O+G Flashcards
(118 cards)
1
Q
Ix for menorrhagia
A
- FBC
- TVUS if abnormal anatomy is indicated
2
Q
Initial mx of menorrhagia before TVUS is done?
A
Tranexamic acid
3
Q
Mx of PROM at 32 weeks?
A
admit for at least 48 hours + steroids + antibiotics
4
Q
Time until effective of progesterone only pill if started NOT on first day of cycle?
A
2 days
5
Q
Time until effective of COCP if started NOT on first day of cycle?
A
7 days
6
Q
Time until effective of implant/injection if started NOT on first day of cycle?
A
7 days
7
Q
Lochia - how long is normal?
A
6 weeks
8
Q
mx of endometrial cancer with high risk disease
A
TAH and BSO
post op RADIOTHERAPY
9
Q
How should a woman who is having elective surgery on COCP be managed?
A
Stop COCP 4 weeks before surgery
Restart COCP 2 weeks after surgery
10
Q
1st line Ix in a pt with infertility after 1 year of trying? when should it be done?
What result would worry you?
A
day 21 progesterone - i.e. 7 days before next period
If not ovulating, it will be <30
11
Q
High risk factors for pre-eclampsia?
A
CKD DM Chronic HTN autoimmune disease antiphospholipid syndrome
12
Q
Moderate risk factors for pre-eclampsia
A
positive family Hx 1st pregnancy >40yo BMI>30 Multiple pregnancy
13
Q
A woman at moderate/high risk of pre-eclampsia - how do you treat her?
A
75mg aspirin OD from 12 weeks
14
Q
3 types of breech presentation
A
Frank = hips flexed, knees extended Footling = one leg at the bottom Full = hips and knees flexed
15
Q
One major risk with breech presentation
A
Risk of cord prolapse
16
Q
How to counsel a mother with breech baby at 36 weeks?
A
Offer ECV (check rhesus status) If still breech - offer elective CS or vaginal delivery
- mode of delivery has no effect on long term health of the baby
- CS is associated with reduced risk of death of the baby during labour and reduced difficulty in early life.
17
Q
How long does the implant work as effective contraception? Once inserted, is additional contraception needed?
A
3 years of effective contraception
Additional contraception needed for first 7 days if not inserted before day 5 of cycle
18
Q
what is asherman’s syndrome?
A
intrauterine adhesions which can occur after dilatation and curettage
19
Q
3 aspects of active management of 3rd stage of labour
A
- Oxytocin 10IU
- Cord clamping between 1-5 mins after delivery
- Controlled cord traction
20
Q
Tx of obstetric cholestasis
A
Ursodeoxycholic acid
21
Q
Complications of obstetric cholestasis
A
stillbirth risk
22
Q
Who needs a higher dose of folic acid?
A
Either partner has NTD/ /previous pregnancy w NTD/FHx of NTD
Anti epileptics Coeliac disease DM Thalassemia trait BMI>30
23
Q
DEGREES OF VAGINAL TEARS?
A
1st - within vaginal mucosa
2nd - beyond vaginal mucosa
3rd - Extends to external anal sphincter
4th - Through external anal sphincter into rectal mucosa
24
Q
Placental abruption
- Symptoms? Signs?
- Mx?
A
Symptoms: constant painful bleeding
Signs: tender hard uterus
Fetal heart distressed/absent
- Mx: RESUS. Urgent delivery of baby once stable.
25
Number of antenatal appointments in 1st pregnancy? in subsequent pregnancies?
```
1st = 10
Subsequent = 7
```
In subsequent pregnancies, appointments at 25, 31 and 40 weeks appts don't happen
26
Sx of vaginal atrophy
PCB + dyspareunia + dryness
27
Potential problems with IUDs
1 in 20 will be removed, usually in the first 3 months
Can make periods heavier/longer/painful
Small increased risk of STI in first 20 days
Risk of uterine perforation - 1 in 500.
28
If a woman is found to have CIN II at colposcopy, when should screening next be?
6 months later
29
What kinda pregnancy is affected by Twin to twin transfusion syndrome?
Monochorionic twin pregnancies
30
Complications in multiple pregnancies?
Mother: polyhydramnios, gestational HTN, anaemia, antepartum haemorrhage
Fetus: PTL
Mortality
SGA, malformation
31
How does Mx of mother with multiple pregnancy differ from normal ?
- US for monthly checks
- Weekly antenatal checks after 30 weeks
- More Fe + folate
- 2 obstetricians at labour
- If not born by 38 weeks --> IOL
32
RFs for shoulder dystocia
Fetal macrosomia
High maternal BMI
GDM
Prolonged labour
33
2 complications of shoulder dystocia to the mother?
Perineal tears
| PPH
34
Common complication of fibroids in pregnancy? how is it managed?
Red degeneration
| V painful, so Mx is rest + analgesia - resolves in a week
35
RFs for hyperemesis gravidarum?
```
Multiple pregnancy
1st pregnancy
Hyperthyroidism
Trophoblastic disease
Obesity
```
36
Mx of hyperemesis gravidarum
Acute Mx - do they need IV hydration??
| - ANTIHISTAMINES (Promethazine = 1st line)
37
Complications of hyperemesis
- Mallory-Weiss tear
- Central pontine myelinolysis
- Acute tubular necrosis
- Wernicke's
Foetus: SGA, PTL
38
Name 4 Abx completely contraindicated in breastfeeding women
Ciprofloxacin
Chloramphenicol
Tetracycline
Sulphonamides
39
Which psych drugs can't be used in breastfeeding women?
Lithium
| Benzos
40
Mx of a woman with GBS bacteriuria during pregnancy?
IV Abx prophylaxis after the start of labour, then every 4 hours until delivery
41
PTL - what should be given IV?
Benzylpencillin for GBS prophylaxis
42
If low lying placenta is found at anomaly scan - what do you do next?
Rescan at 34 weeks
If still low at 34 weeks --> rescan every 2 weeks
If still low at 37 weeks offer elective CS
43
Recommended medication for postnatal depression?
Paroxetine (fluoxetine half life is too long)
44
in pre-eclampsia, at how many weeks gestation can you consider same day delivery?
34 weeks
45
Why avoid eating liver in pregnancy?
High vitamin A levels
46
Which medication used in urge incontinence is avoided in older women
Oxybutynin
47
From what day post partum can a woman get pregnant again?
day 21 post-partum
48
What form of contraception can a woman use after having a child?
if <6weeks postpartum: POP
| from 6 weeks: POP or COCP
49
5 causes of oligohydramnios
1. IUGR
2. Premature ROM
3. Fetal renal probs
4. Post-term gestation
5. Pre-eclampsia
50
medical management of missed miscarriage
- Vaginal misoprostol
- Anti-emetics + analgesia
- Safety net: go to dr if no bleeding within 24 hours
51
Expectant management of missed miscarriage?
- watch and wait: will bleed for 7-14 days.
| - Safety net: fever, discharge,
52
Causes of fetal tachycardia on a CTG
maternal pyrexia
Chorioamnioniitis
Hypoxia
Prematurity
53
Causes of fetal bradycardia on a CTG
Fetal distress e.g. Asphyxia, placental insufficiency
54
Expectant management of ectopic pregnancy - why is this rarely used? What happens?
Rarely used because the patient MUST be asymptomatic
- Monitor closely for 48 hours - if b-hCG starts to rise OR Sx manifest --> requires intervention
55
USS shows Ectopic pregnancy with a fetal heartbeat. best course of mx?
Surgical Mx
56
USS shows Ectopic pregnancy of size 37mm. Best course of Mx?
>35mm --> surgical mx
57
Conservative management of urge incontinence?
Bladder retraining - i.e. increasing time intervals between voiding
58
1st line treatment for a fibroid?
Mirena
59
RFs for placenta praevia
Multip
parity
previous CS
60
BNF advise re use of SSRIs in pregnancy?
Avoid due to risk of congenital malformations, unless the benefits outweigh the risks.
61
How can SSRIs affect the first trimester
congenital heart defects
62
3 Disadvantages of injectable progesterone
```
Delayed reversal (12m)
Irregular bleeding, weight gain
```
63
what class is venlafaxine + duloxetine?
SNRI
64
Menorrhagia without underlying pathology in a woman who doesn't need ongoing contraception - management?
Tranexamic or mefanamic acid
65
Menorrhagia without underlying pathology in a woman who needs ongoing contraception - management? give options 1 2 3
1. IUS
2. cocp
3. long acting progestogens
66
Though withdrawal - what is it? why so important?
it is a 1st rank sx of schizophrenia
- believes thought is removed by an external force
67
1st line med for GAD? How do you counsel the patient
sertraline
- Gets worse before it gets better - risk of suicidal ideation + self harm
- WEEKLY review for ONE month
68
Need for contraception after menopause?
>50yo: required for 12 months after LMP
<50yo: required for 24 months after LMP
69
how to detect haemolytic disease of thenewborn on USS?
What Ix can confirm this?
Mx?
Detected by oedema + ascites
- Doppler will detect fetal anaemia + Fetal blood sampling will show anaemia, reticulocytes etc
- Mx with fetal blood transfusion (w USS guidance) +/- post part phototherapy, early IVIG
70
Management of delivery in woman with pre-eclampsia at 33 weeks gestation + no fetal distress?
Defer delivery and give corticosteroids in a specialist unit. Review in 24 hours
71
Mx of a 33 week gestation woman with eclampsia?
Deliver - emergency CS
72
Drugs given in PPROm
- 10 days Erythromycin
| - Prophylactic steroids
73
1st and 2nd line treatment for endometriosis
- NSAIDs/paracetamol
| - COCP/progestogens
74
Medical management of inevitable miscarriage?
| What else should be co-administered?
Misoprostol + antiemetics + analgesia
75
Medical management of an ectopic?
Methotrexate
76
What is adenomyosis? How is it best visualised?
- Endometrial tissue in ovary
| - MRI pelvis
77
In PCOS, which hormones are elevated?
LH:FSH ratio
| Testosterone
78
Sharp pain on one side of abdomen after intercourse/strenuous exercise.
USS shows free fluid in pelvic cavity
Ovarian cyst rupture
79
Dx of GDM?
- fasting glucose
| - 2hr OGTT
80
Mx of GDM with fasting glucose of 6.5 and a large for dates baby?
if fasting is 6-6.9, and there is macrosomia/polyhydramnios --> INSULIN TX
81
Pregnant women who require high dose folic acid?
- prev NTD
- BMI>30!!!
- antiepileptic drugs
- malabsorptive disease
- DM
- thalassemia trait
82
2 step mx of chroioamnionitis?
- IV broad spec Abx
- IOL
(if <34 weeks, give steroids)
83
Fitz Hugh Curtis syndrome
PID + liver capsule infection "violin strings"
84
Combined test measures...?
Nuchal translucency
b-hCG (high in downs)
PAPP-A (low in downs)
85
quadruple test measures...?
Nuchal translucency
- Oestriol (low)
- AFP (low)
- b-hCG (high)
- inhibin A (high)
86
biggest RF for cord prolapse
Amniotomy
87
Clue cells
Bacterial vaginosis
88
Strawberry cervix
Trichomonas
89
Tx of trichomonas vaginalis?
Metronidazole (oral)
90
Mx of pregnant woman at booking with previous VTE?
LMWH immediately and continue until 6 weeks postpartum
91
Pre-conception Advice to a couple taking methotrexate for RA
BOTH stop methotrexate for 3 months before trying
92
Ideal position of woman with cord prolapse
Prone + on knees + elbows
93
Ovarian tumour associated with endometrial cancer
Granulosa cel tumour
94
Effect of COCP on risk of cervical cancer?
Increased risk
95
Which forms of contraception require special consideration if giving to a woman >40yo
COCP
| Depot
96
3 main criteria (of which you only need 2) for PCOS?
```
Polycystic ovaries
Irregular periods (long cycles)
Hyperandrogenism
```
97
Mx of a baby to a mother with +ve HBsAg
Vaccinate (3 shots) + IVIG
98
If anti-HBc +ve, what does this mean
The patient has been exposed to legit HBV either currently or in the past
99
Routinely screened for infections in booking?
HIV
Hep B
Syphilis
Bacteriuria
100
Treatment of vaginal vault prolapse
Sacrocolpoplexy
101
How to confirm a miscarriage on TVUS?
No fetal heartbeat +
- Fetal pole >7mm
- gestational sac >25mm
102
4th degree perineal tear?
Rectal mucosa :O
103
cut off beta hCG level for medical management of an ectopic
<1500
104
Pseudomyxoma peritonei is a complication of what
Mucinous cystadenoma
105
2nd line for dysmenorrhea (after NSAIDs)
cocp
106
Common breast lump seen in woman who recently stopped breastfeeding, who feels generally well
Galactocele
107
a BP which is an absolute contraindication to COCP?
160/95
108
RFs for VTE which may indicate antenatal LMWH?
previous VTE = this alone is enough!
```
BMI>30
Smoker
Age >35
Gross varicose veins
Immobility
1st deg relative w unprovoked VTE
```
preg related: current PET
Parity >3
Multip
IVF
109
Ovarian cancer staging
1: confined to one or both ovaries
2: within the pelvis
3: within the abdomen
4: beyond the abdomen
110
Important investigations for secondary amenorrhoea
BETA GO PRO AND check EAST THYROID
```
beta-hcg
gonadotrophin
Prolactin
Androgens
Estradiol
TFTs
```
111
Tx of vasomotor sx of menopause?
SSRI or venlafaxine
112
List the major risk factors for PET
Prev HTN/PET in pregnancy
CKD
T1 or T2DM
Antihpospholipid/SLE/autoimmune condition
113
UKMEC4
- Current breast cancer
- Prev history of VTE/stroke/IHD
- Uncontrolled hypertension
- Migraine w aura
-
- Smoking >15 and >35yo
114
Contraception in >50yo
- COndoms ?
- COCP?
- Depot?
- POP?
- IUS?
- Condoms: stop 1 year after amenorrhoea
- COCP: recommend stopping at 50yo
- Depot: stop at 50yo
- POP and IUS: can continue! stop at 55 years
115
value of Hb which indicates anaemia at booking?
<11
116
abx treatment of trichomonas
Oral metronidazole 2g stat
117
Chlamydia - abx treatment? give 2 options
Doxy for 7 days
or
Oral azithromycin 1g stat
118
Gonorrhoea - abx treatment?
IM Ceftriaxone + azithromycin STAT
