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5TH YEAR > OBGYN > Flashcards

OBGYN Flashcards

(71 cards)

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1
Q

What are the side effects of mifepristone?

A

Nausea
Vomiting
Abdominal cramps
Bleeding

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2
Q

What is the treatment for bacterial vaginosis?

A

Metronidazole BD 7 Days

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3
Q

What is the treatment for Chlamydia?

A

Doxycyline BD 7 days

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4
Q

What is the treatment for acute pelvic inflammatory disease?

A

Ofloxacin and metronidazole BD 14 days

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5
Q

What is the treatment of chlamydia in pregnancy?

A

Azithromycin

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6
Q

What is the treatment for primary ovarian insuffiency?

A

Hormonal replacement with HRT or COCP

Reviewed after 3 months then yearly

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7
Q

How many antenatal visits do parous women go to?

When are these?

A

7

Weeks: 10, 16, 18-20, 28, 34, 36, 38

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8
Q

How many antenatal visits do nulliparous women with a low risk pregnancy go to?
When are these?

A

10

Weeks: 10, 16, 18-20, 25, 28, 31, 34, 36, 38, 40

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9
Q

What needs to be done in the antenatal booking visit?

A

Information about: metal development, antenatal classes, financial support and maternity leave, mental health
Maternal assessment: BP, blood tests for blood group rhesus status, haemagobinopathy, infections screen; urine test for proteinuria and asymptomatic bacteria
Foetal assessment: USS to assess gestation, Downs syndrome, structural abnormalities

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10
Q

What is the combined test and when is it carried out?

A 
Blood test (pregnancy associated plasma protein A PAPP-A + beta human chorionic gonadotropin) and an USS to measure the thickness of foetal nuchal translucency
Between the 11th- 13th week- the test can't be used after the 14th week as the NT disappears
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11
Q

What are the results of the combined test in the baby with Down’s syndrome?

A

NT thicker
Low PAPP-A
High beta human chorionic gonadotropin

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12
Q

What are the causes of increased nuchal translucency?

A 
Down's Syndrome
Turner's Syndrome
Edward's Syndrome
Patau's Syndrome
Triploidy
Blockage in the developing lymphatic system
Cardiac failure
Congenital infections
Fetal anaemia
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13
Q

When are foetal movements usually felt?

A

From 20 weeks

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14
Q

How can foetal weight be calculated antenatally?

A

Symphysis fundal height

Maternal height, weight and ethnicity

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15
Q

What information should be given to women about folic acid?

A

Should be taken before conception up until week 12 to reduce neural tube defects
Normally 400micro grams but increased to 5mg daily if woman has:
- Previous pregnancy with neural tube defect
- Neural tube defect or partner has it
- Epilepsy
- Pre-existing diabetes
- Obesity
- Malabsorption
- Sickle cell anaemia
- HIV +ve taking cotrimoxazole

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16
Q

Foods to avoid during pregnancy?

A 
Unpasteurised milk, ripened and blue veined cheese, pate and undercooked food
Raw or partially cooked eggs or meat
Raw fish
Fish such as swordfish or shark
Liver products
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17
Q

What is the gold standard diagnostic technique for chlamydia and how is this carried out?

A

Nucleic acid amplification tests
Men: first void urine
Women: vaginal swabs

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18
Q

What is the gold standard diagnostic technique for gonorrhoea and how is this carried out?

A

Nucleic acid amplification tests
Men: first void urine
Women: vaginal swabs

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19
Q

What are the SIRS criteria?

A

Temperature <36 >38
HR >90
RR >20
WCC <4 >12

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20
Q

What is the definition of sepsis?

A

SIRS + infection

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21
Q

Management of cord prolapse

A

DO NOT handle the cord

Elevate fetus by: m

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22
Q

What are the symptoms of chlamydia?

A

70% asymptomatic
Women: IMB, PCB, urinary frequency, change in discharge, abdo pain, dysuria
Men: testicular/ urethral discomfort, discharge, dysuria

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23
Q

What are the options for emergency contraception?

A

Levonelle- progestogen
EllaOne- ulipristal acetate
Emergency IUD

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24
Q

What are the contraindication for the ellaOne tablet?

A

Liver disease

Severe asthma

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25
What are the side effects of the levonelle pill?
``` Nausea/ vomiting Dizziness Fatigue Headache Breast tenderness Abdominal pain Can cause irregular bleeding ```
26
What are the side effects of the ulipristal pill?
``` Nausea/ vomiting Dizziness Fatigue Headache Breast tenderness Abdominal pain Painful periods Mood swings Muscle and back pain Can cause irregular bleeding ```
27
What is the criteria for PrEP?
> 16 y/o HIV negative test in clinic Attend regular reviews in clinic every 3 months Willing to stop taking PrEP in the future if they are no longer eligible Live in Scotland One of the following Sexual partner is HIV positive and has a detectable viral load Either MSM or a transgender woman who has either: Had a rectal STI in the last year Had anal sex without condoms with more than one person in the last year and you are likely to do this again in the next three months
28
Antenatal complications of multiple pregnancy
Pre-eclampsia Growth restriction Preterm birth
29
Post natal complications of multiple pregnancy
PPH
30
What is the gold standard diagnostic test for endometriosis?
Laproscopy
31
Common locations for endometriosis
Ovary Pelvis Pouch of Douglas
32
Symptoms of endometriosis
Premenstrual pain Deep dyspareunia Heavy bleeding Sub-fertility
33
Management of endometriosis in women who want to conceive
Clomifine | IVF
34
Risk factors for preterm birth
``` Previous preterm birth Multiple pregnancy Short interval between pregnancies Low body mass index Smoking Infection Antepartum haemorrhage ```
35
Predictors of preterm labour
Fibronectin | Cervical length
36
When should you do a fibronectin test?
BEFORE a digital vaginal examination
37
Abortion Act 1967
Allowed up to 24 weeks if there is risk to the physical or mental health of the woman, or the physical or mental health of the woman’s existing children than having a termination. Abortion is allowed after 24 weeks if there is: risk to the life of the woman, evidence of severe fetal abnormality, or risk of grave physical and mental injury to the woman.
38
Medication used in medical TOP
200mg mifepristone | 800mg misoprostol
39
Risks of TOP
Incomplete abortion Infection Bleeding Uterine trauma
40
Advantages of HRT
Relief from vasomotor symptoms and vaginal atrophy Reduced incidence of osteoporosis induced fractures of the wrist, vertebral bodies and hip Reduced incidence of heart disease, colorectal cancer and Alzheimer’s disease
41
Risks of HRT
Increased incidence of thromboembolic disease and stroke Increased incidence of endometrial hyperplasia and cancer when unopposed oestrogen is used in women with an intact uterus Increased incidence of benign and malignant breast disease with prolonged use Increased incidence of ovarian cancer
42
Effects of the IUS
Thickens cervical mucus Thins endometrium Inhibits ovulation
43
Contraindications of the IUS
Recent breast cancer Large fibroids Untreated pelvic infection
44
Disadvantages of the IUS
``` Spotting/ irregular bleeding (usually only first 6-9 months) Expulsion Perforation Infection Mood swings Reduced libido Breast discomfort Acne May get ovarian cysts Fluid retention ```
45
Advantages of the IUS
``` Doesn't interfere with sex Periods usually get lighter or stop Effective for up to 5 years Periods less painful Can be a treatment for endometriosis Fertility returns as soon as it is removed ```
46
When is IUC contraindicated?
MEC 3- History of stroke or IHD, long QT, unexplained vaginal bleeding, distorted uterine cavity, pelvic TB, severe cirrhosis MEC 4- elevated hCG or malignancy, cervical cancer, current PID, current chlamydia/ gonorrhoea
47
Disadvantages of the copper IUD?
Painful fitting Infection Bleeding can become heavier and irregular Can fall out Increased risk of ectopic pregnancy Can make dysmenorrhoea worse in endometriosis
48
Mechanism of action of the IUD
Copper is a spermacide | Inhibits implantation
49
Advantages of IUD
Not user dependent Can stay in for 10 years Non-hormonal Reversible
50
How often is the contraceptive injection given?
Every 12 weeks
51
What is in the contraceptive injection and what is its mechanism of action?
Progestogen Inhibits ovulation Thickens cervical mucus Thins endometrium
52
Advantages of the contraceptive injection
Doesn't contain oestrogen May reduce risk of endometrial cancer May offer some protection against PID
53
Disadvantages of the contraceptive injection
Periods may stop, become irregular or longer Fertility can take up to a year to return after cessation Weight gain Headache Mood changes Acne Breast tenderness
54
What is in the contraceptive implant and what is its mechanism of action?
Progestogen Inhibits ovulation Thickens cervical mucus Thins endometrium
55
Advantages of the implant
Effective for 3 years | Fertility returns immediately
56
Disadvantages of the implant
Periods may become irregular, stop or become longer Acne Mood changes Breast tenderness
57
Contraindications of the implant
MEC 3: IHD, Stroke, Unexplained vaginal bleeding, Past breast cancer, Severe cirrhosis MEC 4: Current breast cancer
58
Differentials for early pregnancy bleeding
``` Miscarriage- most common Ectopic pregnancy Gestational trophoblastic disease Infection Trauma Cervical polyp Cancer ```
59
Differentials for early pregnancy abdominal pain
``` Miscarriage Ectopic pregnancy Corpus luteal cyst Appendicitis UTI Kidney stones ```
60
Causes of miscarriage
Genetic abnormality in embryo- most common Structural cause/ uterine malformation- large fibroids Maternal infections- listeriosis, toxoplasmosis, parvovirus Immunological- antiphospholipid syndrome, SLE
61
Risk factors for misscarriage
``` Advanced maternal age Smoking Alcohol Drug misuse Excessive caffeine ```
62
Investigations for recurrent miscarriage
Anticardiolipin antibody tests Parental karyotype Thrombophilia screen US of the pelvis and/ or hysteroscopy
63
Medical management of miscarriage
Mifepristone (progesterone agonist) given 12-48 hours before | Induced by Misoprostol- prostaglandin
64
Risks of surgical management of miscarriage
Bleeding Incomplete evacuation Intrauterine infection Uterine perforation
65
Indications for emergency surgery in miscarriage
Bleeding profusely Tachycardia, hypotensive Anaemia In need of immediate fluid resuscitation
66
Methods of inducing labour
Prostaglandin tablets, pessary, or gel, oxytocin infusion or artificial rupture of membranes
67
What are the causes of perinatal mortality?
``` Infection Placental dysfunction Antepartum haemorrhage Congenital abnormalities Hypertensive diseases Prematurity ```
68
Definition of prematurity
<37 weeks
69
Health conditions associated with prematurity
``` Respiratory distress syndrome Intracranial bleeds- periventricular laukomalacia Necrotising enterocolitis Sepsis Retinopathy of prematurity PDA Hypothermia Hyperbilirubinaemia ```
70
Patients with increased risk of developing pre-eclampsia
Hypertensive disease during previous pregnancy CKD SLE/ antiphospholipid syndrome Diabetes These patients should be given 75mg od aspirin from week 12
71
Maternal screening tests in pregnancy
BMI Anaemia Gestational diabetes Pre-eclampsia

5TH YEAR (10 decks)

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