O&G Flashcards
(134 cards)
1
Q
When is anti D given
A
to rh negative mothers at 28 and 34w or whenever risk of maternal-foetal blood mixing
2
Q
what happens to hb during preg
A
drops
3
Q
dating scan is when
A
11-14w
4
Q
anomaly scan is when
A
18-21 weeks
5
Q
What screen is done around time of dating scan
A
combined screen for Down’s, Edwards and Pataus
USS+blood (hCG and PAPP-A) + maternal age
6
Q
What is an alternative to combined screening
A
quadruple screen (for down’s only using hcg, AFP, inhibin A and oestriol)
In this case the anomaly scan would be used for Edwards and Pataus.
7
Q
Does the combined/quad screening give you a specific chance?
A
No just more or less than 1/150
8
Q
If you get higher chance in the screenings what are your options
A
NIPT
OR
diagnostic tests-
1) CVS at 11-14 weeks
2) amniocentesis at 15-18 weeks
both have chance of miscarriage
after this terminate or continue
9
Q
What vaccines do pregnant women get
A
flu
rubella at 20-32 weeks
Pertussis 16-32 weeks
10
Q
rx for obstetric cholestasis
A
ursodeoxycholic acid and induce at 37 weeks
11
Q
snowstorm on USS is
A
molar pregnancy
12
Q
risk of molar pregnancy
A
can get persistent tissue that becomes malignant choriocarcinoma (give MTX)
13
Q
antiemetics to use in hyperemesis
A
promethazine or cyclizine
2nd line metoclop/ondansetron
14
Q
Last resort rx for hyperemesis
A
corticosteroids
15
Q
what is defined as low birth weight
A
<2500g (at whatever gestational age)
16
Q
what age do you feel foetal movement
A
18-20 weeks (max is 24 weeks)
17
Q
definition of prolonged gestation
A
exceeding 42 weeks
18
Q
When is induction offered
A
41-42 weeks
19
Q
What gestation is PPROM
A
before 37 weeks
20
Q
Management of PPROM if evidence of chorioamnionitis
A
Betamethasone 12mg IM
Deliver
Broad spec abx
21
Q
Mx of PPROM if no evidence chorioamnionitis
A
-Admit, observe for 48h then can take their own temp at home.
-Betamethasone 12mg IM - 2 doses 12h apart.
-Abx- erythromycin
-OP monitoring until induction at 34 weeks
22
Q
When should pre-eclampsia deliver?
A
34w+
23
Q
Complication of pre-eclampsia/eclampsia
A
HELLP syndrome
haemolysis
elevated liver enzymes
low platelets
24
Q
treatment for HELLP
A
deliver
25
what extra monitoring do diabetic mothers need
extra growth scans 28,32,36w
26
gest diabetes increases risk of what complication during labour
shoulder distocia
27
VQ scan for PE increases risk of
childhood leukaemia for baby
28
CTPA for PE increases risk of
breast ca for mum
29
Treatment for VTE in pregnancy
LMWH
30
How should a woman with previous VTE be managed
LMWH for 6w post partum
31
How should a woman with prev recurrnt VTE
or
prev VTE + FHx
be managed
LMWH antenatally and until 6w post partum
32
How should a woman with 3 persisting risk factors for VTE in pregnancy be managed
LMWH from 28 weeks until 6w postnatal
33
Woman with 4+ vte risk factors mx
lmwh immediately until 6w postnatal
34
When should VBAC be offered
singleton who is cephalic at 37weeks
35
absolute contraindications to VBAC
prior high vertical section
foetal distress
transverse lie
placenta previa
36
What is the risk in vbac
uterine rupture
37
What extra medicaiton should preg women with epilepsy get
5mg folic acid
oral vit k in the last 4 weeks
38
Safest AEDs in pregnancy
carbamazepine and lamotrigine
39
When is medical mx of ectopic indicated (MTX)
<35mm
HCB <1500
No heartbeat
40
How long to wait before conception after medically managed ectopic
3 months
41
UTI treatment in pregnancy
nitro in new
Trimethoprim at term (avoid in 1st trimester - NTD as folate antagonist)
42
Recurrent miscarriage is how many
3 consecutive
43
Medical management of miscarriage
mifepristone --> misoprostol
44
Antiphospholipid ix
lupus anticoagulant
anticardiolipin ab
45
what type of decels are concerning on a CTG
late
46
what foetal pH is worrying on blood sampling
<7.20 --> deliver
47
What are methods of induction
membrane sweep
Vaginal prostaglandin
Amniotomy
IV syntocinon for cervical dilatation
48
When is external cephalic version done
36 weeks in nullip
37w multip
49
Management of slow progress in labour
ARM
Syntocinon
C section
If fully dilated- assisted vaginal delivery (forceps etc)
50
Mx shoulder distocia
McRoberts
Suprapubic pressure
Episiotomy
Rotate anterior shoulder
Deliver posterior arm
Break clavicle
Emergency C section
51
Preterm labour is defined as what gestation
<30 weeks
52
Mx preterm labour if membranes ruptured
No tocolysis
Coticosteroids
MgSO4
Consider infection
53
Mx preterm labour if membranes intact
Nifedipine for tocolysis
corticosteroids
MgSO4
54
How to differentiate antepartum haemorrhage vs threatened miscarriage
+ or - than 24 weeks
55
What does a 'woody' uterus indicate
placental abruption
56
mx bleeding placenta previa
inpatient until delivery
C section at 39 weeks
57
What is each type of vaginal tear
1st- vaginal walls
2nd- perineum
3rd- ext anal sphincter
4th - int anal sphincter/rectal mucosa
58
what drug might be used in the active mx of 3rd stage of labour
syntometrine/Ergometrine
59
when can IUS be inserted after birth
within 48h
OR
after 4 weeks
60
Need for contraception after the menopause
12 months after the last period in women > 50 years
24 months after the last period in women < 50 years
61
when can u restart hormonal contraception with levornogesterel
immediately
62
when can u restart hormonal contraception with ullipristal
5 days
63
if given IUD for emergency contraception and they want it out, when can it be removed
until after next period
64
Down's is suggested by what on combined test
↑ HCG, ↓ PAPP-A, thickened nuchal translucency
65
second pregnancy but had prev gestational diabetes- when to do OGTT?
ASAP
66
hyperemesis gravidarum diagnostic triad
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
67
When to time a blood test to check for ovulation
serum progesterone level 7 days prior to the expected next period ('mid luteal')
68
which women should take aspirin in pregnancy from 12 weeks
1 high risk for pre eclampsia or 2 moderate risk
69
Moderate risk factors for pre eclampsia
-first pregnancy
-age 40 years or older
-pregnancy interval of more than 10 years
-body mass index (BMI) of 35 kg/m² or more at first visit
-family history of pre-eclampsia
-multiple pregnancy
70
High risk factors for pre eclampsia
-hypertensive disease in a previous pregnancy
-chronic kidney disease
-autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome
-type 1 or type 2 diabetes
-chronic hypertension
71
GDM mx if the fasting plasma glucose level is < 7 mmol/l
a trial of diet and exercise should be offered
72
GDM mx if the fasting plasma glucose level is > 7 mmol/l
Insulin
73
When else to offer insulin in GDM?
evidence of complications such as macrosomia or hydramnios
74
previous group b strep baby , next birth should recieve what?
intrapartum IV benpen
75
spot urine protein:creatinine ratio of ?mg/mmol or more is used as the threshold for significant proteinuria in pregnancy
30
76
when are women with pre-eclampsia likely to be admitted and observed
BP >160/110
77
Blood results in PCOS
chronically elevated LH --> increases androgen production--> these are converted to oestrogen peripherally which perpetuate chronic anovulation.
Chronically supressed FSH (no cyclical rise and fall)- new follicular growth continuously stimulated but not to the point of full maturity
SHBG decreased, so circulating testosterone is increased
78
Low FSH and LH indicates
hypogonadismH
79
High FSH and LH indicates
menopause/prem ovarian failure
80
High LH, low FSH indicates
PCOS
81
PCOS rx
COCP
82
Medical mx for urge incontinence
anticholinergics- oxybutynin, solifenacin
83
PID rx
doxy
cef IM
met
84
What is Fitz Hugh Curtis syndrome
RUQ pain- perihepatitis secondary to PID
85
what type of ovarian cyst may become huge
mucinous cystadenoma
86
Medical termination of pregnancy what to give
mifepristone then in 48 hrs misoprostol
87
HRT if have no periods
oestrogen and progest daily
88
HRT if have periods
oestrogen daily
progesterone on last 14 days of cycle (or last 14 days every 3 months if irreg periods)
89
IF start COCP on day 1 of period, when is it effective
immediately
90
IF start COCP on not day 1 of period, when is it effective
7 days
91
When is POP effective
day 1-5 of cycle immediately
any other day- 2 days
92
When is post vasectomy semen analysis done
12 weeks after and after 20 ejaculations
93
chlamydia rx
single dose azithro
7 days doxy
94
gonorrhoea rx
IM cef and 1g azithro po
95
gonorrhoea micro appearance
gram -ve diplococcus
96
trichomonas rx
metro stat or 5-7 days (longer course only for men)
97
clue cells indicates what
BV
98
Penile issue
-white plaques
-red papules
-can't retract foreskin
-fissures around foreskin
candidal banalitis
99
painless mucocutaneous lesions on penis that looks like psoriasis, associated with reiters syndrome
circinate balanitis
100
poorly demarcated plaques of thickened skin on scrotum or labia majora
lichen simplex
101
pale, atrophic genital skin with erosions, telangectasia, adhesions, loss of architecture
lichen sclerosis
102
lichen sclerosis has risk of what
SCC
103
white lacy papules and itching
lichen planus
104
syphilis rx
benpen
105
is chancre painful?
NO
106
Management of hot flushes if they dont want hormones
SSRI/SNRI
107
Endometriosis rx
NSAIDs and/or paracetamol are the recommended first-line treatments for symptomatic relief
if analgesia doesn't help then hormonal treatments such as the combined oral contraceptive pill or progestogens e.g. medroxyprogesterone acetate should be tried
Consider GnRH analogue (to 'induce menopause') or surgery
108
If forget to change contraceptive patch what to do
If the contraceptive patch change is delayed greater than 48 hours, the patch should be changed immediately and a barrier method of contraception used for the next 7 days.
109
symptoms of ovarian hyperstimulation syndrome in IVF
vomiting
ascites
oliguria
VTE
110
Recurrent thrush regime
induction: oral fluconazole every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 months
111
Coag findings in Von Willebrand
prolonged bleeding time
APTT may be prolonged
factor VIII levels may be moderately reduced
defective platelet aggregation with ristocetin
112
alternative condom in latex allergy
Polyurethane
113
What menopause treatment may cause irreg bleeding within the first 12 months
tibolone
114
UKMEC 3 for COCP
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)
current gallbladder disease
115
UKMEC4 for COCP
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
positive antiphospholipid antibodies (e.g. in SLE)
116
Early referral for infertility criteria (6m rather than 1 y)
Female
Age >35
prev pelvic surgery
Prev STI
amenorrhoea
abnormal genital exam
Male
prev genital surgery
prev STI
varicocele
sig systemic illness
abnormal genital exam
117
Cervical excitation is found in
pelvic inflammatory disease and ectopic pregnancy.
118
After 20 weeks, symphysis-fundal height in cm should =
gestation in weeks
119
Simple ovarian cyst on USS management
Repeat ultrasound in 12 weeks.
120
What is Meigs syndrome
Meigs' syndrome is a benign ovarian tumour (usually a fibroma) associated with ascites and pleural effusion
121
Most common benign ovarian tumour in <25yo
Dermoid cyst (teratoma)
122
most common cause of ovarian enlargement in women of a reproductive age
follicular cyst
123
Are follicular or corpus luteum cysts more likely to present with intraperitoneal bleeding
Corpus luteum
124
Ruptured mucinous cystadenoma can cause
pseudomyxoma peritonei (jelly belly)
125
most common benign epithelial tumour
Serous cystadenoma
126
single painless genital lesion
Syphilis
127
single painful genital lesion
H. ducreyi
128
Multiple painless genital lesions
HPV warts
129
Multiple painful genital lesions
herpes simplex
130
most common ovarian ca
Serous carcinoma
131
Which emergency contraception can they have if breastfeeding
LNG ok
Ullipristal stop breast feeding for a week
132
If a pregnant woman is not immune to rubella, she should be offered the MMR vaccination when
in the post-natal period
133
First line PPH mx
manual compression
IV oxytocin
134
urge incontinence in frail older woman medication?
avoid oxybutynin
can have mirabegron if concern re anticholinergic SEs
