/3rd = IM, IV in neuro primary - painless chnacres and local lymphadenopathy secondary - snail track ulcers, papulonodular rash, condylomata lata tertiary - gummatous, cardio - aortic regurg, neuro - dementia, labile emotions, lightning pains non-treponemal - RPR, VDRL treponemal - EIA repeat bloods at 6 and 12 weeks if myalgia - admit mothers after 22 weeks

Answer 2

<26w= 36 weeks to delivery = oral daily + VSD (IV acyclovir intrapartum and neonate) >26w until delivery = c section + acyclovir recurrrent - daily until delivery from 36 weeks SEM, CNS, disseminated avoid forceps

Answer 3

Keratinised warts = imiquimod cream Non-keratinised warts = podophyllin/tri-chloro-acetic acid dermatoscopy

Answer 4

need to check Ig first if not, give IVIG if <20 weeks or > 20 weeks, within 10 days exposure, no symps oral acyclovir if >20 weeks, within 24 hours foetal specialist unit 16-20 weeks/ 5 weeks after infection <7 days of delivery/ rash - IVIG to neonate if neonatal infection = oral acyclovir congenital: cataracts, microcephaly, limb hypoplasia, IUGR neonate: purpura fulminans, pneumonia 15 mins contact can be contagious monitored until after 28 days

Answer 5

high risk vaginal: hyperextended neck, LBW, HBW, footling, foetal compromise CI for ECV: antepartum haemorrhage in prev 7 days, ROM, indications for c-section, multiple preg, abnormal CTG 36 - nulli. 37 - multi hands off approach, Pinard - poke politeal bend knees, Loveset - transverse + anterior arm if head stuck - winging of scapulae C section -ves: normal c section risks, uterine rupture, placenta accreta .etc. +ve: better APGAR, perinatal mortality better tocolytic like terbutaline can improve success rate of ECV

Answer 6

o Pregnancy test o Scan o Height, weight, bloods and urine dip with nurse o STI screen o Speak with a counsellor regarding your reasons, options available and future contraception Antibiotics are given to reduce risk of infection chance of ectopic, 24 hr help line HSA 1 and HSA 4 expulsion at home, <14 weeks MVA, > 14 weeks dilatation and curetagge more painful as further along antiibiotics and painkillers anti D >10 weeks or any surgical 4 weeks = chorio, ectopic 24-48 hours apart, 10-23 = 36-72, >21 = feticide = digoxin, KCl/ regular interval misoprostol (max 5 doses) urine preg usually 2 weeks after

Answer 7

CXR, ECG eleavte legs USS: · If -ve and low clinical suspicion à stop anticoagulants · If -ve and high clinical suspicion à stop anticoagulants and repeat USS on days 3 and 7 Subcutaneous LMWH until at least 6 weeks postnatally and until ≥3 months of treatment until at ≥24 hours after last dose of LMWH stop 24 hours before at term = IV unfractionated Prevention at 12w BOOKING visit: · Prolonged use of LMWH (>12 weeks) · Graduated elastic compression stockings Graduated elastic stockings should be used initially and worn for 2 years following DVT to prevent post-thrombotic syndrome · From 12w until 10 days to 6 weeks post-partum ≥4 risk factors, VTE event · From 28w until 10 days post-partum 3 risk factors Conservative <3 risk factors <50, >90

Answer 8

protective against endometrial and ovarian inc risk of breast and cervical

Answer 9

<12 weeks : CRS - PDA, microcephaly, cataracts 12-20 - chorioreitnetitis - cataracts >20 weeks - low risk forcheimer spots foetal specialist unit and HPU no MMR IgM and IgG and PCR no work until 5 days after rash TOP if < 16 weeks parvovirus B19 serology

Answer 10

>30 dietician referral good diet and exercise anaesthetic review >40 IOL discussion to avoid c-section 5mg folic acid 1 month before conception 150mg aspirin diabetes screening from 24 weeks do USS instead of SFH TVUSS for nuchal translucency instead of transabdo >35 obstetric consutant led constant foetal monitoring active management of 3rd stage

Answer 11

nitrofurantoin, trimethoprim after 12 weeks IV cefuroxime if admitted otherwise PO cefalexin in pyelonephritis urinalysis in every antenatal appointment urine MCS at booking preterm and pyelonephritis nitrofurantoin at term = neonatal haemolysis

Answer 12

no sex for 3 months, no alcohol, sensitive to sun weekly serum bhcg until negative pregnancy test after 2 weks metho CI in surgical requirements, liver disease, intrauterine preg, breastfeeding >63, 50-63, >50 no kleihauer, 250 IU of anti-D syncope, fatigue copper IUD not used if have salpingectomy

Answer 13

hypogonadotrophic hypogonad, normo nromo = PCOS, hyper hypo, also hypothyroid previous pelvic/ abdo surgery asherman's septate can be corrected for varicocoele lifestyle - acholo, drugs semen analysis done 3 months apart mid-luteal progesterone not in POI if unexplained try another 12 months ovarian induction = clomiphene (OHS) intrauterine - mild endo, not responsive to OI LH and FSH only in irregular periods can do laporoscoipic dye to check tubal abnormalities

Answer 14

o Women <40 offered 3 cycles of IVF if… § Subfertility for 2 years § Not pregnant after 12 cycles of artificial/intrauterine insemination o Women 40-42 offered 1 cycle of IVF if… § Subfertility for 2 years and/or not pregnant after 12 cycles of AI § Never had IVF § No evidence of low ovarian reserve Informed about additional implications of IVF at this age if children with another partner, dont give

Answer 15

COCP: none in first 5 days, any other time 7 days barrier red risk of ovarian and endometrial tricyclic or three weeks and 1 week off stop 4 weeks before surgery switch to POP 2 weeks after UKMEC 1 pill vs 2 pills missed POP: immediate protection if switch from COCP, osteoporosis, if not first 5 days, then 2 days barrier missed = 3 hours >3 hours late: take missed pill, barrier for 48 hours if 2 missed: take both and same, emergency if UPS desogesterel = 12 hours patch: 48 hours, barrier 7 days, emergency if <5 days of patch free or during ring IUS: 7 days after insertion if not 5 days first, 3-5 years IUD: 10 years, childbirth 48 hours or.4 weeks after , not in menorrhagia injection: 6-12 months for fertility to return, weight gain and ectopic implant never give contraception under 30 cocp: prevent ovulation pop: thickens cervical implant, injection, IUS: thickens cervical and prevent ovulation

Answer 16

cocp, injection: continue after 50 years, switch to POP injection can also be stopped after 2 years amenorrhoea implant, POP, IUS continued xondoms stopped 2 years <50, 1 year >50

Answer 17

maternal: anaemia, GDM, pre-eclampsia, preterm birth, hyperemesis, DVT foetal: TTTS monochorionic: 12, 16 weeks -delivery every 2 weeks dichorionic: 12, 20, to delivery every 4 weeks after 24 weeks every 2 weeks to check IUGR - growth scans monochorionic: 9 antenatal, at least 2 with consultant dichorionic: 8, at least 2 with consultant Twin trust support - SOB, abdomen largens, swollen IPV laser ablation of vascular anastomoses hydrops fetalis if TTTs, deliver by 37 weeks can offer elective 36 (mono) and 37 (di) mono - 36-37 di - 37-38

Answer 18

Energy: more fat storage, less protein requirement, increased insulin sensitivity Resp: no change in RR, inc minute ventilation, TV and breathlessness, red FRC cardio: inc CO, SV, HR, more hypotensive and less peripheral resistance endo: inc progesterone = reflux and constipation kidney: inc aldosterone, GFR and reduced creatinine haem: macrocytosis, dilutional anaemia, thrombocytopaenia, neutrophilia Kidneys - increased urine output, pee more frequently - not only because of more urine from both foetus and mother but also foetus compressing the bladder and causing the feeling of fullness If dysuria, haematuria, fever --> UTI Skin - warm hands, palmar erythema Advise woman to dress in layer · Oesophageal sphincter not functioning --> reflux, heart burn Lying down makes worse - upright after eating for 2 hours If 3 meals difficult - break down into 6 snacks Check OXBASE to see if medicines suitable in pregnancy BUMPS - best use in medicine

Answer 19

daily foetal movement check by mum after 28 weeks no carboprost or ergometrine smoking cessation continue inhalers follow up flu vaccine

Answer 20

2 FSH >30 4-6 weeks apart anti mullerian hormone, antral follicular count DEXA scans donor oocyte IVF

Answer 21

11-16 weeks after dating if less than 25mm on USS between 16 and 24 weeks LLETZ or cone biopsy, >=3 previous preterm emergency if 16-28 weeks, unruptured membranes, dilated cervix CI = infection, bleeding, contractions

Answer 22

IPA if maternal pyrexia, preterm labour, previous GBS, GBS detected, UTI with GBS IV benzylpenicillin if <4hrs of Abx before delivery = monitoring if > 4hrs no need moniotor 1hr-->2hr-->every 2 hours for 12 hours IPA given as soon as labour started then every 4 hourly 1 risk factor --> remain in hospital for at least 24 hours for observations ≥2 risk factors or one red flag à sepsis ABx + septic screen 50% risk of GBS in next preg If women are going to have swabs for GBS, this should be at 35-37 weeks (or 3-5 weeks before EDD) if ECS no need active management is IM oxytocin

Answer 23

28 weeks 6 weeks oral acyclovir IV intrapartum to mother and neonate SEM (blistering vesicular rash and chorioretinitis), CNS (seizures, drowsiness, bulding fontanelle, poor feeding, irritability) disseminated - encephaltiis if recurrent daily supplement from 26 weeks

Answer 24

viral load <50 at 36 = SVD >50 = ELCS at 38 no breastfeeding no foetal blood sampling zidovudine to neonate for 2-4 weeks if <50, if >50 then triple treatment viral PCR at 6, 12, 18 weeks for neonate 2 x CD4 delivery and booking 8x viral load, every 2-4 weeks, at 36 weeks and after delivery cabergoline to suppress lactation immunisations inc BCG cord clamp immediately even if not on any HIV therapy, must start from 24 weeks pep

Answer 25

vitamin b1 and folic acid macrocytic anaemia peak at 9 weeks hyperthryoid, multiple preg, obesity IUGR Mallory Weis reassess in 24 hours PUQE-24 score (>=13) - vomiting, retching 7 times or more, nauseated for 6 hours more ondansetron - cleft palate in 1st trimester

Answer 26

from 36 weeks vitamin K 28-36 weeks - 4 weekly growth scans eclampsia if not epilepsy diagnosis other causes enceph, alcohol withdrawal, SOL monotherapy, encourage breastfeeding

Answer 27

increase dose by 25 ug monitor TFTs in 2 weeks time then every 2-4 weeks, incase need adjusting of dose 6-8 weeks after delivery recheck TFT levels, reduce right after delivery thyrotoxicosis - propanolol in hyper then levothyroxine in hypothyroid - check 2 monthly TFTs IUGR, preterm, miscarriage euthyroid = TSH <4, optimum is 2.5-3

Answer 28

propyluracil in 1st as placenta less freely cross, hepatotoxicity ofr mother carbimazole is 2nd and 3rd; can cause aplasia acutis - patch on head of baby never grows hair, 20-->15-->10 agrunlocytosis in both WCC, LFTs

Answer 29

I and D, word catheter salt eater vath, painkillers, warm compress

Answer 30

o < 110 g/L in 1st trimester o < 105 g/L in 2nd/3rd trimester o < 100 g/L postpartum < 70 g/L – URGENT REFERRAL recheck in 2-3 weeks after giving trial of iron group and save at booking consultant led booking and 28 weeks check anaemia foetal - enlarged heart, red foetal movements - <60 foetal Hb

Answer 31

post-partum thyroiditis Edinburgh post-natal depression scale >12

Answer 32

sabin feldman dye test spiramycin pyrimethamine and sulfadiazine cataracts, convulsions, intracranial calcifications, hydrocephalus, microcephaly 3rd trimester toxoplasma gondii

Answer 33

hydrops fetalis high output HF intrauterine blood transfusions <20 weeks GA foetal anomaly 4 weeks after and serial 2 week scans rule out rubella serology as presents similarly

Answer 34

<20 weeks within 10 days - IVIG >20 weeks within 24 hrs = oral acyclovir severe = IV acyclovir underlying immunocompromise = admission in latter half of preg foetal specialist unit = 16-20 weeks/ 5 weeks after infection 21 days infections vs 28 days with IVIG acyclovir in neonate if infected at birth if <7days of birth then IVIG to neonate want to delay by 7 days ideally 7days acyclovir Tx opthalmic exam and observe 28 days § Eyes (chorioretinitis à cataracts) § CNS (microcephaly) § MSK (limb hypoplasia, cutaneous scarring) IUGR purpura fulmianns in neonate if the pregnant woman > 20 weeks gestation is not immune to varicella then either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure

Answer 35

vanciclovir and ganciclovir >21W GA, <21d neonate PCR SNHL, jaundice, hepatosplenomegaly, periventricular calcifications, opthalmic audiology follow up

Answer 36

tocolytics - terbutaline dont eant cord spams and hypoxia CTG artifiial rupture of membranes can cause

Answer 37

if little fluid can discharge if premature admit until 37 weeks 4 hourly observations and 24hr foetal monitoring no tests if established labour - straight to labour ward >15mm preterm birth likely erythro 10 days before delivery mag sulph <30w AND labour/ <24 hrs del

Answer 38

bacteriuria assoc with preterm and pyelonephritis do MCS at booking, urinalysis at every appointment for pyelo: PO cephalexim OP, IV cefuroxime in admiited low birthweight encourage fluid intake

Answer 39

goose egg bump on forehead umbilical cord bleeding, guthrie test bleeding, vitamin K injection avoid IM, NSAIDs, aspirin high APTT

Answer 40

within 72 hours cord blood analysis if Rh+ve, 500IU within 72 hrs of delivery and in all previously sensitised women weekly MCA doppler if antibodies at booking 500IU at 28 and 34 or 1500IU at 28 weeks if continuous bleeding anti D every 6 weeks, Kleihauer every 2 weeks <12 weeks + heavy painful >12 weeks vaginal bleeding

Answer 41

delivery +/- hysterectomy DIC so repair coagulation - FFP, cryoprecipitate, transfusions coag screen placental abruption, IOL, c-section

Answer 42

tone -placental praevia, tissue - blood clots, accreta, percetra, incretra, thrombin, trauma oxy --> erg-->carb-->balloon catheter-->B lynch suture --> hysterectomy DIC secondary 24hrs - 6 weeks catheter to allow uterine contractions

Answer 43

pill, puberty, preganncy move away from oestrogen cotnraceptives

Answer 44

sessile, pedunculated due to overgrowths of endocervix unscheduled vaginal bleeding TVUSS, outpatient hysteroscopy hysteroscopic polypectomy

Answer 45

within 1 week joint clinic then 2 weekly vists 6 week postnatal check discontinue medication immediately after birth

Answer 46

urinary incontinence, repeated UTIs before deinfub - check UTIs give prophylactic abx if daughter let safeguarding midwife know put in redbook 1=clitorectomy, 2= labior minora and clitorus should be recorded in notes safeguarding risk assessment in preg specialist gynae/ FGM clinic

Answer 47

saline hysterosonography - balloon with saline + TVUSS amenorrhoea, subfertility hysteroscopic adhesiolysis - increase cavity size through resection, follow up in 3-6 months place copper IUD and give PO oestrogens and progesterones

Answer 48

clobetasol for 3 months white parchment paper tacrolimus as next line

Answer 49

missed/ delayed <6 weeks no need USS, expectant, 1 week preg test, 2 week follow up if expectant >6 = 1-2 weeks bleeding, 3 weeks preg test, 4 weeks follow up periods in 4-8 weeks threatened if bleeding over 14 days/ gets worse come back always do expectant first

Answer 50

may itch and bleed imiquimod cream in keratanised tri-chloro-azetic acid in non-keratinised both CI in preg but uslaly no tx, may refer to GUM for STI screening

Answer 51

mixed, overflow - urogynae referral overactive bladder syndrome 8 contractions TDS for 3 months urodynamic: detrusor = bladder - IAP urinary dye studies for vesicovaginal fistula colposuspension

Answer 52

refer to specialist centre no sex for 12 months monthly bHCG until stable for complete 4 weeks later bhCG for partial 3 weeks after Mx preg test may need methotrexate after surgery if rising levels anti-D painless PV bleeding

Answer 53

come back for weekly USS and check ups no foetal distress: admit and observe for 48 hrs, aim to deliver 37-38 weeks foetal distress: c-section if >36 weeks - deliver (vaginal if no distress, c section if distress)

Answer 54

mirena/ hysterectomy unschedule bleeding for first 3 months oestrogen SE: breast tenderness, headache progesterone: fluid retention, mood swings should subside >2 years of contraception if <50 and amenorrhoea >1 yr if >50

Answer 55

2x LFTs, FBC and U&E's 3x if severe 4x a day inpatient, eevry 48 hours outpatient >150 on diacharge community midwife takes measurements if severe MgSo4 intrapartum, avoid ergometrine, continuous obs, CTG >30mg =significant protein on PCR SLE, APLS are autoimmune risk facotrs

Answer 56

hysterectomy in uterine prolapse anterior colporrhaphy posteriorcolprrhaphy sarcocoplexy in vaginal vaunt ask about HRT use - menopasuek, constipation rectoceoele = tenesmus, constipation cystocele - UTI Shwa's staging to introitus first stage topical oestrogen can be used in elderly

Answer 57

polymorphic eruptionn of pregnancy - buttocks and thighs erythomycin for acne all late 2nd/3rd trimester prurigo and PEP = 3rd pruirtis follivulitis pemphigus refer to derm no icnrease in pregnancny loss

Answer 58

Mento means chin so you're thinking about where the chin lies Mento anterior is what you want Want flexed foetus but when neck and head extends becomes brow then face When brow can palpate supraorbital bridges When face palpate facial features Brow = c-section - worried about hyperextension of bone Face if mento anterior position = mentoposterior = csection Transverse = c-section, can do ECV but real risk of prolapse Occipito-anterior > posterior - vaginal possible Occipito transverse - vaginal possible but may need forceps Advise epidurals and foetal monitoring OP cause by weak uterine contraction, flat sacrum, poorly flexed head

Answer 59

latent to 4cm then established to 10 1,2 in mutli, 2,3 in nulli <5 = prostaglandin <3 = IOL not gonna help if prolonged and ruptured = oxytocin, if not = ARM braxton: painless, infreqeunt not cervical change 1,5 minutes 4 hourly exams crowning when head no longer retracts breastfeeding in 1st hour 2cm per hour in multiparous

Answer 60

causes of prolonged: cephalopelvic disproportion, malpresentation, malposition, epdiural, infrequent uterine contractions CI: vase praevia, placenta pevia, midline scar Indciated: prolonged, obstetric cholestatsis, diabetes, pre-eclampsia,preterm rupture, post dates, abnormal CTG uterine hyperstimulation ?5 over 10, 1 lasting >2, stop infusion/ remove prostaglandins, consider tocolytics * if the Bishop score is ≤ 6 ○ vaginal prostaglandins or oral misoprostol ○ mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean * if the Bishop score is > 6 amniotomy and an intravenous oxytocin infusion

Answer 61

mpre blood to uterus, skin, breats, kdineys urine output higher but creatinine lower TV higher but residual capacity lower HR higher, BP lower, SV and CO higher oestrdial high, LH and FSH low GOR warm peripheries RR same macrocytosis, thrombopaenia, neutrophilia, inc fibrinogen

Answer 62

miscarriage, preterm birth, meconium staining IV amoxicillin sepsis, meningitis

Answer 63

NYHA peripartum cardiomyopathy: volume cant keep up with CO arryhtmias can increase rish GUCH no problems if acyanotic, and if cuyanotic and treated no ergometrine 2nd stage short with elective ventouse/ forceps if rlly bad then ELCS - NYHA III and IV epidural echo at booking and 28 weeks LMWH in arrhythmias HDU cardiologist follow up avoid IOL

Answer 64

exotoxin from strep and staph wounds, tampons GI symps, desquamation, erythrodermic rash all over body macular spesis protocal clindamycin

Answer 65

established by 24 felt by 20 >28 = concern 70% prognosis may do USS despite normal CTG if concerned if recurrent check genetil abnormalities praevia, obesity, oligo/poly if not felt by 24 = referral to maternal foetal medicine unit USS looks at abdo circum, weight and amniotic fluid

Answer 66

if severe SSRI and CBT and lifestyle advuce - preventing social and professional

Answer 67

>10cm3, 12cycts, 2-9cm3 one cyst annual BP, 6 monthly weight OGTT in pregnancy 2-6 days of menstrual cycle give clomipehen eflornithine worsens acne BMI>35 = IUS co-cyprindiol better anti-androgenic but inc risk of clots give oral medroxyprogesterone if havent bled in a couple months to induce a withdrawal bleed for cirrect interpretation - 14 days

Answer 68

before conception

Answer 69

copper IUD

Answer 70

during adolescence

Answer 71

sertraline

Answer 72

adolescence

Answer 73

CIN 1 is conservative if +ve HPV ithe colposocpy in 6 weeks otherwise routine recall CIN2 and 3 colposcopy in2 weeks and treat test of cure after 6 months inadeuqate within 6 weeks colposcopy if hysetrectomy then 6 and 18 motnhs smear after test of cure retunr to routien recall but 3 years regardless of age

Answer 74

if not fully dilated = ARM and reassess in 2 hours then may need oxytocin if not dilating then vaginal gel/ pessary if filly dilated and head is low = ventouse if high = forceps both OA forceps need episiotomy

Answer 75

can cause preterm birth and late miscarriage potassium hydroxide

Answer 76

In general NSAIDs avoided because renal agenesis but can give ibuprofen as low secretion into breastmilk Coedine should be avoided in 3rd trimester close to delivery due to resp depression May be able to prescribe co-codamol but don’t co give with paracteamol as overdose

Answer 77

mittelschmerz fluid means mid cycle

Answer 78

progesterone only

Answer 79

addisons disease

Answer 80

oestrogen patch

Answer 81

3 monthly for irregular monthly for regular

o&g Flashcards

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