O&G Key Concepts Flashcards
(424 cards)
1
Q
Which SSRI leads to QT elongation and torsades de pointes?
A
Citalopram
2
Q
What is first-line treatment for menorrhagia?
A
Tranexamic acid
3
Q
What is the definition of pre-eclampsia?
A
New-onset BP >140/90mmHg after 20w AND proteinuria/organ dysfunction
4
Q
When can hormonal contraception be started again after using levonorgestrel for emergency contraception?
A
Immediately
5
Q
How do you manage a pregnant woman with previous VTE history?
A
Prophylactic LMWH throughout pregnancy until 6 weeks postnatal
6
Q
What does an older woman with a labial lump + inguinal lymphadenopathy suggest?
A
Vulval carcinoma
7
Q
What should you do if you are presented with a case of FGM in someone under 18?
A
Report it to the police
8
Q
How does ovarian cancer initially spread?
A
Locally into pelvic area
9
Q
What advice should you give about contraception to patients assigned female at birth?
A
Can’t use any contraceptions with oestrogen in if they’re undergoing testosterone therapy as antagonises it
10
Q
What does a complete hydatidiform mole (pregnancy) look like on ultrasound?
A
‘snow storm’ appearance on ultrasound scan
11
Q
How are pregnant women >20w who present within 24 hrs of a rash appearing (chickenpox) treated?
A
Oral aciclovir
12
Q
What sign is ovarian torsion associated with on ultrasound?
A
Whirlpool sign
13
Q
For transgender males, does testosterone therapy provide protection against pregnancy and what effects can it have on the pregnancy if it doesn’t?
A
No it doesn’t
Teratogenic effects
14
Q
What is an important risk factor for hyperemesis gravidarum?
A
Multiple pregnancy
15
Q
What is the cervical screening timeline?
A
25y - first invite 25-49 - every 3 years 50-64 - every 5 years 65+ not offered delay 3 months post-partum unless missed previous or previous abnormal
16
Q
What treatment is first-line for painful periods that are otherwise normal?
A
NSAIDs - inhibit prostaglandin synthesis (one of main causes of dysmenorrhoea pains)
17
Q
What is the symphysis-fundal height, where is it measured, and what should you do if it’s abnormal?
A
Measure to establish whether small for dates, should be 1-2cm from the gestational age in weeks e.g. 24 weeks should have a SFH of 22-26cm.
Measured from top of pubic bone to top of uterus in cm.
Get ultrasound to confirm if foetus is small for gestational age.
18
Q
What is the main investigation of suspected placenta praevia?
A
Transvaginal ultrasound
19
Q
What are 2 common long-term complications of vaginal hysterectomy with antero-posterior repair?
A
Enterocele
Vaginal vault prolapse
20
Q
Which emergency contraception should be used with caution in patients with severe asthma?
A
Ulipristal
21
Q
What is the first step after a woman presents concerned about reduced foetal movements?
A
Handheld Doppler to confirm foetal heartbeat
22
Q
How long does it take each contraceptive type to be effective after administration?
A
Instant - IUD
2 days - progesterone-only pill
7 days - combined oral contraceptive, injection, implant, IUS
23
Q
What is a major risk factor for cord prolapse?
A
Artificial amniotomy/rupture of membranes
24
Q
What is a potential complication of ovulation induction?
A
Ovarian hyperstimulation syndrome
25
Acute presentation of hours-ago onset abdominal pain + bloating that has been increasing. On exam abdo tenderness + ascites. Hx of IVF treatment (ovulation induction). Diagnosis?
Ovarian hyperstimulation syndrome
26
What is a major contraindication for injectable progesterone contraceptives?
Current breast cancer
27
What scale is used to screen for postnatal depression?
The Edinburgh Scale
28
How should you manage premenstrual syndrome?
SSRIs (fluoxetine) either continuously or during the luteal phase
29
What is the first-line treatment for a <35mm ectopic pregnancy with no heartbeat?
Methotrexate (interferes with DNA synthesis and disrupts cell multiplication so pregnancy doesn't develop)
30
What is the definition of pregnancy-induced hypertension? (and what features does it lack that differs from pre-eclampsia?)
>140/>90 mmHg after 20w
| No proteinuria or oedema
31
How do you manage pregnancy-induced hypertension?
Oral labetalol
32
When must methotrexate be stopped for males AND females before conception?
At least 6 months in both men and women
33
What is the management if at the time of diagnosis of gestational diabetes, the fasting glucose is >7mmol/L?
Insulin (with or without metformin) should be started immediately
34
PPROM (preterm premature rupture of membranes) investigation steps
Sterile speculum exam
| Then, if no fluid in posterior vaginal vault, use US to assess for oligohydramnios
35
How are perineal tears classified after birth?
1st degree - tear within vaginal mucosa only
2nd degree - tear into subcutaneous tissue (submucosa)
3rd degree - laceration extends into external anal sphincter
4th degree - laceration extends through external anal sphincter into rectal mucosa
36
What is the key clinical feature of placenta praevia?
Painless bleeding after 24w
37
How long are healthy couples expected to take to conceive and when would investigations be started?
Up to 1 year, investigations only started after 1 year of regular attempts to conceive
38
What are 3 important causes of placental abruption and what are their distinguishing features?
Placental abruption - abdominal pain + vaginal bleeding
HELLP (Haemolysis, Elevated Liver enzymes, Low Platelets) syndrome - Anaemia or low platelets seen in blood results
Cocaine use - Dilated pupils + hyperreflexia
Pre-eclampsia - absence of the other 2 and fit of clinical scenario
39
If 2 COCP pills are missed in week 3, what should the patient do?
Finish pills in the current pack and omit pill-free interval starting a new pack immediately
40
Appropriate management if breastfed baby loses >10% birth weight in first week of life?
Refer to midwife-led breastfeeding clinic
41
What are the 4 classic symptoms of endometriosis?
Pelvic pain
Dysmenorrhoea
Dyspareunia
Subfertility
42
What is tamoxifen a risk factor for?
Endometrial hyperplasia (anti-oestrogen effect in breasts hence anti-breast cancer use but PRO-oestrogen effect in endometrium - proliferation)
43
What treatment is used for Group-B Streptococcus prophylaxis?
Benzylpenicillin
44
When should Group-B Streptococcus infection be suspected or prophylaxis started?
Fever of >38 in labour (use benzylpenicillin)
45
What is the COCP a protective factor for?
Endometrial cancer (reduced proliferation of endometrium)
46
What are the long-term complications of PCOS?
```
Subfertility
Endometrial cancer
Diabetes
Stroke and TIA
Coronary artery disease
Obstructive sleep apnoea
```
47
What is the difference between chronic/pre-existing hypertension, pregnancy-induced hypertension, and pre-eclampsia?
Pre-existing - BP >140/90 before 20w gestation with no new proteinuria (can have a small amount present from chronic hypertension), no oedema
PIH - BP >140/90 AFTER 20w gestation, no new proteinuria, no oedema
Pre-eclampsia - BP >140/90 during pregnancy WITH proteinuria (>0.3g/24hrs). Oedema may occur
48
When can contraception be stopped in women above and below the age of 50?
<50 - 2 years amenorrhoea
>50 - 1 year amenorrhoea
49
What is the pathway that should be in your head for management of a pregnant patient at risk of exposure to chickenpox?
1) Ask mum about her chickenpox history
2) Check for varicella antibodies
3) If confirmed mum isn't immune then give varicella immunoglobulin (effective any point during pregnancy up to 10 days after exposure)
50
Management of stress incontinence
1 - pelvic floor exercises
2 - consider surgery
3 - duloxetine if no surgery
51
Which component of HRT increases the risk of breast cancer?
Progestogen (remember POP is also contraindicated if Hx of breast cancer)
52
Process of medical abortion/ToP
Mifepristone + 1+ set of prostaglandins (vaginal)
53
Postpartum Hb cutoff for iron supplementation
100g/L (105 2nd trimester, 110 1st trimester)
54
1st line treatment for primary dysmenorrhoea
NSAIDs - mefenamic acid
55
Important cause of visual impairment in babies born before 32 weeks
Retinopathy of prematurity
56
AFP raised in...
Neural tube defects (meningocele, myelomeningocele, anencephaly)
Abdominal wall defects (omphalocele, gastroschisis)
Multiple pregnancy
57
AFP lowered in...
Down's syndrome
Trisomy 18
Maternal DM
58
18y/o girl
Sudden onset sharp tearing pelvic pain + vaginal bleeding +/- shoulder tip pain.
Hypotensive, tachycardic, cervical excitation
Ectopic pregnancy presentation
59
25y/o lady
2 day RUQ pain, fever, white vaginal discharge.
Previous recent Hx of pelvic pain + dyspareunia
PID presentation
60
16 y/o girl
12hr pelvic discomfort otherwise well + LMP 2 weeks ago.
Mild suprapubic discomfort OE.
Mittelschmerz presentation
| "middle pain", pain halfway/14 days through menstrual cycle associated with ovulation, no Tx required
61
Risk factors for gestational diabetes
```
BMI >30
Previous macrosomic baby ≥4.5kg
Previous GD
1st degree relative with diabetes
Family origin (South Asian, Black caribbean, middle eastern)
```
62
Investigation for gestational diabetes
OGTT - oral glucose tolerance test
| - 24-28 weeks if risk factors +ve
63
Diagnostic thresholds for gestational diabetes
Fasting ≥5.6
| 2-hour ≥7.8
64
Course of action if 1 COC pill missed at any point
Take last pill even if this means 2 in one day + continue taking pills daily
No additional contraceptive needed
65
Course of action if 2 or more COC pills missed (w1, w2, w3)
Take last pill even if this means 2 in one day + continue taking pills daily + abstain/use condoms for 7 days of pills
W1 - emergency contra if unprotected sex in pill-free interval/W1
W2 - after 7 days consecutive pills no emergency contra needed
W3 - finish pills in current pack + start new pack next day leaving out pill-free interval
66
Chronic pelvic pain, secondary dysmenorrhoea starting days before bleeding, deep dyspareunia, subfertility.
On exam reduced organ mobility, tender nodularity in posterior vaginal fornix
Presentation of endometriosis
67
Gold standard investigation for endometriosis
Laparoscopy
68
Endometriosis management
1 - NSAIDs +/- paracetamol
2 - COCP or progestogens
3 - GnRH analogues
4 - surgery
69
Urge vs stress incontinence presentation
Urge - can't get to toilet in time after urge comes on
Stress - small amounts come out on coughing/sneezing/laughing
70
Urge vs stress incontinence management
Urge - bladder retraining
Stress - pelvic floor muscle training
71
30w pregnant + intense itching on palms and soles, no rash.
Presentation of intrahepatic cholestasis of pregnancy (obstetric cholestasis)
72
Major complication of intrahepatic cholestasis of pregnancy
Stillbirth
73
Normal lab findings in pregnancy (different to non-pregnant)
Reduced urea
Reduced creatinine
Increased urine protein (increased loss in urine)
74
Caesarian section categories + reason
Category 1 - immediate threat to life of mum or baby
Category 2 - threat to mum or baby that's not immediately life-threatening (deliver <75 mins)
Category 3 - delivery required but mum and baby stable
Category 4 - elective caesarean
75
Indications for Cat 1 c-section
Suspected uterine rupture
Major placental abruption
Cord prolapse
Fetal hypoxia or persistant fetal bradycardia
76
Levonelle vs ulipristal effective periods since UPSI
Levonelle (levonorgestrel) - 72 hrs (can go up to 96)
Ulipristal - 120 hrs
77
Prophylaxis in women at moderate to high risk of pre-eclampsia
Aspirin 75-150mg daily - 12w gestation until birth
78
Commonest adverse effect of progestogen-only pill
Irregular vaginal bleeding
79
Cervical screening test method
Tests for high-risk HPV strains first
| Cytological exam only if HPV test positive
80
Cervical screening pathway
Negative hrHPV - return to normal recall
+ve hrHPV + abnormal cells = COLPOSCOPY
+ve hrHPV + normal cells = repeat 12mths and 24mths if still +ve + normal. Return to normal recall if -ve. If +ve after 24mths then COLPOSCOPY
Inadequate sample - repeat 3mths, COLPOSCOPY if 2 consecutive
81
Treatment for fibroids if wishing to preserve fertility
Myomectomy
82
COCP use can mask Sx that would exist without it for this condition
PCOS
| Use of COCP masks hirsutism, infertility, oligo/amenorrhoea
83
HRT delivery route to avoid VTE?
Transdermal (NOT oral)
84
Investigation indicated for menorrhagia + Sx
ULTRASOUND
| if abnormal exam findings, pelvic pain, intermenstrual or postcoital bleeding
85
Precautions needed when on POP + ABx
NO extra precautions needed (media hype is fake)
86
Date post-delivery contraception needed
21 days postpartum
87
Unopposed oestrogen is a major risk factor for this type of cancer
ENDOMETRIAL cancer (not breast, that's progesterone)
88
Criteria for expectant management (close monitoring + 48hr B-hCG) of ectopic pregnancy
```
Unruptured embryo
<35mm in size
No heartbeat
Asymptomatic
B-hCG <1,000IU/L and declining
```
89
Endometrial hyperplasia presentation
Intermenstrual bleeding
Post-menopausal bleeding
Menorrhagia
Irregular bleeding
90
Concerning symptom in pregnancy
Dysuria (pain on urination)
91
Management of cervical cancer to maintain fertility + stage
CONE biopsy + negative margins (stage IA)
92
Life choice that reduces incidence of hyperemesis gravidarum
Smoking
93
Normal CTG findings
Accelerations present
Variability >5bpm
No decelerations
HR 110-160
94
Main complication of induction of labour
Uterine hyperstimulation
95
Criteria for gynae oncology biopsy referral of ovarian cysts ('M' rules)
```
'M' rules = malignant
Irregular, solid tumour
Ascites
4+ papillary structures
Irregular multilocular solid tumour diameter ≥100m
Very strong blood flow
```
96
FGM Act 2003 principle
All forms of female genital cutting/modification for non-medical reasons is ILLEGAL and cannot be performed under any circumstances
Illegal to perform the procedures but not illegal to discuss it
97
Features of threatened miscarriage
Bleeding + closed cervical os
98
Change in folic acid dose for pregnant women on antiepileptics
5mg folic acid OD (instead of 400mcg)
99
Investigation findings suggesting Down's syndrome
Raised HCG
Decreased PAPP-A
Thickened nuchal translucency
100
Antibiotic group safe for use in pregnancy + examples
Cephalosporins (ceftriaxone, cefuroxime, cephalexin)
101
Recurrence rate of postnatal psychosis
25-50%
102
Blood test used to measure LMWH effect in both VERY small or VERY large women (<50, >90)
Anti-Xa activity
103
Preferred method of induction of labour
Vaginal PGE2 (prostaglandin) gel
104
Guideline on using MMR vaccines in pregnant or attempting-to-become-pregnant women
DON'T USE IT
Don't administer at all, contraindicated in pregnancy
Instead advice - avoid becoming pregnant for 28 days after having the vaccine and stay away from people with one of the MMR diseases if not immuned
105
Wood's screw manoeuvre + indication
Place hand in the vagina and attempt to rotate the foetus
Shoulder dystocia (shoulder stuck on pubic symphysis)
106
Management of transverse lie without amniotic sac rupture
External cephalic version
107
Indications for continuous CTG monitoring
Suspected chorioamnionitis or sepsis, or temp ≥38
Severe hypertension ≥160/110
Oxytocin use
Presence of significant meconium
Fresh vaginal bleeding develops in labour
108
Classic vasa praevia triad
Rupture of membranes followed by painless vaginal bleeding and foetal bradycardia
109
Group B strep treatment in pregnancy
Intrapartum IV benzylpenicillin
| IV is key to make sure baby is protected too
110
Start time + dose of folic acid for women at risk of neural tube defects + reason
Start 0.4mg daily before conception and continue until 13 wks
Neural tube formed in 1st 28 days of embryo's development so need to be on it before this and only come off it way after
111
Timeframe for Cat 1 c-sections to occur
Cat 1 = emergency
| Within 30 minutes of making the decision
112
Treatment for delayed placental delivery in pts with placenta accreta
Hysterectomy
113
Polyhydramnios is a risk factor for...
Placental abruption risk factor
114
Turner's syndrome expected bloods results
Raised FSH/LH (primary amenorrhoea due to gonadal dysgenesis so body trying harder to make the hormones)
115
SSRIs for breastfeeding women
Sertraline
| Paroxetine
116
BMI indication for 5mg folic acid + recommended timeline of use
BMI ≥30
| Daily until 13th wk of pregnancy
117
Pain present or absent in placenta praevia?
Absent
118
Mental health drug to be avoided in breastfeeding
Lithium
119
Bishop's score for ripe or 'favourable' + significance
≥8
High chance of spontaneous labour
OR
High chance of response to interventions for inducing labour
120
Cyclical pain but no periods and otherwise well =
Imperforate hymen
121
How long before women can restart hormonal contraception after Ulipristal acetate
5 days
122
Investigations needed to differentiate between galactocele and breast abscess
None - clinical Hx + exam enough
123
Definition of Sheehan's syndrome/postpartum hypopituitarism
Reduction in function of the pituitary gland following ischaemic necrosis due to hypovolaemic shock following birth
- amenorrhoea (GnRH), hypothyroidism, milk production problems
124
Expected results for Down's syndrome - AFP, oestriol, -HCG, PAPP-A, nuchal translucency
AFP - low
Oestriol - low
PAPP-A - low (pregnancy-associated plasma protein A)
-HCG - high
Nuchal translucency - thickened
125
Points at which women with gestational diabetes in previous pregnancy should be offered an OGTT
Immediately after booking AND at 24-28 weeks (different to just 24-28 weeks in someone with just risk factors)
126
Most common explanation of short <40 min episodes of decreased CTG variability
Foetus is asleep
127
Contraception method most associated with weight gain
Injectable contraceptive (depo-provera)
128
Management of all postmenopausal women with atypical endometrial hyperplasia
Total hysterectomy + bilateral salpingo-oophorectomy
| due to risk of malignant progression
129
Management of non-immune pregnant women exposed to varicella zoster virus + effective period
Single dose of varicella zoster immunoglobulin
| Within 10 days of contact
130
Tiers of treatment for ectopic pregnancy
1 - methotrexate
2 - salpingectomy
3 - salpingotomy if risk factors for infertility as alternative to salpingectomy
131
Potential large side-effect of ovulation induction
Ovarian hyperstimulation syndrome
132
Gestation time where further investigation required if no foetal movements + management step
24 weeks - referral to maternal fetal medicine unit
133
Significant risk factor for placenta praevia
Assisted fertilisation (IVF)
134
Summary of increased risk and protective features of COCP
Increased risk - breast & cervical cancer
| Protective - ovarian & endometrial cancer
135
Summary of 3 steps of gestational diabetes treatment
Fasting glucose <7 = trial of diet and exercise. If ineffective = metformin. If ineffective = insulin.
Fasting glucose >7 = insulin
136
Postnatal rule if patient receives antenatal VTE prophylaxis
Patient must receive 6 weeks of prophylaxis postnatally as well
137
Management of pregnant patient with Hx of VTE
Prophylaxis - LMWH antenatally + 6 weeks postpartum
138
Criteria for URGENT gynaecology referral if suspicion of ovarian cancer
Abdominal or pelvic mass palpable (skip CA125 and US tests and go straight to referral)
139
Management of placental abruption with alive fetus, <36wks, no fetal distress
Admit + give steroids + monitor both mum and baby
140
Management of ?PE in pregnant woman with confirmed DVT
Treat with LMWH FIRST
| THEN investigate to rule in/out
141
Risk factor for shoulder dystocia
Diabetes mellitus (type 1 or 2)
142
McRobert's manoeuvre process + why it works
Flexion + abduction of maternal hips - bringing mother's thighs towards her abdomen
Increases relative anterior-posterior angle of pelvis and often facilitates successful deliver
143
1st line investigations in infertility
Females - day 21 progesterone
| Males - semen analysis
144
How often progestogen injectable contraceptive given
Every 12 weeks
145
Placenta praevia vs placental abruption main difference
Praevia = no pain
146
1st line management of mastitis in breastfeeding women
Advise to continue breastfeeding and use simple analgesia and warm compresses
147
Cervical ectropion more common in which women
COCP users - due to higher oestrogen levels
148
Cause of oligohydramnios
Renal agenesis (amniotic fluid mainly derived from foetal urine)
149
Most specific sign to confirm pre-eclampsia
Brisk tendon reflexes (most specific, oedema diagnostic feature but non-specific)
150
Appropriate investigations for vaginal candidiasis
CLINICAL diagnosis
| High vaginal swab NOT routinely indicated if clinical features are consistent with candidiasis
151
Most EFFECTIVE form of emergency contraception + not affected by BMI
Copper IUD
152
1st line treatment for intrahepatic cholestasis of pregnancy (obstetric cholestasis)
Ursodeoxycholic acid
153
Treatment for vaginal vault prolapse
Sacrocolpoplexy
154
Mirena effect on periods
Initial frequent/irregular bleeding later followed by light menses or amenorrhoea
155
Precautions for antibiotics when on POP + exception
None - no need for extra precautions
| Exception is rifampicin
156
Decelerations - abnormal vs normal
Normal - deceleration commences and ends with onset/completion of contraction (head compression)
Abnormal - deceleration which lags behind contraction onset + doesn't return to normal until 30 SECONDS after end of contraction (foetal distress)
157
Postpartum haemorrhage definition
Blood loss of 500ml or more within 24 hours of the birth of a baby
158
BMI threshold for 5mg folic acid instead of 400mg
BMI >30
159
Diagnostic investigations needed for diagnosis of postpartum thyroiditis
Clinical manifestations and thyroid function tests alone
160
5 parts of cord prolapse management
Advise patient to go onto all fours
Push back presenting part of foetus into uterus
Give tocolytics (terbutaline) to reduce cord compression and allow c-section
Deliver by immediate c-section
DO NOT push cord back into uterus
161
Breast-feeding changes needed when on antiepileptic drugs
None needed, BFing acceptable with nearly all anti-epileptics
162
Cervical screening time to wait until restart after pregnancy
3 months
| Unless missed previous or previous abnormal
163
Teenager with primary amenorrhoea + regular painful cycles - leading differential?
Imperforate hymen
164
1st stage of labour definitions (active + latent)
```
Latent = 0-3cm dilation
Active = 3-10cm dilation
```
165
Clinical features of infectious mastitis
```
Breast pain (unilateral)
Erythematous, warm, tender area associated. Can have fever/flu-like sx
```
166
Treatment of infectious mastitis
Oral flucloxacillin + continue breastfeeding
167
Most common CO of infectious mastitis
Staph aureus
168
Treatment of stage 2-4 ovarian cancers
Surgical excision
| Can be accompanied by chemo
169
Treatment for bacterial vaginosis
Oral metronidazole
170
Treatment for trichomonas vaginalis
Oral metronidazole
171
Treatment for gonorrhoea
IM ceftriaxone
172
Potential complication of HG in pregnancy + treatment
Wernicke's encephalopathy
| Supplementation with thiamine (vit B1) and vit B+C complex (e.g. Pabrinex)
173
2 features indicative of Wernicke's encephalopathy
Diplopia
| Ataxia
174
Management of PCOS woman with BMI >35 + wanting contraception
Progestogen IUS
175
Management of PCOS woman with BMI <35 + wanting contraception
COCP
176
When to refer to fertility services in case of PCOS
When cause of infertility is KNOWN (i.e. PCOS)
177
Rovsing's sign + significance
Palpation of LIF causes increased tenderness in RIF
| - appendicitis
178
Uterus size greater than expected for gest. age + abnormally high serum hCG - presentation of...
Complete hydatidiform mole
179
Management of post-term pregnancy (41wks) in patient with pregnancy-induced hypertension
Medical induction of labour 1st line
| C-section if foetal compromise
180
When can postpartum women (BFing and non-BFing) start the POP again?
Immediately (don't theoretically need to but can)
181
When can BFing and non-BFing postpartum women start the COCP again?
Non-BFing - 3 weeks (UKMEC2) or 6 weeks (UKMEC1)
| BFing - 6 weeks (UKMEC2) or 6 months (UKMEC1)
182
Presence of foetal heartbeat in context of ectopic pregnancy means what for management
Indication for SURGICAL (both expectant and medical require no heartbeat)
183
Date at which a mid-luteal progesterone level should be done
7 days before end of menstrual cycle
184
Normal BP changes in pregnancy
Falls in 1st half of pregnancy
| Rises to baseline in 2nd half
185
Management of ?ruptured ectopic pregnancy
Resus + emergency laparotomy
186
When can patients restart COCP post-partum and why
Minimum 3 weeks (if non-BFing)
| Due to increased VTE risk post-partum
187
Contraceptive patch regime
1 patch weekly for 3 weeks then 1 week no patch (repeat)
188
COCP increased risk/protective factor for which cancers
Increased risk - breast, cervical
| Protective - ovarian, endometrial
189
Most important investigation to request in ?obstetric cholestasis
LFTs
190
Medical management of PCOS-related infertility
Lifestyle changes (WL, exercise, no smoking)
Clomifene
+/- Metformin
191
Induction of labour order of interventions
```
1 - Membrane sweep
2 - Vaginal prostaglandins (Prostaglandin E2)
3 - Oxytocin
4 - Amniotomy (artificial ROM)
5 - Cervical ripening balloon
```
192
Stress vs urge incontinence medical management
Stress - duloxetine
| Urge - oxybutynin
193
Drug that can cause folic acid deficiency
Phenytoin (antiepileptic - look for hx of epilepsy)
194
Criteria for infectious mastitis diagnosis
Sx don't improve/worsen after 12-24hrs despite effective milk removal
Nipple fissure present + infected
Bacterial culture positive
195
Medical management of miscarriage
Vaginal misoprostol alone
196
COs of late and early onset sepsis in neonates
Early <48hrs after birth = Group B Strep
| Late >48hrs after birth = Staph epidermidis/aureus
197
Rule for 'Traditional' POP missed pill
<3 hrs late - no action
| >3 hours late - take missed pill asap, continue as normal, extra precautions until pill-taking for 48 hrs
198
Rule for cerazette (desogestrel) POP missed pill
<12 hrs late - no action
| >12 hours late - take missed pill asap, continue as normal, extra precautions until pill-taking for 48 hrs
199
Booking visit date
8-12 weeks
200
Early scan to confirm dates and exclude multiple pregnancy date
10-13+6 weeks
201
Down's syndrome screening + nuchal scan date
11-13+6 weeks
202
Anomaly scan date
18-20+6 weeks
203
Information on anomaly scan + blood results. Offer iron supp if Hb <11 (<110). Routine BP, urine dip. Date
16 weeks
204
Post-20 weeks routine pregnancy appointments
```
25 wks (if primip)
28 wks
31 wks (if primip)
34 wks
36 wks
40 wks (if primip)
41 wks
```
205
Management of pregnancy-induced hypertension (of any form) + eclampsia
```
Oral labetalol (beta blocker so contra in asthmatics)
Nifedipine and methyldopa are alternatives but methyldopa is contra in depression.
Eclampsia = IV magnesium sulphate
```
206
Contraception method associated with delayed return to fertility
Depo-provera (progestogen injection)
207
Menorrhagia + subfertility + palpable abdo mass = ?
Fibroids
208
Diagnosis process for ?atrophic vaginitis
Diagnosis of exclusion
| - do TVUS for ?endometrial cancer first
209
Antiepileptics ok for pregnancy
Lamotrigine
Carbamazepine
Levetiracetam
210
Antiepileptics NOT ok for pregnancy
Phenytoin
Phenobarbitone
Sodium valproate
211
Management of menorrhagia with/without desire for contraception
No contraception - TE acid or MN acid
| Contraception - IUS 1st line, COCP, long-acting progestogens
212
Short-term option to rapidly stop heavy menstrual bleeding
Norethisterone 5mg TDS
213
Management of pregnant lady not immune to Rubella during pregnancy
Advise of risks of infection + need to keep away from infected individuals
214
Investigations for urinary incontinence
URINALYSIS - rule out UTI and diabetes
215
Continuous dribbling incontinence after prolonged labour + area with limited obstetric services
?Vesicovaginal fistulae
216
Investigation for underlying cause of recurrent candidiasis?
HbA1c - exclude diabetes
217
What is lochia?
Vaginal discharge after birth - can contain all sorts of material (blood, mucus, uterine tissue etc)
218
When to investigate + investigation in patient with persistent lochia
If persists beyond 6 weeks
| - ultrasound
219
Pre-eclampsia effect on amniotic fluid
Oligohydramnios
220
Infections to offer antenatal screening for
Hep B
HIV
Syphilis
221
Management options (4) for HIV positive pregnant women
Maternal antiretroviral therapy (zidovudine)
Mode of delivery (c-section)
Neonatal antiretroviral therapy (zidovudine)
Infant feeding by BOTTLE (do not breast feed)
222
Contraindication for COCP
Smoking >15 a day
223
Definition of premature ovarian insufficiency
Onset of menopausal Sx + elevated gonadotrophin levels <40 y/o
224
Treatment of premature ovarian insufficiency
HRT or COCP offered up to 51 years
225
Investigation indicated if any of these on regular basis:
- abdo distension
- early satiety/loss of appetite
- pelvic/abdo pain
- increased urinary urgency/frequency
CA125 - checking for ovarian cancer
226
Primary care management of positive pregnancy test + abdo/pelvic pain + cervical motion tenderness
IMMEDIATE EPU assessment referral (worried about ectopic)
227
Examples of muscarinic antagonists used in treatment of urge incontinence
Oxybutynin
Tolterodine
Solifenacin
228
2 treatments indicated for PMS
COCP
SSRIs
(NOT progesterone-only methods)
229
3 factors for increased risk of placental abruption
Increased maternal age
Multiparity
Maternal trauma
230
When is anti-D given and not given in management of ectopic pregnancy
If medical - NOT required
| If surgical - required (potential of leak of Rho +ve)
231
Ideal placement of implantable contraceptives
Subdermal, non-dominant arm
232
Anti-D giving dates in Rhesus-negative pregnant women
28 weeks
| 34 weeks
233
HRT giving in women with uterus or if has mirena or has vte risk near menopause
If has uterus - combined O+P required
If has mirena - just give oestrogen (progesterone will come from IUS)
If at risk of VTE - give transdermal NOT oral
234
Antenatal complications of monochorionic twins
Polyhydramnios
Pregnancy-induced hypertension
Anaemia
Antepartum haemorrhage
235
Management of premenstrual syndrome
New-gen COCP
| If severe = SSRI
236
Commonest + most severe sites of ectopic pregnancy
Commonest - ampulla of fallopian tube
| Most severe - Isthmus
237
First-line treatment for magnesium sulphate-induced resp depression
Calcium gluconate
238
Principle concern with postmenopausal bleeding
Must rule out endometrial cancer
239
Management of secondary dysmenorrhoea
Refer to gynae for investigation
240
Management of pregnancy post-GBS treatment around delivery
INTRApartum antibiotics
| - IV BenPen ASAP after start of labour
241
Analgesic to be avoided in breastfeeding
Aspirin
242
Management of PROM
Admit for 48hrs+
ABx
Steroids
243
Chocolate cysts due to external appearance
Endometriotic cyst
244
Commonest ovarian cancer
Serous carcinoma
245
3cm 'simple cyst' on left ovary, asymptomatic
Follicular cyst
246
Woman <6wks pregnant, vaginal bleeding, no pain. Management?
Expectant
| - advise repeat preg test in 7/7. If negative = miscarriage. If positive or continued/worsened symptoms - refer to EPU
247
Endometriosis RF for...
Ectopic pregnancy
248
Complications + commonest of open myomectomy
Adhesions (most common)
Bladder injury
Uterine perforation
249
Definitive management of obstetric cholestasis
IoL at 37-38 wks (ursodeoxycholic acid is only symptomatic relief)
250
Aetiology of overflow incontinence
Bladder outlet obstruction
251
High detrusor pressure + low peak flow rate = which incontinence
Overflow
252
Nexplanon contraceptive type
Subdermal progesterone implant
253
Macrosomia definition
Baby that's >4kg at birth
254
Adduction + internal rotation of arm in newborn
Erb's palsy, 'waiter's tip'
255
Aetiology of Erb's palsy
Damage to upper brachial plexus due to shoulder dystocia. Common in macrosomia due to increased risk of dystocia
256
Active management of 3rd stage of labour
```
Uterotonic drugs (IM oxytocin)
Deferred clamping/cutting or cord (>1min post delivery but <5 min)
Controlled cord traction after signs of placental separation
```
257
Increased nuchal translucency associated with...(2)
Down's syndrome
| Congenital heart defects
258
Test results from ?molar pregnancy
High bhCG
Low TSH
High T4
(trophoblastic disease, ectopic source of T4)
259
Most likley cause of vaginal discharge post-antibiotic treatment
Candidiasis
260
Expected fundal height growth timeline
<24 weeks - 2cm per week
| >24 weeks - 1cm per week
261
When should fundus be palpable at umbilicus and xiphoid sternum during pregnancy
Umbilicus - 20 wks
Xiphoid - 36 wks
Anywhere in between this during this period
262
First-line treatment for menorrhagia + requires contraception
IUS
263
Definition of menorrhagia
An amount that the woman considers to be excessive
264
Normal signs on cardiac exam for pregnant woman
Third heart sound
Ejection systolic murmur
Forceful apex beat
265
Management of pregnant women with BP >160/110
Admit + observe
266
Secondary amenorrhoea + low gonadotrophins
Hypothalamic cause
267
Positive day21 progesterone challenge
PCOS
268
Usual booking appointment tests
BMI
Urine culture for asymptomatic bacteruria
RBC alloantibodies
Hep B
269
Investigation for ?vesicovaginal fistula (continuous dribbling incontinence)
Urinary dye studies
270
Investigation for non-respondent stress incontinence to pelvic floor exercises
Urodynamic studies
271
Investigation when cause of incontinence is uncertain or there are plans for surgery
Urodynamic studies (basically use at the end of investigations)
272
2 rules for Cu IUD use as emergency contra
Within 5 days after UPSI in a cycle
| Within 5 days after earliest estimated ovulation date
273
Investigation for ?adenomyosis
MRI Pelvis
274
Hep B mum, treatment for baby?
Hep B vaccine + 0.5ml HepB Ig <12hrs after birth
| Then hep B vaccine 1-2mths + 6 mths
275
Name for bleeding in 2wks post-birth
Lochia
276
HNPCC/Lynch syndrome cancer RF
Endometrial cancer
277
Acute intense abdominal pain + free fluid in abdomen + hx of endometriosis = ?
Ruptured endometrioma
278
Increase in risk of cervical cancer by smoking
Smoke = two-fold increased risk of developing cervical cancer
279
MAIx when endometrial pipelle biopsy is inconclusive
Hysteroscopy with biopsy
280
Delayed patch change over 48 hours - next steps
Barrier protection/abstinence for 7 days
Emergency contra if required
Restart new patch immediately
281
Primary MoA of contraceptive implant
Inhibition of ovulation
282
Test to confirm menopause (if menopausal age) or premature ovarian failure (if younger)
FSH level
283
Baby with umbilical hernia, large + protruding tongue, flattened face, low muscle tone
Down syndrome
284
Indications for COCP in fibroids
If <3cm + not distorting uterine cavity - try medical treatment (before myomectomy)
285
BMI at which 5mg folic acid given
BMI >30
286
Initial definitive management of cord prolapse
Place hand into vagina to elevate presenting part (or by filling urinary bladder)
287
Management approaches of ovarian cysts
Premenopause - conservative if small and reported as 'simple'. Repeat US at 8-12 weeks + refer if persists
Postmenopause - urgent referral to gynaecology (any nature/size)
288
Wheelchair use UKMEC for COCP
UKMEC 3 (risks outweigh benefits)
289
Which contraceptive to stop after 50 y/o
Injectable (e.g. depo-provera)
290
Amiodarone in breastfeeding?
AVOID
291
Premature labour management
If early stage then admit + tocolytics/steroids (tocolytics stop labour, steroids develop baby's lungs in case labour continues)
292
Hyperemesis gravidarum diagnostic triad
5% pre-pregnancy WL
Dehydration
Electrolyte imbalance
293
Manoeuvre to improve McRobert's manoeuvre
Suprapubic pressure
294
Commonest CO for PID
Chlamydia trachomatis
295
Meigs' syndrome associated cyst
Fibroma
296
Commonest benign ovarian tumour <25y/o
Dermoid cyst
297
Commonest ovarian enlargement at reproductive age
Follicular cyst
298
Presentation of fibroid degeneration during pregnancy
Pregnant - low-grade fever, pain, vomiting
299
Management of pregnancy with previous baby with GBS
Prophylactic IV abx for mum during labour
300
6 steps in POST-PARTUM HAEMORRHAGE management
```
Bimanual uterine compression
IV oxytocin/ergometrine
IM carboprost
Intramyometrial carboprost
Rectal misoprostol
Surgical - balloon tamponade
```
301
Length of time urine preg test positive post-ToP
Up to 4 weeks (incomplete abortion or persistent trophoblast if still positive)
302
2 blood thinners contra in pregnancy
Rivaroxaban
| Warfarin
303
Hormone responsible for fibroid growth
Oestrogen
304
Management of placenta praevia
Grade I - trial vaginal delivery
| Grade III/IV - elective c-section 37-38wks
305
Syntocinon =
Oxytocin
306
Oral hypoglycaemic safe for use in breastfeeding
Metformin
307
Next action if semen sample abnormal
Repeat in 3 months (allow sperm to regroup)
| Immediate recheck if sperm conc <5million per ml
308
Site of ectopic pregnancy most associated with rupture
Isthmus
309
Migraine with aura - contra choice?
Progesterone-only method (oestrogen increases risk of ischaemic stroke)
310
Complete miscarriage diagnosis
Vag bleeding suprapubic pain followed by EMPTY uterine cavity
311
Difference between gonadal dysgenesis + Kallman's
GD (Turner's) - high LH/FSH (gonadal issue)
| Kallman's - low GnRH, FSH, LH (hypothalamic issue)
312
Ulcerated labia majora lesion
Vulval carcinoma
313
Time period after which IUD/IUS can be inserted after childbirth
Within 48hrs of childbirth OR after 4wks
314
Management of chickenpox in pregnant women
If <20wks and antibodies absent then VZIG
| If >20wks and within 24hrs of rash then oral aciclovir
315
Treatment for endometrial carcinoma (stages)
Stage I and II - total abdo hysterectomy + bilateral salp-oo-ectomy
Stage IIb - Wertheim's radical hysterectomy (removal of LNs)
Provera - slows growth of malignant endometrial cells
316
Treatment for perineal tears
1st degree - no repair required
2nd degree - suture by midwife/clinician on ward
3rd/4th degree - surgical repair in theatre
317
When to admit in N&V in pregnancy
Ketonuria +/- WL DESPITE oral antiemetic use
318
Short-term treatment for uterine fibroids
GnRH agonist (e.g. reduce size before surgery)
319
Prophylaxis in PPROM
10d erythromycin
320
When to give DOUBLE dose levonorgestrel
BMI >30 (clinically obese)
321
If vomiting after taking levonorgestrel...
If within 3 hours of taking it, repeat dose
322
Protocol for magnesium sulphate treatment in eclampsia
IV admin - 4g over 5-10 mins then 1g/hr
Monitor urine output, RR, sats, reflexes
Given calcium gluconate if resp depression occurs
Continue treatment until 24hrs post-seizure/delivery (whichever most recent)
323
Cyst which can cause pseudomyxoma peritonei if rupture
Mucinous cystadenoma
324
Summary of restart points for contraceptives after birth
IUS/IUS - <48hrs or 4wks
COCP/POP - 3wks
Implant - anytime
325
Intrauterine sac with no fetal pole
MISSED miscarriage
326
Therapeutic target for treatment of hypertension in labour
<135/85 (IV labetalol)
327
3 components of Risk Malignancy Index (RMI) (prognosis in ovarian cancer)
US findings
Menopausal status
CA125 levels
328
4 steps in ovulation induction
Exercise + WL
Letrozole
Clomiphene
Gonadotropins
329
Uterus appearance in endometriosis
Fixed, retroverted uterus
330
What changes in endometrium are classified as a premalignant condition
Atypical hyperplasia of the endometrium
331
Ovarian tumour associated with development of endometrial hyperplasia
Granulosa cell tumours (secrete unopposed oestrogen)
332
Sex cord stromal tumours
Thecomas
Fibromas
Sertoli cell
Granulosa cell (ass. w/endomet hyperplasia)
333
Treatment for recurrent candidiasis
```
Oral fluconazole (induction-maintenance)
Induction = oral flucon every 3 days for 3 doses
Maintenance = oral flucon weekly for 6 months
```
334
Usual topical treatment for candidiasis
Topical CLOTRIMAZOLE (fluconazole sucks as cream so oral if recurrent)
335
Preparations of iron supplements for pregnant women + length of dosage
Ferrous sulphate or ferrous fumarate
| - continue for 3 months AFTER CORRECTION of iron to allow stores to replenish
336
COCP changes around surgery
Stop 4 weeks before and restart 2 weeks after (VTE risk)
| USE POP instead during COCP-free period
337
Points at which pregnant women with T1DM should measure their blood glucose levels
Daily fasting, pre-meal 1-hour post-meal, and bedtime tests (should monitor very closely)
338
Mutation conferring higher risk of breast and ovarian cancer
BRCA1
339
Mutation conferring higher risk of Wilm's tumour
WT1
340
Mutation conferring higher risk of retinoblastoma
Rb
341
Mutation conferring higher risk for Burkitt lymphoma
c-Myc
342
First-line subfertility treatment in PCOS
Clomiphene
343
First-line treatment for hirsutism features of PCOS
3rd gen COCP or co-cyprindiol (anti-androgen effects)
344
Method to reduce BP in induced labour
Epidural anaesthesia
345
MoA of implantable contraceptive
Inhibits ovulation
346
First step if pregnant woman receives abdominal trauma
Blood type + rhesus testing (anti-D Ig given in 72hrs of trauma)
347
Rokitansky protuberance =
Teratoma/dermoid cyst
348
Absolute contraindication for IUD
Pelvic inflammatory disease (test with endocervical swab)
349
Change to cervical screening if HIV +ve
Offer screen at date of diagnosis
| ANNUAL cervical cytology due to increased CIN risk
350
Worst (mortality+morbidity) breech presentation
Footling presentation at delivery
351
Medication for suppressing lactation
Cabergoline (dopamine receptor agonist - suppresses prolactin production)
352
Procedure with greatest risk of haemorrhage in newborn
Prolonged ventouse delivery (vacuum)
| - cephalohaematoma or subgaleal haemorrhage if thrombocytopenia present (AI inherited)
353
RFs for pre-eclampsia
```
40+
Nulliparous
Preg interval 10+ yrs
FHx or previous Hx
BMI >30
Pre-existing vascular or renal disease
Multiple pregnancy
```
354
4 causes of primary postpartum haemorrhage
4 T's
- tone
- tissue (retained placenta)
- trauma
- thrombin (coag abnormalities)
355
Commonest cause of primary postpartum haemorrhage
Uterine atony (90% cases)
356
Oxybutynin SE + demographic + alternatives
Careful using in ELDERLY due to increase risk of FALLS
| - use solifenacin or tolterodine instead
357
Switching from IUD to COCP - additional contra needed?
If day 1-5 of menstrual cycle - no barrier needed
| If day 6+ - barrier needed for 7 days
358
Management of placenta praevia woman who goes into labour
Emergency c-section (due to risk of PPH)
359
Date for second screen for anaemia + atypical RBC alloantibodies
28 wks
360
PCOS diagnostic critera
If 2/3 of:
- infrequent/no ovulation (oligomenorrhoea)
- clinical/biochemical signs of hyperandrogenism or elevated total/free testosterone
- polycystic ovaries on US or increased ovarian volume
361
Components of the Down syndrome QUADRUPLE test
Inhibin A, beta-hCG, alpha-fetoprotein, unconjugated oestriol
362
+ve results of QUADRUPLE test for Down's
High - b-HCG, inhibin A
| Low - unconjug oestriol, alpha-fetoprotein
363
When do you do quadruple test instead of combined screening for Down's
POST-14 WKS (comb screening test no longer accurate)
364
Management of asymptomatic newborns at risk of GBS sepsis
If 1 minor RF = 24hrs observation
| If 2 minor or 1 red flag = empirical BenPen + Gent + full septic screen
365
Red flags for newborn sepsis
Suspected/confirmed infx in another baby if multiple preg
Parenteral abx given to mum during labour/24hrs before/after birth
Resp distress >4hrs after birth
Seizures
Need for mechanical ventilation in a term baby
Signs of shock
366
Absolute contraindications for VBAC
Vertical (classical) caesarean scars
Previous uterine rupture
Other contraindications to vaginal birth (e.g. placenta praevia)
367
POP with 12hr window
Cerazette/Desogestrel
368
Commonest risk post-ToP
INFECTION
369
Sudden onset unilateral pelvic pain after intercourse/strenuous activity
Ruptured ovarian cyst
370
Treatment of candidiasis when PREGNANT
Clotrimazole pessary (flucon contra in preg)
371
Preterm-PROM + triad of pyrexia, tachycardia, fetal tachycardia =
CHORIOAMNIONITIS
372
COCP 2 pills missed week 3 =
Finish pills in current pack + start new pack immediately (no pill-free interval)
373
Escalation of suspected case of rubella in pregnancy
Discuss with local Health Protection Unit (advice on investigations)
374
Hepatic adhesions =
Fitz-Hugh-Curtis syndrome (complication of PID)
375
Diabetes drugs contraindicated in pregnancy
Gliclazide and liraglutide
376
Name of organism that causes GBS (Gram +ve cocci in chains)
Strep agalacticae
377
Examination contraindicated in placenta praevia
Digital vaginal exam (risk of haemorrhage)
378
UKMEC of COCP use in breastfeeding postpartum
<6 weeks - UKMEC 4 ABSOLUTELY contraindicated
| 6wks-6mths - UKMEC3
379
If risk of infection in miscarriage - management
Medical or surgical (misoprostol or manual vacuum)
380
"Bulky" uterus on palpation
Fibroids
381
Investigation of choice for ?ectopic
TVUS
382
If pregnant >20wks, management if exposed to chickenpox and not immune
Aciclovir or VZIG 7-14days post-exposure (not immediately)
383
Factors not associated with increased risk of miscarriage
```
Heavy lifting
Bumping tummy
Having sex
Air travel
Being stressed
```
384
Factors associated with increased risk of miscarriage
Increased maternal age
Smoking/alcohol/recreational drugs/caffiene
Obesity
Infx and food poisoning
Health conditions (HTN, thyroid, diabetes)
Medicines (ibuprofen, methotrexate, retinoids)
Unusual shape/structure of womb
Cervical incompetence
385
After vomiting emergency contraception, management
<3 hrs - repeat dose
386
Consequences of delivering baby in occiput posterior vs occiput anterior head position
Can deliver baby in OP position but labour is likely to be longer and more painful
387
Most successful instrumentation-assisted kind of delivery
Kielland's forceps (requires particular expertise)
388
Management of perimenopausal women struggling with vasomotor symptoms (e.g. hot flushes)
Fluoxetine
389
Criteria for surgical management of ectopic pregnancy
>35mm in size
| Serum b-hCG >5000
390
Criteria required for instrumental delivery
FORCEPS
- fully dilated cervix
- OA position, OP possible
- ruptured membranes
- cephalic presentation
- engaged presenting part (head must not be palpable abdominally and below/at ischial spines)
- pain relief
- sphincter (bladder) empty (use catheter)
Must also be a clear indication for instrumental delivery
391
Investigations if ?ovarian malignancy
CA-125, aFP, beta-hCG + elective cystectomy
392
Wheelchair COCP UKMEC
UKMEC 3 (risks outweigh benefits)
393
Investigations for PPROM
Speculum exam for fluid in vaginal vault
US for oligohydramnios
Vaginal secretion test for IGFBP-1 or PAMG-1
394
Risk factors for placenta accreta
Previous c-section
| Placenta praevia
395
Contraceptives which inhibit ovulation as primary MoA
COCP
Desogestrel-only pill (not-POP)
Injectable
Implant
396
Contraceptives which thicken cervical mucus as primary MoA
Progestogen-only pill
Secondary action of desogestrel-only pill, injectable, implant, and IUS
397
Contraceptives which decrease sperm motility and survival as primary MoA
IUD
398
Levonorgestrel + ulipristal MoA
Inhibit ovulation
399
Management of mild PMS
Lifestyle changes
- regular exercise
- small 2-3hrly balanced meals rich in complex carbs
- stop smoking/alcohol
- regular sleep etc
400
Cells that secrete HCG
First by embryo
| Maintained by placental trophoblast (syncytiotrophoblasts)
401
Main function of HCG
Prevent disintegration of the corpus luteum
402
Reason for >35mm limit to medical management of ectopic pregnancy
Risk of spontaneous rupture (measured by TVUS)
403
Rule for patch UPSI
<48hrs after UPSI - change patch + no further precautions
>48hrs - change immediately + barrier for 7 days
Emergency contra if UPSI during extended patch-free period
404
Drug to facilitate delivery + prevent PPH
Oxytocin/ergometrine
405
Contraindication for using epidural anaesthesia
Coagulopathy
406
Management of all patients with secondary dysmenorrhoea
Referral to gynaecology for investigation
407
Reason nulliparity is RF for endometrial cancer
Progesterone is protective which body shifts towards during pregnancy
408
Blood glucose targets for gestational diabetes treatment
Fasting 5.3
1hr postprandial 7.8
2hr postprandial 6.4
409
Drug for N&V in pregnancy that can't be used >5 days due to EXTRAPYRAMIDAL side effects
Metoclopramide
410
Length of time urine pregnancy test positive for post-ToP
4 weeks
411
Next step if patient is yet to have a diagnosis of pre-eclampsia but it is suspected AT MIDWIFE appointment
Urgent obstetrics referral
412
Terbutaline drug class
Tocolytic
413
Drugs to reduce uterine contractions
Tocolytics e.g. terbutaline
414
Antibiotic safe for use in breastfeeding
Trimethoprim (think trimester/primip or something)
415
Benign ovarian tumour (usually fibroma) + ascites + pleural effusion
Meig's syndrome
416
Reasons for US monitoring in monochorionic twins
16-24wks - monitor for twin-to-twin transfusion syndrome
| 24+wks - monitor for fetal growth restrictions
417
Management for prophylaxis of Rhesus sensitisation (Rhesus -ve bleeding in pregnancy)
1 dose of anti-D immunoglobulin + Kleihauer test (for FMH to calculate additional anti-D Ig)
418
Is there an ovarian cancer screening test?
No, no current screening programme for ovarian cancer
419
Risk of metabolic acidosis + Reye's syndrome in infants if this drug is used in pregnancy
Aspirin
420
Drug transmitted in breast milk which can cause renal and thyroid dysfunction
Lithium
421
Type of insulin used in treating gestational diabetes
SHORT-acting, no longer-acting SC insulin is used in gestational diabetes
422
Triptorelin drug class
GnRH agonist
423
Next indicated investigation if late decelerations on CTG
Fetal blood sampling (assess for fetal hypoxia + acidosis, >7.2 is normal)
424
Investigation/procedure that increases risk of 2nd trimester miscarriage
Large cervical cone biopsy
