O&G Flashcards
(247 cards)
1
Q
Placenta contains large and small villi with scalloped outlines and trophoblastic hyperplasia
A
Hydatidiform Mole
2
Q
Virus causing vulval warts
A
HHV6 and 11
3
Q
Score used to assess favourability of cervix
A
Bishop’s Score
4
Q
How long should active 1st stage last?
A
1cm/hr in nullips, 2cm/hr in multips
16hrs max
5
Q
How is delay in active 1st stage defined as?
A
<2cm in 4hrs
6
Q
How is delay in active 2nd stage defined as?
A
2hrs in nullip, 1hr in multips
7
Q
What is main risk factor for preterm delivery?
A
Infection (GBS, BV, chlamydia)
8
Q
The cervical length which increases preterm risk
A
Cervical lenght <25mm
9
Q
Shoulder tip pain in ectopic
A
Intraperitoneal blood loss (phrenic nerve supplies supraclavicular)
10
Q
Transvaginal US shows pseudosac
A
Ectopic Pregnancy
11
Q
Support group for ectopic patients
A
Ectopic Pregnancy Trust
12
Q
“Snow-storm” appearance on US
A
Molar Pregnancy
13
Q
Pathophysiology of pre-eclampsia
A
Incomplete trophoblast invasion of spiral arteries in placenta –> no vasodilation in spiral arteries –> placenta not perfused well
14
Q
2 urine-based investigations for pre-eclampsia
A
- ++ protein on dip
2. Urine PCR >30
15
Q
When should pre-eclampsia deliver?
A
By 36 weeks
-use oxytocin instead of ergometrine in 3rd stage
16
Q
Diagnosis of GDM (fasting and 2hr post-GTT)
A
Fasting >5.6 mmol/L
Post-GTT >7.8 mmol/L
17
Q
Leading cause of maternal death in UK
A
Heart disease
18
Q
Pregnant woman with excessive thirst, epigastric pain and jaundice
A
Acute Fatty Liver
19
Q
Cause of Acute Fatty Liver
A
LCHAD deficiency –> can’t metabolise fatty acids –> fatty acid build-up in liver
20
Q
Itchy without rash, worse on palms and soles
Itch increases in evenings
A
Obstetric Cholestasis (oestrogen prevents bile acid uptake by liver cells)
21
Q
Treatment of thrombosis in pregnancy
A
Enoxaparin (LMWH)
22
Q
US:
Lamda Sign
T Sign
A
Lamda Sign = dichorionic (thick dividing membrane as it meets the placentas)
T Sign = monochorionic (thin dividing membrane)
23
Q
Blueberry muffin rash in newborn
A
Congenital Rubella Syndrome
24
Q
Urticarial rash on tummy, which spares the umbilicus
A
Polymorphic Eruption of Pregnancy
25
Bullous eruption on urticaria, involves umbilicus
Pemphigoid Gestationis
26
"Woody" uterus
(Severe) Placental Abruption (woody as bleeding stimulates myometrial contractions)
27
Pregnant woman has sudden increase in abdominal size
Polyhydramnios in Twin-Twin Transfusion Syndrome
28
Twin-Twin Transfusion Syndrome only affects which type of twins?
MCDA (shared placenta means shared vasculature)
29
Fused epiphyses in baby = side effect if this drug is used in pregnancy
Warfarin
30
Tense uterus and can't feel foetal parts
Polyhydramnios
31
What drug class can cause closure of ductus arteriosus?
NSAIDs
32
When do you give anti-D to Rh-ve women?
1500IU at 28 weeks
OR
Within 72hrs of sensitising events
33
Kleihauer Test
Checks number of foetal cells in mum’s circulation --> detects fetomaternal haemorrhage
34
Waiter's Tip deformity in baby
Erb’s Palsy after shoulder dystocia (excess traction on neck damages brachial plexus)
35
Management of shoulder dystocia
1. McRoberts Manoeuvre = max flexion of mum to give baby more room
2. Episiotomy and Wood's Screw Manoeuvre = pressure behind posterior shoulder --> baby rotates 180
36
Liquor looks like pea soup
Undiluted meconium in amniotic fluid
37
Definition of foetal hypoxia
Foetal scalp pH <7.20
38
Features of foetal distress on CTG
- Late decelerations
- HR > 160
- Reduced baseline variability
39
Pelvic bone pain worse on movement/end of day
Pelvic Girdle Pain
40
After C-section: heavy vaginal bleeding, boggy poorly contracted uterus
Retained Products
- can happen if not all products removed during C-section
- Offensive lochia = products infected
- Management: EUA to remove the products
41
Uterus too large for dates + hyperthyroid symptoms
Molar Pregnancy
| -hCG looks similar to TSH!
42
Schiller's Test
Lugol iodine applied --> normal cervix dark brown, cervical cancer not stained
43
Definitions of oligomenorrhoae and amenorrhoae
Oligomenorrhoea: <6 periods in 1 year
Amenorrhoea: no periods in 6 months
44
Investigation in subfertility which confirms ovulation
Day 21 progesterone >30 (ovulation leaves behind corpus luteum, which makes progesterone)
45
PCOS criteria
(i) Polycystic ovaries on US
(ii) Irregular periods >35 days apart
(iii) Hyperandrogenism (clinical = acne/hair; biochem = raised testosterone)
46
Free Androgen Index calculation
(Total Testosterone/SHBG) x 100
| = shows active cholesterol
47
When would you do blood tests in menopausal woman?
- Under 45yrs
- Over 45yrs with atypical symptoms
-->check increased FSH on 2 samples, 4-6 weeks apart
48
When would you give:
1. Monthly cyclical HRT
2. Continuous HRT
1. Perimenopause (LMP within 1yr)
| 2. Postmenopause (LMP after 1yr)
49
HRT benefits
- Decreases fragility fractures
| - Improves muscle strength
50
HRT risks
- Oestrogen only: endometrial cancer
- Combined: breast cancer
- Oral: VTE
51
1st-line investigation in postmenopausal bleeding
Transvaginal US --> measure endometrial thickness:
<4mm and only 1 bleeding ep: do nothing!
>4mm/many bleeding eps: endometrial biopsy +/- hysteroscopy
52
Types of endometrial cancer
Type 1 = mucinous and secretory adenocarcinoma
- Oestrogen-dependent -- arises from hyperplasia
- Low grade --> doesn't invade past uterus
Type 2 = serous and clear cell carcinoma
- Oestrogen-independent -- arise from atrophic endometrium
- High grade --> invades more
53
Transvaginal US shows "skip lesions"
Asherman's Syndrome = intrauterine adhesions
54
* Cyclical pelvic pain
* Period pains before periods start
* Deep dyspareunia (“on deep penetration”)
* Pain on passing stool during periods
Endometriosis
55
Transvaginal US shows "venetian blind appearance"
Adenomyosis
56
Transvaginal US shows chocolate cyst and "ground glass" bloos
Endometriosis
57
What is squamocolumnar junction (SCJ)?
Columnar epithelium of endocervix meets squamous epithelium of ectocervix
58
High-risk HPV strains
16 and 18
59
Follow-up after treat CIN
Repeat smear and HPV test after 6 months
o Normal? Return to normal smears
o Abnormal? Colposcopy
60
Cervix bleeds on contact
Cervical cancer (UNLESS smears are normal = ectropion)
61
Cancer types in cervical cancer
90% squamous cell. 10% adenocarcinomas (BAD)
62
Surgical treatment of cervical cancer
Radical (Wertheim’s) hysterectomy
- Pelvic nodes
- Uterus
- Parametrium
- Upper 1/3 vagina
63
What is a Krukenberg tumour?
Met on ovary, coming from GI primary
64
Risk of Malignancy Index calculation
Ultrasound Score x Menopause Status x CA125
- US score = one point for every US feature (max 5)
- Menopause status = 3 points if post-menopausal
65
Gynae cause of colicky abdo pain and vomiting
Ovarian cyst torsion -- causes infarction of ovary and tubes
66
Vaginal discharge that is cyclical with period
Physiological discharge (increases with oestrogen)
67
Amsel Criteria for bacterial vaginosis
1. Thin white discharge
2. Clue cells on microscopy
3. Vaginal pH >4.5
4. Fishy odour after adding 10% KOH to the discharge (on a microscope slide)
68
Cause of bacterial vaginosis
Gardnerella vaginalis (loss of commensal lactobacilli + increased anaerobes)
69
- Multiorgan failure + hypotension
| - Desquamation
Toxic Shock Syndrome
= when keep tampon for a long time
-->Staph aureus/ Group A Strep releases toxins (superantigens) --> cytokines
70
Which STI causes arthritis, urethritis, conjunctivitis (Sexually Acquired Reactive Arthritis)
Chlamydia Trachomatis
71
Most common bacterial STI
Chlamydia Trachomatis
72
STI which is Gram -ve diplococcus
Neisseria Gonorrhoeae
73
Treatment of Neisseria Gonorrhoeae
IM ceftriaxone + PO azithromycin
74
Treatment of Chlamydia Trachomatis
Azithromycin 1g single dose
| Or, doxycycline for 7 days
75
Most common viral STI
Genital warts (HPV)
76
Which types of HPV cause genital warts?
HPV 6 and 11
77
Solitary painless ulcer (on penis glans, tongue etc)
Syphilis
78
Which bacterium causes Syphilis?
Treponema Pallidum
79
Lots of warts at sites of skin friction in genitals
Condylomata lata = secondary syphillis
80
Treatment of Syphilis
IM penicillin
81
Strawberry cervix and frothy discharge
Trichomonas Vaginalis = flagellate protozoan
82
Bilateral lower abdo pain and deep dyspareunia
PID
83
Most common cause of pruritus vulvae (itchy vulva)
Contact dermatitis
84
Pruritus vulvae: really bad itch, worse at night
Lichen Simplex = eczematous plaque (due to repeated rubbing/scratching)
85
Pruritus vulvae: parchment skin + figure-of-eight distribution around vulva
Lichen Sclerosus (autoimmune = vulva epithelium loses collagen)
86
Vaginal pus cells on wet-mount smear
PID
87
Treatment of PID
IM ceftriaxone --> PO doxycycline + PO metronidazole
| +screen partners for STI and treat them!
88
Difference between Urinary Stress Incontience and Overactive Bladder
Urinary Stress Incontinence = leaking during cough, WITHOUT detrusor contraction
Overactive Bladder = involuntary detrusor contraction after cough --> leak after cough
89
Dragging sensation in vagina
Urogenital Prolapse
90
Examination specific for urogenital prolapse
Sims’ Speculum: can see anterior and posterior vaginal walls
91
What does COCP contain?
Ethinyl oestrogen + progestogen
92
How does COCP work?
o -ve feedback on gonadotrophins --> suppresses ovulation
o Thickens cervical mucus
o Thin endometrium = more hostile
93
Pregnant even though have Mirena- what should you think about?
Ectopic!
94
What should you warn women about re. Mirena?
Reduces menstrual blood loss --> may become amenorrhoeic
| Causes irregular light bleeding
95
What should you warn women about re. depot progesterone?
Can have prolonged amenorrhoea after stop depot … warn potential mums about this!
96
Sharp, shooting breast pain - esp when breastfeeding
Mastitis
97
Deep burning breast pain
Ductal infection
98
Bladder still palpable after urination
Urinary Overflow Incontinence (retention, due to bladder outlet obstruction)
99
Sharp unilateral pain immediately following intercourse or strenuous exercise
Ruptured ovarian cyst (see free fluid on US)
100
Most common cause of post-coital bleeding
Cervical ectropion
101
Chignon vs cranial abrasion
Chignon = birth trauma on skull after ventouse
| Cranial abrasion = after instrumental/C-section
102
Ectopic pregnancy: foetal heartbeat present but minor symptoms and haemodynamically stable
Surgical (foetal heartbeat = emergency due to rupture risk!)
103
Tender RIF --> when palpate LIF, there is more pain in the RIF than LIF
Rosvig's Sign in appendicitis
104
Most common cause of PID in UK
Chlamydia trachomatis
105
US shows intrauterine sac with no fetal pole
Missed miscarriage
106
PCOS increases risk of which cancer?
Endometrial (oligo/amenorrhoea in the presence of pre-menopausal levels of oestrogen)
107
Ovarian tumour causing ascites and pleural effusion
Fibroma (benign) --> causes Meigs' Syndrome
108
Most common benign ovarian tumour in women <30yrs
Dermoid Cyst
109
Most common ovarian malignant cancer
Serous Adenocarcinoma
110
Large ovarian malignancy cancer (can become massive)
Mucinous Cystadenoma
111
Sudden collapse (low BP, high HR) after ROM
Amniotic Fluid Embolism
112
Lack of postpartum milk production and amenorrhoea following delivery
Sheehan Syndrome = PPH causes ischaemia of pituitary
113
Best LARC for young people
Progestogen-Only Subdermal Implant (Nexplanon = 40mm rod containing etonogestrel)
114
Commonest ovarian cyst
Follicular Cyst --> regresses after a few menstrual cycles
115
"Redness around cervical os"
Cervical ectropion = larger area of columnar epithelium being on ectocervix
- COCP
- Pregnancy!
116
Itchy, sore ulcer on vulva - does not respond to steroids
Vulval Carcinoma
- VIN = white plaque
- HSV = small vesicles
117
Ovarian cancer type which causes endometrial hyperplasia
Granulosa cell tumour
118
Treatment for endometrial hyperplasia
Simple hyperplasia with no atypia: progestogens (IUS) --> 3-6monthly hysteroscopy + biopsy
Atypia: hysterectomy
119
Fibroid complication that occurs during pregnancy
Red degeneration
120
Which cancer drug increases risk of endometrial hyperplasia?
Tamoxifen = oestrogen antagonist in breast, agonist in endometrium!
121
"Whirlpool sign" on US
Ovarian Torsion (whirlpool = twisty = torsion)
122
When is mid-luteal progesterone?
Cycle length - 7 days
| should be high (>30) as ovulation leaves behind corpus luteum, which makes progesterone…
123
Disease which is an absolute contraindication for any hormonal therapy
Current breast cancer
124
Riskiest form of breech
Footling = feet first --> 15% risk of cord prolapse
125
What med suppresses lactation, and how does it work?
Cabergoline - dopamine receptor agonist --> inhibits prolactin
126
Biggest risk factor for cord prolapse
ARM - because the baby is not yet engaged in the pelvis when the membrane is ruptured, so cord compressed if suspended below the baby
127
If need to monitor LMWH in pregnancy, what do you use to monitor it?
Anti-Xa Activity (use APTT to monitor unfractionated)
128
Painless lump in woman who has just stopped breastfeeding
Galactocele (obstruction of lactoferous duct) --> clinical diagnosis
129
Which contraceptives should not be used >50yrs?
COCP and Depo-Provera (decreases BMD)
130
Contraceptives used with enzyme-inducing drugs
Copper IUD
Progesterone injection (Depo-provera)
Mirena IUS
131
Absolute contraindication for copper IUD
PID
132
Chick presents >5 days after UPSI - is it too late to give UPSI?
Not necessarily - can give copper IUD within 5 days after earliest ovulation date (start of next period - 14 days)
133
Endometrial/ovary cancer, who also had bowel cancer at young age
HNPCC
134
Ovarian cysts that ruptures to cause pseudomyxoma peritonei
Mucinous cystadenoma
135
Where is most common site for ectopic rupture
Ampulla (middle region of Fallopian Tube)
136
Most common site for lymphatic spread in ovarian cancer
Para-aortic lymph nodes
137
Erythematous cervix with pinpoint areas of exudation
= Strawberry Cervix in Trichomonas vaginalis!
| --> oral metronidazole
138
Most common site in the tube for an ectopic pregnancy
Ampulla (70% ectopics)
| --> then isthmus, then fimbriae
139
Ovarian cyst containing Rokitansky's protuberance
Teratoma (dermoid cyst)
| -project from wall to centre of cyst
140
Ovarian cyst that forms in early pregnancy (is completely normal)
Corpus luteum
141
Main side effect of Progesterone Only Pill
Irregular vaginal bleeding
142
What secretes hCG?
Syncytiotrophoblast
143
Function of hCG
Prevent the disintegration of the corpus luteum, so it continues to make progesterone
144
Definition of anaemia in pregnancy
Hb <11 --> give oral iron
145
Fitz-Hugh–Curtis syndrome
PID --> liver adhesions
146
Early Decelerations on CTG
Benign, head compression -- starts with onset of contraction and ends when contraction ends
147
Late Decelerations on CTG
Foetal distress -- starts after contraction and ends >30 secs after end of contraction
-->foetal blood sampling --> C-Section if pH <7.2
148
Variable Decelerations on CTG
= independent of contractions = cord compression
149
Solitary painless, self-healing ulcer on penis --> unilateral lymphadenopathy
Lymphogranuloma venerum (chlamydia)
150
Argyll-Robertson pupils
Neurosyphillis (pupils that accommodate but don't constrict)
151
Oestradiol functions
- Endometrium proliferation
- Production of thin cervical mucus
- Maintains eggs in ovary
152
Progesterone functions
- Induces secretory changes in endometrium
- Thickens cervical mucus
- Decreases uterine contractility and inhibits breast milk (so progesterone drops before labour)
153
Pelvic pain in pregnancy, which radiates to upper thighs/perineum-- worse on walking
Symphysis Pubic Dysfunction (common)
154
Cephalic presentation-- feel Y-shaped dip anteriorly, and diamond posteriorly
Occipito-anterior = 95% and preferred
- Y-shaped: posterior fontanelle
- Diamond-shaped: anterior fontanelle
155
Longitudinal lie, with irregular contours of uterus
Occipito-posterior (irregular contours = legs!)
156
Drug which increases risk of necrotizing enterocolitis
Co-amoxiclav
157
Ovarian tumour causing Meigs' Syndrome
Fibroma (Meigs = ascites and transudative pleural effusion
158
Ovarian tumours that secrete AFP
Yolk sac tumour and malignant teratoma
159
Ovarian tumours causing precocious puberty/endometrial hyperplasia
Granulosa cell tumour
| Thecoma (both are sex cord tumours)
160
Ovarian tumour that secretes androgens
Sertoli-Leydig Cell tumour (sex cord tumour)
161
Baby born with sensorineural deafness, cataracts and heart defect -- what infection in pregnancy?
Rubella
162
Mother ate dodgy cheese --> baby has much increased risk of stillbirth
Listeria
163
Infection in mum causing fetal hydrops
Parvovirus B19 (haemolytic anaemia)
164
Most common cause of gynae cancer death in UK
Ovarian Cancer
165
Most common gynae cancer in UK
Endometrial Cancer
166
Diabetes increases risk of risk gynae cancer?
Endometrial Cancer
167
Drug used in Overactive Bladder if anticholinergics cannot be used
Mirabegron = B3 adrenoceptor agoinst --> relaxes detrusor muscle
168
Painkiller causing premature closure of ductus arteriosus (if used in late pregnancy)
Ibuprofen = 2nd line after paracetamol
169
Main oestrogen secreted by ovaries
17β-estradiol
170
Adipose makes this type of oestrogen
Oestrone
171
Oestrogen precursor
Androstenedione
172
Painful genital ulcers --> phimosis and supppuration of inguinal lymph nodes (abscesses)
Chancroid = haemophilus ducreyi
| -->culture on chocolate agar
173
STI with RUQ pain
Fitz-Hugh-Curtis Syndrome, due to ascending chlamydia infection
174
Painless genital ulcer --> systemic symptoms (fever, headache, skin rash)
Secondary Syphilis
175
Cause of genital warts (including specific subtypes)
HPV 6 and 11
176
Measurement of gestational age after 1st trimester
Head Circumference
177
What is Biophysical Profile?
Looks at foetal breathing movements, body movements, tone... = measure foetal neuro status
178
STI which is an obligate intracellular organism (can only replicate inside host cell)
Chlamydia trachomatis
179
Infection with "cobblestone" cervix
Chlamydia trachomatis
180
What position does head enter pelvis?
Occipito-transverse (looking sideways)
181
How does head change position as it moves through pelvis?
Internal rotation (90degrees to OA) and flexion (flexed head = smallest diameter)
182
Surge of this hormone initiates ovulation
LH
183
Type of prolapse causing urinary problems
Cystocele = bladder descends through anterior vaginal wall
184
Type of prolapse causing pooing problems
Rectocele = rectum protrudes into lower vaginal wall
185
Term pregnancy -- heartbeat heard above umbilicus
Breech (also don't feel definite presenting part, and feel ballotable part in fundus)
186
Most common endometrial cancer
Adenocarcinoma
187
Dull red papule --> single, painless well-demarcated ucler
Syphillis (ulcer = "chancre")
188
Placenta accreta vs increta vs percreta?
- Accreta: invades into superficial myometrium, does not invade through the muscle itself
- Increta: myometrium only
- Percreta: beyond myometrium (outside of uterus)
189
Inevitable vs Incomplete miscarriage
```
Inevitable = vaginal bleeding (foetus may still be alive)
Incomplete = pass foetal parts
```
190
Tumour marker for Granulosa Cell tumour
Serum inhibin
191
Class of ovarian tumour seen in young women
Germ Cell Tumour
192
Most common ovarian malignancy in young women
Dysgerminoma
193
Ovarian tumour with increased AFP
Yolk Sac Tumour
194
Supports of the uterus
- Transverse cervical ligaments
- Uterosacral ligaments
- Round ligament
195
2 important side effects of NSAIDs in pregnancy
- Renal agenesis
| - Premature closure of ductus arteriosus
196
First site of mets in molar pregnancy
Lungs
197
Dizziness/LOC when pregnant woman lies supine ("at night")
Aortocarval Compression (compression of abdominal aorta and inferior vena cava)
198
Sudden-onset shock and cyanosis in labour (at height of a contraction)
Amniotic Fluid Embolism
199
Painkiller contraindicated in breastfeeding
Aspirin
200
Newborn with hypoplastic finger nails -- what meds cause this?
Carbamazepine and phenytoin
201
Treatment of trichomonas
Metronidazole for 7 days
202
Treatment of BV
Metronidazole
203
Treatment of Toxic Shock
IV clindamycin and vancomycin
204
When can IUS be inserted post-partum?
Within 48hrs or after 4 weeks (risk of uterine perforation)
205
When can COCP be used post-partum?
After 21 days if not breastfeeding
| After 6 weeks if breastfeeding
206
Criteria for the cysts in PCOS
At least 12 in one ovary, 2-9mm
207
Foetal HR dropping steadily, but mum fine
Insertio velamentosa = umbilical vessels attached to membrane, not placenta --> bleeding from vessels compromises the foetus
208
How do prolactinoma cause amenorrhoea?
High prolactin inhibits GnRH on anterior pituitary
209
What hormone is in Depo-Provera?
Medroxyprogesterone acetate 150mg
210
Which antihypertensive drug class causes oligohydramnios?
ACEi (reduces renal perfusion)
211
Dyspareunia and menstrual pain --> ovarian cyst
Endometriosis (cyst = chocolate cyst! = endometrial ovarian deposit)
212
Mechanism of action for transexamic acid
Prevents plasminogen to plasmin --> fibrin cannot be degraded
213
Definition of low-lying placenta
- Placental edge <20mm from internal os
| - >16 weeks
214
Erb's Palsy caused by trauma to which nerves roots?
C5 and 6
215
Nerves affected in Erb's Palsy
```
Musculocutaneous = C5, 6 (and 7)
Radial = C5, 6 (7, 8, T1)
Axillary = C5, 6
```
216
Newborn with claw hand
Klumpke's Palsy = C8, T1
217
When should PID be hospitalised?
Fever >38
218
Laparoscopy shows thickened uterosacral ligament
Endometriosis
219
Mechanism of mifepristone
Binds to progesterone receptors in endometrium --> degeneration of endometrium and ripens cervix
220
Mechanism of misoprostol
Prostaglandin E1 analogue = stimulates contractions
221
Mechanism of ectropion
Visible part of cervix goes from squamous to columnar (as cervical canal is columnar)
222
Frothy vaginal discharge, with musty smell
Trichomonas vaginalis
223
Treatment of DVT in pregnancy
LMWH until 6 weeks post-partum (3 months minimum)
224
Normal histo appearance of endometrium
Pseudostratified columnar with tubular glands
225
Most common cause of DIC in pregnancy
Placental abruption
226
Condition causing "streak ovaries" (underdeveloped)
Turner Syndrome
227
Cardio changes in pregnancy
CO 40% increase
Systemic Vascular Resistance 50% decrease
BP- small decrease in 2nd trimester
228
Resp changes in pregnancy
Tidal volume 40% increase --> increased Minute Ventilation (feel SOB)
FRC decreases
229
Definition of polyhydramnios
Amniotic Fluid Index > 25cm
230
Definition of oligohydramnios
Amniotic Fluid Index < 5cm
231
Endometrial cancer first metastasises to ...
Para-aortic lymph nodes
232
Low-grade dyskariosis and +ve HPV
Colposcopy in 6 weeks (2 weeks if moderate dyskariosis)
233
Management of delay in 1st stage of labour
ARM if membranes intact
| --> reassess 2hrs later -- syntocinon if necessary
234
Optimal contraction frequency in 1st stage of labour
4-5 every 10mins
235
Down's results in Combined Test
Low PAPP-A
| High NT and hCG
236
Down's results in Quadruple Test
Low AFP and oestriol
| High inhibin and hCG
237
Oestrogen which increases most during pregnancy
Oestriol
238
Pregnant woman with low-grade pansystolic murmur over precordium (4th ICS midaxillary line)
Flow murmur = normal!
239
Newborn with nasal hypoplasia, vertebral calcinosis and brachydactyly (shortening of fingers and toes)
Warfarin
240
Treatment of PE
Enoxaparin
241
Young obese pregnant with headache + raised ICP, but no evidence of raised ICP/hydrocephalus
Idiopathic Intracranial Hypertension
242
Pregnancy rash on trunk/upper limbs, spares abdomen
Prurigo gestationis
243
Urinary incontinence, with urine leaking through vagina
Vesico-vagina fistula
244
Diagnosis of vesico-vaginal fistula
Inject methylene blue into bladder --> use speculum to see blue dye in vagina
245
Congenital infection causing chorioretinitis, microcephaly and convulsions
Toxoplasmosis
246
Bony landmarks of pelvic outlet
Bottom of pubic symphysis
Left and right ischial tuberosities
Tip of coccyx
247
Important indications for transdermal HRT
- Family history VTE
- BMI >30
- Variable blood pressure
- Liver enzyme-inducing drugs
