O&G Flashcards
(199 cards)
1
Q
Premenstrual symptoms management?
A
moderate (some impact) = Combined OCP
severe (withdrawal from social activities and normal functioning) = SSRI - initial 3 month trial
*If OCP contraindicated eg history of blood clots, give SSRI
2
Q
management for umbilical cord prolapse?
A
- Call for senior help, continuous ctg, theatre for immediate delivery
- Prevent further cord compression
- elevation of presenting part of fetus manually or by filling bladder with saline
- on all fours position, knee to chest position or left lateral position. - Emergency c section
- do not push cord back in - but keep warm and moist.
- tocolytics eg terbutaline can be used to reduce uterine contractions if attempts to reduce compression are failing
3
Q
management for shoulder dystocia
A
Step 1 = lie woman flat and tell to stop pushing!!!
Step 2 = call for senior help
Step 3 = legs hyperflexed tightly to abdomen (Mc Roberts maneuvre) = 1st line manoeuvre +/- suprapubic pressure
4
Q
treatment for CIN?
treatment for +ve HPV but normal cytology?
treatment for inadequate smear sample?
A
- LLETZ
- Repeat in 12 months. then 12 months again. if 2nd repeat the same -> colposcopy
- repeat in 3 months. if 2 consecutive inadequate samples -> colposcopy
5
Q
what is the routine call frequency for cervcial smears?
A
AGES 25-49 = every 3 years
50-64 = every 5 years
6
Q
urge incontinence treatment?
A
bladder retraining = 1st line
antimuscarinics -> oxybutinin (risk of falls in elderly), tolterodine, darifencacin
mirabegron is an alternative in elderly people to avoid confusion associated with anticholinergics
7
Q
stress incontinence treatment?
A
pelvic floor muscle training = 1st line
surgical procedures: e.g. retropubic mid-urethral tape procedures
duoloxetine!! if surgical procedures denied
8
Q
most common benign ovarian cyst in women under 25?
A
dermoid cyst, teratoma
9
Q
most common ovarian pathology associated with Meigs syndrome (ascites, pleural effusion)
A
fibroma
10
Q
intrahepatic cholestasis of pregnancy management?
name a differential
A
Weekly LFTS, pay close attention to fetal movements
ursedoxycholic acid -> symptomatic treatment, emollients
the risk of stillbirth only rises above the population rate once the serum bile acid concentration is ≥100μmol/L. So advise early delivery based on levels
induction of labour at 37 weeks to avoid stillbirth
*20% present with jaundice too
Acute fatty liver of pregnancy -> this will present with abdominal pain and nausea/vomiting also
11
Q
chickenpox case management in pregnant woman?
chicken pox contact exposure management in pregnant woman?
A
oral aciclovir if >20 weeks pregnant and presents within 24 hours of rash onset
- check for varicella antibodies
if history of chickenpox unknown/negative antibodies give oral aciclovir 7-14 days post exposure!! NOT` IMMEDIAtely
12
Q
during pregnancy, fibroids may increase in size due to increased oestrogen -> pelvic pain, pressure symptoms
A
13
Q
what is a missed miscarriage?
A
a gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion
mother may have light vaginal bleeding
cervical os is closed
14
Q
management of pregnant women with GBS bacteuria?
A
treatment at time of diagnosis
+
intravenous benzylpenicillin given as soon as possible after the start of labour, then at 4-hourly intervals until delivery.
15
Q
which HPV strains causes cervical cancer?
A
16 and 18, 33
16
Q
management of infertility in PCOS?
Management Periods?
management of hirsutism
A
Clomifene = 1st line
OCP
Co-cyprindiol (dianette): cyproterone acetate + ethinyloestradiol, used in PCOS
complicated by hirsutism and acne (also acts as contraception)
Generally= dietician, weight loss
17
Q
gestational diabetes definition?
gestational diabetes management?
A
fasting plasma glucose level of > 5.6. or a 2-hour plasma glucose level of >/= 7.8 mmol/L. I
if the fasting plasma glucose level is < 7 mmol/l a trial of diet and exercise should be offered
if glucose targets are not met within 1-2 weeks of altering diet/exercise metformin should be started
if glucose targets are still not met after another 1-2 weeks, insulin should be added to diet/exercise/metformin
gestational diabetes is treated with short-acting, not long-acting, insulin
if at the time of diagnosis the fasting glucose level is >= 7 mmol/l insulin should be started
Explain how to monitor blood glucose (using glucometer)
Need to be seen at a joint diabetes and antenatal clinic within 1 week (and every 2 weeks
thereafter)
Need to have ultrasound growth scans every 4 weeks from 28-36 weeks
Explain that medication will be stopped after delivery but that they will be followed up to
check if glucose problem continues
18
Q
targets for gestational diabetes management?
A
fasting: 5.3mmol/L
AND
1 hour postprandial: 7.8 mmol/L or
2 hours postprandial: 6.4 mmol/L
19
Q
induction of labour methods?
A
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
20
Q
management of pregnant women with autoimmune conditions eg SLE, antiphospholipid syndrome?
A
low dose aspirin from 12 weeks pregnancy to date. to prevent pre-eclampsia
21
Q
when do baby blues occur?
management
A
3-7 days post delivery
reassurance and support
22
Q
when does postnatal depression occur?
management?
A
usually start within a month and peak at 3 months
CBT
SSRI if severe
23
Q
When is screening done for gestational diabetes?
A
oral glucose tolerance test (OGTT) = 1st line
- women who’ve previously had gestational diabetes: OGTT should be performed as soon as possible after booking and at 24-28 weeks if the first test is normal.
- women with any of the other risk factors for GDM should be offered an OGTT at 24-28 weeks. RFs= BMI >30, previous baby >4.5kg, first degree relative with diabetes, family origin with high prevalence
24
Q
rokitanskys protuberance in a mass in ovary indicates?
A
teratoma/dermoid cyst
25
Premature ovarian insufficiency symptoms?
diagnosis?
climacteric symptoms: hot flushes, night sweats
infertility
secondary amenorrhoea
RAISED!! FSH, LH levels
low oestradiol
diagnosis:
- elevated FSH levels demonstrated on 2 blood samples taken 4–6 weeks apart
26
how is downs syndrome tested for antenatally
combined test = standard
may use quadruple test instead
if these test show higher chance of down syndrome then perform:
- NIPT
- Or amniocentesis/CVS
27
placental abruption RFs?
A for Abruption previously;
B for Blood pressure (i.e. hypertension or pre-eclampsia);
R for Ruptured membranes, either premature or prolonged;
U for Uterine injury (i.e. trauma to the abdomen);
P for Polyhydramnios!!
T for Twins or multiple gestation;
I for Infection in the uterus, especially chorioamnionitis;
O for Older age (i.e. aged over 35 years old);
N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)
28
1st line treatment for pre-eclampsia in woman with asthma?
nifedipine
29
how often is cervical screening carried out?
every 3 years for patients aged 25-49 years and every 5 years for patients aged 50-64 years.
every 1 year HIV +ve
30
how to confirm ovulation?
Take the serum progesterone level 7 days prior to the expected next period
31
history of endometriosis, acute abdomen, and the pelvis filled with fluid all point towards?
ruptured endometrioma
32
vasa previa classic triad?
rupture of membranes followed by painless vaginal bleeding and fetal bradycardia.
33
PPH medical management?
ABCDE approach - cannulas, cyrstaloid infusions
palpate uterus
IV oxytocin = first line!!
other options include: ergometrine slow IV or IM (unless there is a history of hypertension)
carboprost IM (unless there is a history of asthma)
misoprostol sublingual
34
upper limit of Bhcg in weeks 9 -12 of pregnancy?
300,000 mIU/ml i
35
hyperemesis gravidarum criteria?
management
5% !!pre-pregnancy weight loss
dehydration
electrolyte imbalance
admit for IV saline and potassium = 1st line. THEN prescribe oral cyclizine or promethazine (antihistamines) and discharge
36
when should insulin be commenced for GDM?
if fasting glucose is >= 7 mmol/l at time of diagnosis
37
which pregnant women should be given a higher dose of folic acid at 5mg?
BMI > or equal to 30. diabetes!!, sickle cell disease (SCD), thalassaemia trait, coeliac disease, on anti-epileptic medication, personal or family history of NTD, or who have previously given birth to a baby with an NTD.
otherwise give 400mcg to others
38
which condition occurs when placenta attaches past myometrium through the outer wall of uterus and can attach to organs such as the bladder?
placenta percreta
39
first line treatment for menorrhagia?
intrauterine sytstem/mirena coil if contraception desired
contraception not desired = mefanamic acid/ tranexamic acid
40
tetracylcines eg doxycycline, lymecycline are _ in pregnancy
contraindicated -> negative effect on child skeletal development and discolouration of teeth
41
how long should magnesium treatment for preclampsia last?
24 hours after delivery or 24 hours after last siezure
42
what is the most common cause of PID?
chlamydia
43
management of pregnant women with HTN but blood pressure that is consistently <160/110mmHg?
home management -> oral labetalol and weekly follow up
44
endometrial hyperplasia symptoms?
1. simple endometrial hyperplasia without atypia = high dose progestogens with repeat sampling in 3-4 months. The levonorgestrel intra-uterine system may be used
2. atypical endometrial hyperplasia: hysterectomy + bilateral salpingo-oophorectomy
45
medical abortion medication?
oral mifepristone! (anti-progestin)
+ prostaglandinds to sti ulate contractions (misoprostol)
46
when should booking visit occur?
anomaly scan?
8-12 weeks
18- 20+6 weeks
47
what testing occurs during booking appointment for women?
HIV, syphilis and hepatitis B
48
a positive urine pregnancy test is considered normal uptil how many weeks after abortion?
4 weeks
49
signs of ectopic pregnancy?
RFS?
abdominal pain, vaginal bleeding
absence of intrauterine pregnancy on ultrasound + pelvic free fluid (ruptured?)
PID
previous ectopic
endometriosis!!!
IVF
progesterone only pill
50
how to distinguish pre-existing hypertension from Pregnancy related blood pressure problems (such as pregnancy-induced hypertension or pre-eclampsia)
the latter do not occur before 20 weeks!!! pregnancy
before pregnancy or before 20 weeks, no proteinuria or edema = pre existing htn
note, if a pregnant woman takes an ACE inhibitor or angiotensin II receptor blocker (ARB) for pre-existing hypertension this should be stopped immediately and alternative antihypertensives started (e.g. labetalol) whilst awaiting specialist review
51
A 57-year-old lady presents to the postmenopausal bleed clinic with a 2 week history of light vaginal bleeding, and mild pain on intercourse. She is otherwise well. On vaginal examination she is tender and has slight dryness. What should be done next in clinic?
referral to secondary care and TVUS must be done first to exclude endometrial cancer. atrophic vaginitis is a diagnosis of exclusion.
normal TVUS = oestrogen cream or referral to HRT clinic
abnormal TVUS (>4mm), then endometrial biopsy would be done.
Vaginal atrophy symptoms = Vaginal dryness.
Vaginal burning.
Vaginal discharge.
Genital itching.
Burning with urination.
Urgency with urination.
Frequent urination.
Recurrent urinary tract infections.
So symptoms are like a UTI picture
52
what is the main complication of induction of labour? how does it present?
uterine hyperstimulation
high contraction frequency (tachysystole) and duration, for greater than 20 minutes, which may or may not be associated with signs of foetal distress.
53
which ectopic pregnancy should be managed surgically?
when should ectopic pregnancies be managed expectantly? what does this involve?
ectopic pregnancies >35 mm in size or with a serum B-hCG >5,000IU/L s
expectant management if:
1) An unruptured embryo
2) <35mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <1,000IU/L AND declining!
= safety netting (for pain, bleeding) and asked to return in 48 hours for serum B-hcg
54
when treating acute VTE in pregnancy, what must be measured/monitored?
anti-xa activity
55
can you breastfeed on anti-epileptic medication?
yes
56
Fetal movements should be established by 24 weeks gestation.
If after 28/40 weeks, if a woman reports reduced fetal movements and no heart is detected with handheld Doppler, what is the next step?
immediate ultrasound
if heartbeat present on ultrasound ->CTG for at least 20 min
57
advice for patient with lactational mastitis?
continue breastfeeding
58
Woman aged > 30 years with dysmenorrhoea, menorrhagia, symmetrically enlarged, boggy uterus is most likely?
adenomyosis
59
25 weeks pregnant woman with history of watery discharge but no fluid seen on speculum examination and a closed os. positive fibronectin. how do you manage?
watery discharge not enough to diagnose premature rupture of membranes.
raised fibronectin indicateds inreased risk of preterm labour -> therfore admit and give IM steroids to promote fetal lung maturity. also monitor blood glucose in diabetics as steroids may cause hyperglycemia
60
what is retinopathy of prematurity?
visual impairment seen in premature baby born before 32 weeks and had received oxygen treatment.
Over-oxygenation can cause retinal vessel proliferation which can lead to a loss of the red reflex and neovascularisation seen in the examination.
61
why should cooked liver be avoided in pregnancy?
high levels of vitamin A
62
signs of ovarian torsion?
enlarged ovary with free pelvic fluid
whirlpool sign! (also seen in volvulus)
63
ultrasound is indicated if lochia persists beyond?
6 weeks
USS to look for retained products of conception
64
which drug when used as an anti-emetic in pregnancy can cause extrapyramidal side effects (tremor, increased upper limb tone)
metoclopramide -> thus not used as 1st line!
65
name some potentially rhesus sensitizing events for pregnent women
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)
66
management of anemia in pregnancy?
start oral iron replacement therapy
if in
First trimester < 110 g/L
Second/third trimester < 105 g/L
Postpartum < 100 g/L
67
what investigation can be done for urinary incontinence when the type is not known?
urodynamic studies
68
placenta accreta?
increta?
percepta?
present with pph
accreta = placenta attaches to myometrium
increta = invades myometrium
percepta = invades all layers of uterus and can reach organs eg bladder
69
Which condition presents with low values in quadruple test bar inhibin which is normal?
edwards syndrome
70
what risk is associated with odansetron use in pregnancy?
increased risk of cleft lip/palate if used in 1st trimester
71
when should anti-D be given to a resus negative pregnant woman?
at 28 and 34 weeks
72
what is a ring pessary used for?
pelvic organ prolapse
73
first line investigation for P-PROM?
sterile speculum investigation
Further management
Admit to antenatal ward to perform sterile speculum examination to look for pooling of amniotic fluid and administer following:
o 1st line = oral erythromycin
Then IM betamethasone for lung maturity
74
when should a pregnant woman with HTN be admitted to the maternal unit for observation?
when BP >/= 160/110
75
first line investigation for pregnant woman with vaginal bleeding?
TVUSS to assess the viability of the pregnancy and determine the source of bleeding.
Should the pregnancy be viable then other management options such as Rho(D) immunoglobulins would be considered if the woman is Rh-negative,
76
What supplement should all pregnant women take daily
10 micrograms of vitamin D
77
key side effect of magnesium sulfate? what should you monitor?
what is the antidote?
respiratory depression
monitor resp rate (and check reflexes)
antidote = calcium gluconate
78
If PPH medical management fails, what is first line surgical management?
intrauterine balloon tamponade (intrauterine bakri-catheter). - particularly if uterin atony suspected as main cause
other interventions:
B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
if severe, uncontrolled -> hysterectomy is sometimes
79
what is a galactocele?
painless firm breast lump occuring in women that have recently stopped breastfeeding
80
advice on methotrexate use when trying to concieve?
must be stopped at least 3 months before conception in both men and women
81
first stage of labour ends when?
cervix fully dilated (10cm).
2nd stage = birth of fetus
3rd stage = expulsion of placenta
82
why is induction of labour indicated for intrahepatic cholestasis?
it increases chance of stillbirth
83
placental abruption management?
ABCDE approach
o Gain 2x IV access
o Bloods (FBC, Rhesus status, cross-match and clotting screen)
o Continuous foetal monitoring
o Kleihauer test and anti-D if needed
Then decide on delivery:
Fetus alive and < 36 weeks
fetal distress: immediate caesarean
no fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation
Fetus alive and > 36 weeks
fetal distress: immediate caesarean
no fetal distress: deliver vaginally
84
Raised FSH/LH in primary amenorrhoea - consider what?
gonadal dysgenesis (e.g. Turner's syndrome)
85
Stereotypical PCOS lab results?
raised LH:FSH ratio
testosterone may be normal or mildly elevated
SHBG (sex hormone binding globulin) is normal to low
86
First line treatment for nausea and vomiting in pregnancy?
Antihistamines - eg promethazine
87
Normal laboratory findings in pregnancy?
Reduced urea, reduced creatinine, increased urinary protein loss
88
Most common complication of a myomectomy for fibroids
Adhesions
89
Hysterectomy associated with what type of prolapse?
Vaginal vault
90
How does induction of labor method vary based on bishop score?
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
Score >8 indicates likely spontaneous labor
91
HTN in pregnancy is defined as?
systolic > 140 mmHg or diastolic > 90 mmHg
92
in patients with continuous dribbling incontinence after prolonged labour and from a country with poor obstetric services, what do you expect? Management?
Vesicovaginal fistula. Urinary dye studies
93
A pregnancy with β-HCG higher than 1,500 IU/L should be visible on ultrasound.
If not, then most likely what?
ectopic pregnancy, rather than missed miscarriage
94
what medication is useful in short term treatment of fibroids?
what surgery to remove?
management of menorrhagia?
what is the only treatment that improves fertility?
GOSERELIN (GnRH agonist) - only used in short term due to menopausal symptoms and loss of bone kineral density. used to shrink fibroid
myomectomy, hystorectomy, uterine artery embolization.
menorrhagia -> IUS if uterus not distorted, mefanamic acid
myomectomy improves fertility
95
what is the most common type of ovarian epithelial cell tumour?
serous cystadenoma - is benign
96
treatment for BV and trichomonas?
oral metronidazole
97
treatment for gonorrhea?
IM ceftriaxone
98
if a woman is pregnant, when should they have their routine cervical screening?
Cervical screening in pregnancy is usually delayed until 3 months post-partum unless missed screening or previous abnormal smears
99
a delayed 3rd stage of labour in a patient with a history of c-section (most important risk factor )and PID points towards?
management?
placenta accreta. can cause major blood loss after delivery as part of placenta remains attached.
hysterectomy = definitive. attempts to remove placenta may cause hemorrhage
100
describe the woodscrew maneuvre. when is it used?
put hand in uterus and attempt to rotate fetus 180 degrees.
used in shoulder dystocia as second line to mc roberts maneuvre
101
ovarian hyperstimulation syndrome symptoms?
ascites, vomiting, diarrhoea, high hematocrit, SOB
102
miscarriage management?
expectant = first line
Medical management instead if patient has ris of hemorrhage, evidence of infection.
medical management = VAGINAL MISOPROSTOL 1st line
last resort = surgical management eg vacuum aspiration
103
management of mastitis in breastfeeding mothers?
flucloxacillin
104
first line treatment for thrush in non pregnant women?
oral fluconazole
105
effect of pre-eclampsia on amniotic fluid?
oligohydramnios
106
causes of oligohydramnios?
premature rupture of membranes
Potter sequence
bilateral renal agenesis + pulmonary hypoplasia
intrauterine growth restriction
post-term gestation
pre-eclampsia!
107
causes of folic acid deficiency?
phenytoin
methotrexate
pregnancy
alcohol excess
108
after colposcopy and treatment for CIN2, when should a patient return for a test of cure?
6 months
109
53 YR old woman presents with urinary urgency and frequency, treated in past for utis but urine cultures were always negative. cyst found in ovary on ultrasound. most likely diagnosis?
ovarian cancer - urgency is a pressure effect
110
Name some LMWHs used in pregnancy in place of DOACS and warfarin
enoxaparin
dalteparin
tinzaparin
111
Medical treatments for postpartum haemorrhage secondary to uterine atony?
oxytocin, ergometrine, carboprost and misoprostol
112
50% of umbilical cord prolapses occur after which surgical intervention?
artificial rupture of membranes
113
endometrial cancer investigations?
TVUSS = 1ST LINE
then, hysteroscopy with endometrial biopsy
114
if fetal movements have not been felt by __ weeks, a refferal should be made
24
115
if a patient with menopausal symptoms already has a mirena IUS in, what other treatment do you add?
patient already has progesterone from iUS so just add on estradiol
HRT is incorrect as it contains both progesterone and estrogen
116
the progestogen component of HRT increases the risk of what? in menopausal women
breast cancer
117
management for patients w secondary dysmennoorhea
must all be referred to gynaecology
118
state some absolute indications to vaginal birth after c section
previous vertical (classical) caesarean scars, previous episodes of uterine rupture and patients with other contraindications to vaginal birth (e.g. placenta praevia).
119
preclampsia management first line?
antihypertensives!!
Magnesium sulfate is only given after! this to prevent siezure
120
how to differentiate placenta preavia and vasa praevia?
vasa praevia is a triad of bleeding PLUS (rupture of membranes and fetal compromise
121
if NSAIDS and OCP dont control endometriosis symptoms, what should be tried?
GNRH analogues
122
low levels of LH/FSH indicate what causes of secondary amenorrhea?
hypothalamic causes
123
in a woman >50 presenting with symptoms suspicipous of IBS and not having these symptoms prior, what must you rule out? first line investigation?
rule out ovarian cancer
ca-125 first line.
if this is elevated, then ultrasound scans of abdomen and pelvis is performed, NOT TVUSS
124
first line management for menorrhagia in fibroids as long as there is no distortion of uterine cavity and fertility is not desired?
LNG-IUS
125
cervical motion tenderness/cervical excitation is a sign that is seen in ectopic pregnancy and _____
pelvic inflammatory disease
126
what are some signs of false labour?
Occurs in the last 4 weeks of pregnancy
Presentation: contractions/pain felt in the lower abdomen. The contractions are irregular and occur every 20 minutes. Progressive cervical changes are absent.
127
name a risk factor for a second trimester miscarriage
cervical cone biopsy
128
first line treatment for UTI in non-pregnant women?
trimethroprim - also safe in breastfeeding
129
in which condition does placenta invasion go beyond the myometrium and into the perimetrium?
placenta percreta
130
name the SSRIs of choice for breastfeeding women
Sertraline
Paroxetine
131
what is a normal fetal heart rate?
100 - 160
132
what should be prescribed for severe hyperemesis gravidarum
IV Saline with potassium chloride.
*in hyperemesis gravidarum, electrolyte depletion is common
133
management for postpartum thyroiditis?
thyrotoxicosis = propanolol (symptomatic treatment only)
hypothyroid phase = thyroxine
134
effect of cocp on endometrial cancer
protective.
progesterone component of pill protects against estrogen
135
which antihypertensives are contraindicated in pregnancy?
ACE inhibitors and ARBS
136
define PPH. what is a differential?
passage of >500ml of blood following delivery
lochia = differential
137
managment of placental abruption under 36 weeks if fetus not in distress
admit and give IV steroids
138
management of pregnant woman with low-lying placenta at 20 week scan?
rescan at 32 weeks
139
what conditions may cause a pregnant woman to have a raised AFP?
Neural tube defects (meningocele, myelomeningocele and anencephaly)
Abdominal wall defects (omphalocele and gastroschisis)
Multiple pregnancy
140
What conditions can cause a pregnant woman to have a low AFP?
Down's syndrome
Trisomy 18
Maternal diabetes mellitus
141
name a GnRH agonist used to shrink fibroids?
Triptorelin
Leuprolide
142
↓ AFP
↓ oestriol
↑ hCG
↑ inhibin A
(quadruple test done at 15-20 weeks) indicates what condition most likely?
also suggested by ↑ HCG, ↓ PAPP-A, thickened nuchal translucency. (combined test, done earlier in pregnancy)
Downs syndrome
143
if a speculum examination shows no signs of PPROM, what is the next step in management?
testing the fluid for placental alpha microglobulin-1 protein (PAMG-1) (e.g. AmniSure®) or insulin-like growth factor binding protein‑1
144
When do you give anti-D prophylaxis for an abortion?
Offer to women who are rhesus D negative and are having an abortion after 10 weeks' gestation.
Before 10 weeks, only offer if it is a surgical abortion NOT a medical abortion
145
After termination of pregnancy, when is a multi level pregnancy test carried out?
After 2 weeks - should show lower HCg levels although test may be normal and positive for up to 4 weeks post termination
146
Name a drug that is a rf for thrush?
Antibiotics. Eg thrush post treated uti
147
What fetal conditions call for a category 1 c section (ie in 30 mins)
, fetal hypoxia or persistent fetal bradycardia
148
What maternal conditions call for a cat 1 c section?
suspected uterine rupture, major placental abruption, cord prolapse
149
How do you manage late declarations on a Ctg trace?i
urgent fetal blood sampling
Concerning finding for fetal hypoxia or fetal acidosis! If acidosis, urgent delivery
149
Placenta praevia risk factors
previous placenta praevia, previous caesarean section, endometrium damage and multiple pregnancies.
150
what is given to treat hirsutism in PCOS?
COCP
151
what is given to treat oligomenorrhea in PCOS?
COCP or LNG-IUS
treatment needed to prevent endometrial hyperplasia
152
what differential test must you do in urinary incontinence?
urinalysis - rule out UTI and diabetes
153
what bugs cause early vs late onset sepsis in newborn
early (<48 hours)
= GBS
late ( >48 hours)
= staph epidermis, staph aureus
154
what are some high risk and moderate risk factors for preeclampsia?
high risk factors:
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
moderate:
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
155
Treatment for pregnant women with risk factors for pre-eclampsia?
If a woman has one or more high-risk factors (or ≥2 moderate risk factors), she should be prescribed 75-150mg of aspirin daily from 12 weeks gestation until birth to help prevent pre-eclampsia.
156
endometrial cancer treatment?
localised disease is treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy
patients with high-risk disease may have postoperative radiotherapy
Progestogen therapy is sometimes used in frail elderly women not considered suitable for surgery.
157
Persistent unexplained vulval skin lesion management?
2 week wait referral to rule out cancer
158
cat 2 c section should be done in how many minutes
75 minutes
159
Which HRT does not appear to increase the risk of VTE?
Transdermal HRT
vs oral which does
160
contraindication to the use of epidural anaesthesia?
coagulopathy
161
when do baby blues occur?
typically in 3-7 days following birth
162
If a uterine fibroid is less than __cm in size, and not distorting the uterine cavity, medical treatment can be tried (e.g. IUS, tranexamic acid, COCP etc)
3
163
what are some common cardiac findings in pregnancy and what is a concerning finding?
an ejection systolic murmur is heard in 96% of women and 84% have a third heart sound. Forceful apex beat is not a cause for concern provided it is still within 2cm of the mid-clavicular line
pulmonary edama is concerning. in addition, that + HTN = most likely pre-eclampsia
164
how do bartholiin cysts appear on examination?
painful and soft
pain while walking, dyspareunia
common in childbearing woman
165
what analgesic must be avoided in breastfeeding women?
aspirin
166
if NSAIDs/COCP have not controlled symptoms of endometriosis, what can be tried?
GnRH analogues/agonists
*avoid the copper IUD as it does not contain hormones and so does not prevent build up of uterine lining
167
what medication is safe in pregnant women to help quit smoking?
nicotine replacement therapy
168
first line non hormonal treatment for menorrhagia?
tranexamic acid
mefanamic acid can be given if painful periods or fertility not desired
169
mode of delivery for pregnant women with HIV?
vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks
170
what is urogenital prolapse? state different types
management?
In urogenital prolapse there is descent of one of the pelvic organs resulting in protrusion on the vaginal walls.
cystocele, cystourethrocele
rectocele
uterine prolapse
Management
if asymptomatic and mild prolapse then no treatment needed
conservative: weight loss, pelvic floor muscle exercises
ring pessary
surgery
Surgical options
cystocele/cystourethrocele: anterior colporrhaphy, colposuspension
uterine prolapse: hysterectomy, sacrohysteropexy
rectocele: posterior colporrhaphy
171
when is mastitis treated in a breastfeeding woman?
'if systemically unwell, if nipple fissure present, if symptoms do not improve after 12-24 hours of effective milk removal of if culture indicates infection'. The first-line antibiotic is flucloxacillin
erythema is not an indication!
172
management of PPROM?
oral erythromycin should be given for 10 days
antenatal corticosteroids
delivery should be considered at 34 weeks of gestation
173
women presenting with ectopic pregnancy and abdominal pain, what is the management?
surgical management -> due to presence of abdominal pain!!
174
management of ovarian cyst in pregnant woman?
reassurance.
in early pregnancy, ovarian cysts are usually physiological - known as a corpus luteum. They will usually resolve
175
post menopausal vaginal bleeding is a _ to HRT
contraindication
176
fetal movements should be felt by X weeks?
24
177
breech presentation is common before x weeks? and only becomes a problem if woman goes in to preterm labour
34
178
name some causes of perpeural pyrexia
endometritis: most common cause
urinary tract infection
wound infections (perineal tears + caesarean section)
mastitis
venous thromboembolism
178
how to distinguish active and latent 1st stage of labour?
active =3-10cm dilation
179
cat 2 c sections are how long
75 min
180
How can you tell if pregnancy is SGA or LGA? from symphysis-fundal height
SFH should match the gestational age in weeks to within 2 cm after 20 weeks,
181
pre-existing renal disease is a risk factor for pre-eclampsia
182
what is the most common cause of post menopausal bleeding (including post coital bleeding)
vaginal atrophy!!!
endometrial cancer less common
and cervical cancer even less in UK due to screening programs
183
If a uterine fibroid is less than 3cm in size, and not distorting the uterine cavity what is management?
try medical first -> IUS, OCP, Tranexamic acid
184
when would you refer a cyst for biopsy?
when its a complex/multi-loculated cyst rather than a simple cysts
presence of ascities, strong blood flow etc
185
is severe gestational diabetes treated with short or long acting insulin?
short acting
185
pregnancy >6 weeks and bleeding management?
pregnancy < 6 weeks and bleeding with no other symptoms management.
>6 weeks = TVUSS
<6 weeks = expectant management, do a repeat pregnancy test in 7 days if negative = miscarriage, if positive = more management
186
cocaine abuse has been associated with placental abruption. what other signs can be seen on examination?
pupil dilation + hyperreflexia
187
when can IV magnesium sulphate be used to treat pre-eclampsia rather than eclampsia?
when delivery is planned in 24 hours, or high risk of eclampsia/siezures
188
Causes of pulmonary edema in pregnancy?
cardiac:
- peripartum cardiomyopathy
- cardiac ischemia
- pre existing heart disease
non cardiogenic
- fluid overload
- pre-eclampsia
- drugs - eg steroids and non steroidal eg diclofenac
189
spontaneous hepatic rupture in pregnancy is a complication of what condition?
HELLP syndrome
190
a short duration of vomiting or reduced oral intake in pregnancy can lead to starvation ketoacidosis. how do you differentiate it from DKA?
glucose is normal or low unlike in DKA and you treat by giving iV glucose
191
naproxen/ibuprofen is safe until what stage of pregnancy?
safe till before 32 weeks
192
is candesartan safe for breastfeeding mothers
yes unless child is premature
193
which antiepileptcs are safe in pregnancy?
leveticetam
lamotrigine
clozabam
194
state secondary causes of headache in pregnancy and their management
1. cerebral venous sinus thrombosis -> CT venogram -> LMWH
2. posterior reversible encephalopathy syndrome -> visual disturbance, headache siezure -> MRI -> manage BP
3. reversible cerebral vasoconstriction syndrome -> thuderclap headache typically seen after delivery -> calcium channel blockers
4. pituitary apoplexy ->
meningitis, IIH
195
itchy rash on the abdomen of a pregnant woman is most likely?
polymorphic eruption of pregnancy (PEP)-> typically in 3rd trimester or post partum
196
