Obgyn

Question 1

Abdo pain in early preg

Answer 1

Ectopic

Miscarriage

Question 2

Abdo pain in late preg

Answer 2

Labour
Placental abruption
Symphysis pubis dysfunction
Pre-eclampsia/HELLP
Uterine rupture

Question 3

Abdo pain at any time in preg

Answer 3

Appendicitis

UTI

Question 4

Ectopic pregnancy RF

Answer 4

damage to tubes (salpingitis, surgery)
prior ectopic
IVF

Question 5

Threatened miscariage

Answer 5

<24w
Painless vag bleed
Usually week 6-9
Cervical os closed
25%

Question 6

Missed miscarriage

Answer 6

<20w
Gestational sac w dead fetus with no expulsion
Light PV blood/discharge
Gestational sac >25mm w no fetal parts –> blighted ovum/anembryonic

Question 7

Inevitable miscarriage

Answer 7

Cervix open

Heavy bleeding w clots + pain

Question 8

Incomplete miscarriage

Answer 8

not all products expelled

Question 9

Placental abruption ft

Answer 9

shock out of keeping with visible loss
Constant pain
Tenter, tense uterus
Normal lie + presentation
Fetal heart: absent/distressed
Coag problems
Beward pre-eclampsia/DIC/anuria

Question 10

Placental abruption

Answer 10

Separation of normally sited placenta from uterine wall

Maternal hemorrhage into the space

Question 11

Symphysis pubis dysfunction

Answer 11

Ligament laxity causes pain over pubic symphysis w radiation to groins and medial aspects of thighs

Question 12

Uterine rupture RF

Answer 12

previous CS

Question 13

Uterine rupture ft

Answer 13

maternal shock
abdo pain
vaginal bleeding

Question 14

UTI in preg risks

Answer 14

pre term delivery

IUGR

Question 15

Appendicitis in preg

Answer 15

RLQ in 1st tri
Umbilicus 2nd tri
RUQ 3rd tri

Question 16

Breech mortality and morbidity due to:

Answer 16

vaginal birth trauma/hypoxia (CS @39w)
prematurity
cord prolapse (esp footling)
Intracranial hr - compression of head in delivery

Question 17

External cephalic version offered when

Answer 17

if still breech as of 36w to avoid CS

Question 18

Major concern in breech baby

Answer 18

cord prolapse

Admit at 37/40

Question 19

Frank breech

Answer 19

Extended

hips bent, legs straight up by face

Question 20

Complete breech

Answer 20

Flexed

sitting cross legged

Question 21

footling breech

Answer 21

one or both feet as presenting part

Premature often

Question 22

Maternal RF/Causes Breech

Answer 22

Multiparity (muscle laxity)
Uterine malformations (bicornuate, septate, fibroids)
Polyhydramnios (sometimes oligo)
Android pelvis
Placenta previa

Question 23

Fetal RF/causes Breech

Answer 23

Prematurity
Macrosomia (big head)
Twins
Abnormality (anencephaly, T21 hypotonia)
NMD

Question 24

LT risks of CS

Answer 24

Repeat
Scar dehiscence
Placenta accreta
Massive hr + potential hysterectomy
Recovery 6w

Question 25

ECV risks

Answer 25

``` cord entanglement placental abruption APH fetal distress **pre and post CTG ```

Question 26

ECV contraindications

Answer 26

``` APH PROM Uterine abnormality Prior CS Abnormal CTG Twins Placenta previa ```

Question 27

Breech mgmt

Answer 27

ECV >36w ELCS vs Vaginal breech >37w ELCS recommended for primip, multip can wait till 40w to see if they turn

Question 28

Unstable lie mgmt

Answer 28

ADMIT @ 37w Keep until delivery with ELCS @ 39 **if turns cephalic, need to wait 48h at cephalic before discharge or >38 induce

Question 29

PROM

Answer 29

rupture of membranes AFTER 37 weeks

Question 30

PPROM

Answer 30

rupture of membranes BEFORE 37 weeks

Question 31

Prolonged ROM mgmt

Answer 31

>18h Benzylpenicillin @24h --> augment/induce with Oxytocin if cephalic and no HVS and CRP taken

Question 32

GBS+ prolonged ROM mgmt

Answer 32

>18h | Benxylpenicillin and augment/induce righgt away

Question 33

PPROM RF

Answer 33

African APH, cerclage, amniocentesis, polyhydramnios, multiple preg PTD, STD Smokers, poor

Question 34

ROM

Answer 34

GUSH clear fluids followed by trickling Need toknow time Contraction, PV bleed Confirm w speculum exam - pool of clear fluid @ posterior fornix

Question 35

Chorioamnionitis

Answer 35

``` Uterine tenderness Foul smelling discharge Tachy fever CTG tachy ```

Question 36

ROM confirm

Answer 36

speculum exam - pool of clear fluid @ posterior fornix | Amnisure - rapid immunoassay, HVS if <37w

Question 37

PPROM increases risks of:

Answer 37

``` PIN PICCk Preterm delivery Infection - neonatal sepsis Periventricular leucomalacia (holes in brain) RDS, TTN IVH Cerebral palsy Chronic lung disease ```

Question 38

PPROM mgmt

Answer 38

Admit If signs of chorioamnionitis or maternal sepsis give benzylpen (if allergic --> clindamycin) + deliver No sepsis --> aim to deliver after 34w, ideally 36-37 Erythromycin PO 10d, IV BenzylPen till HVS clear Bloods, HVS weekly CTG twice daily Doppler 2-3/w IV fluids, Analgesia Steroids if <36w Innohep, stockings NO tocolytics unless transfering MOD - If cephalic use oxytocin for IOL, not cephalic LSCS MgSO4 for neuroprotection <32w

Question 39

Small for dates (SFD)

Answer 39

Fetus below 10th centile

Question 40

P53 gene mutation

Answer 40

breast CA

Question 41

Nulliparity cancers

Answer 41

Ovarian Endometrial Breast

Question 42

COCP risks

Answer 42

Breast CA | Cervical CA

Question 43

20yo, 1w crampy, constant low abdo pain, intermenstrual bleed, dyspareunia, dysuria

Answer 43

PID

Question 44

30yo, nulliparous, severe dysmenorrhea, heavy + irregular bleeding, pain on defection, dyspareunia

Answer 44

Endometriosis

Question 45

RF endometrial CA

Answer 45

late menopause

Question 46

Late menopause can lead to

Answer 46

Cervical CA Ovarian CA Breast CA

Question 47

Unopposed estrogen

Answer 47

endometrial CA

Question 48

Womens CA w smoking

Answer 48

cervical CA

Question 49

Types of cervical CA

Answer 49

``` Squamous cell (80%) Adenocarcinoma (20%) ```

Question 50

Cervical CA ft

Answer 50

abnormal vaginal bleeding (postcoital. intermentrual, postmeno), vaginal discharge

Question 51

Cervical CA RF

Answer 51

``` HPV (16, 18. 33) Smoking (2 fold increase) HIV Early intercourse, many partners High parity Low SES COCP ```

Question 52

Smear: high risk HPV +ve w normal cytology

Answer 52

repeat 12 mo

Question 53

Smear high risk HPV w cytological evidence of dyskaryosis

Answer 53

colposcopy

Question 54

Smear: 3 successive high risk w no cytology

Answer 54

colposcopy

Question 55

Smear: 2 smears inadequate, 3 mo apart

Answer 55

colposcopy

Question 56

HIV cervical screening

Answer 56

yearly cytology

Question 57

Primary amenorrhea

Answer 57

No periods by 14 (if no other puberty signs) | No periods by 16 (if other signs - breast buds)

Question 58

Puberty starts at:

Answer 58

8-14 girls (breasts/hair/periods) | 9-15 boys

Question 59

Hypogonadotrophic hypogonadism

Answer 59

Low LH and FSH from pituitary --> low estrogen/test from gonads Problem in hypo or pit

Question 60

Causes of hypogonadotrophic hypogonad

Answer 60

``` Kallman's Prader-Willi Pit tumour Hyperprolactinemia Cranial tumour Radiation tx Drugs (opiates, alcohol) Systemic/chronic illness Idiopathic ```

Question 61

Hypergonadotrophic hypogonadism

Answer 61

Gonads not responding to gonadotrophins, no neg feedback = HIGH LH and FSH

Question 62

Hypergonadotrophic hypogonadism causes

Answer 62

``` Hypothyroid Hyperprolactinemia Congenital adrenal hyperplasia Turners Androgen insensitivity syndrome PCOS ```

Question 63

Hypothalamic causes of primary amenorrhea

Answer 63

hx excessive exercise, stress, eating dx, chronic disease, low bmi

Question 64

Hormonal causes primary amenorrhea

Answer 64

Androgen excess, thyroid problems, high prolactin, dysmorphic

Question 65

Structural primary amenorrhea

Answer 65

abdo and pelvic exam

Question 66

Primary amenorrhea IX

Answer 66

Pelvic US | Hormones (LH, FHS, TSH, prolactin)

Question 67

Assess pubertal status

Answer 67

Height + weight | Dev of pubic hair, breast tissue, acne

Question 68

Secondary amenorrhea

Answer 68

No periods x 3mo after already having had them | Ix after 6mo

Question 69

Secondary amen causes

Answer 69

``` Preg Meno Hypothalamic Pituitary Ovarian Uterine Hypothyroid ```

Question 70

Hypothalamic secondary amen

Answer 70

Physiologic stress stops GnRH production - excessive exercise - low weight/eatign dx - chronic disease - psychological

Question 71

Pituitary causes of secondary amen

Answer 71

tumour (prolactinoma) | failure (sheehan)

Question 72

Ovarian secondary amen

Answer 72

PCOS Premature ovarian failure Menopause

Question 73

Uterine secondary amen

Answer 73

Asherman's syndrome

Question 74

Sheehan's syndrome

Answer 74

Woman loses life threatening amount of blood during child birth or severe low BP --> lack of O2 --> damage to pituitary gland --> low ant-pit hormones

Question 75

Asherman's syndrome

Answer 75

Scar tissue in uterus or cervix, makes walls of the organ stick together and reduce uterus size (D&C, endometriosis, infection,)

Question 76

FSH high in secondary amen

Answer 76

primary ovarian failure

Question 77

High LH or LH:FSH ratio in secondary amen

Answer 77

PCOS

Question 78

Secondary amen Ix

Answer 78

FSH, LH MRI head TSH

Question 79

Androgen Insensitivity Syndrome

Answer 79

Male characteristics don't develop = female phenotype w male sex organs (testes in abdomen - inguinal canal) No uterus, upper vagina, fallopian tubes or ovaries. Infertile

Question 80

Androgen insensitivity syndrome causes

Answer 80

Usually testes make Mullerian hormone - stops male developing female sex hormones Insensitivity to androgens - no pubic hair, no facial hair or male type muscle development

Question 81

Androgen insensitivity syndrome mgmt

Answer 81

estrogen therapy | bilateral orchidectomy

Question 82

Premenstrual syndrome

Answer 82

Fluctuation of hormones, esp E and P Bloating, headaches, backaches, anxiety, low mood, irritability **resolve with onset of menstruation

Question 83

PMS tx

Answer 83

symptom diary lifestyle change COCP SSRI

Question 84

If PMS has significant effect on QOL

Answer 84

premenstrual dysphoric disorder

Question 85

Causes of menorrhagia

Answer 85

``` Fibroids Hormone imbalance (PCOS, thyroid disease, obesity) Copper coil Ehlers-Danlos Bleeding disorders (vWD) Endometrial Ca ```

Question 86

Menorrhagia ix

Answer 86

pelvic exam | Pelvic/transvag US if abn pelvic exam, postcoital bleed, intermenstrual bleed, pelvic pain

Question 87

Menorrhagia mgmt

Answer 87

Exclude pathology (anemia, CA) and manage cause If no contracep: -tranexamic acid if no pain (antifibrinolytic) - mefenamic acid (NSAID - reduce pain + bleed) Contracep: - Mirena coil, COCP, POP (norethisterone), Depo injection If all fails: - endo ablation - hysterectomy

Question 88

Fibroids

Answer 88

common in later reproductive age (meno) Afro carribean Increase in estrogen sensitivity

Question 89

Fibroid locations

Answer 89

Intramural Subserosal Submucosal Pedunculated

Question 90

Intramural fibroids

Answer 90

within myometrium | change shape of uterus as they grow

Question 91

Subserosal fibroids

Answer 91

below outer layer of uterus | grow outwards, can be v big, fill abdominal cavity

Question 92

Submucosal fibroids

Answer 92

below lining of uterus (endometrium)

Question 93

Pedunculated fibroids

Answer 93

on a stalk

Question 94

Fibroids Sx

Answer 94

``` Asymptomatic Menorrhagia (top one) >7 day periods Abdo pain worse during period Bloating or full feeling Urinary/bowel sx Deep dyspareunia Reduced fertility ```

Question 95

Fibroids dx

Answer 95

Pelvic/transvag US

Question 96

Fibroids conservative mgmt

Answer 96

analgesia, tranexamic acid mirena coil (fibroid <3cm and no uterus distortion) COCP GnRH agonist (goserelin) to reduce size, induce menopause sx. Used to reduce size prior to myomectomy

Question 97

Other fibroids mgmt

Answer 97

Uterine artery embolization (starves fibroid of O2, shrinks it) Myomectomy (removes tumoour via abdo surg) Hysteroscopic endometrial ablation (destroy endo via telescope through cervix w diathermy resecting loop) Hysterectomy

Question 98

Fibroids complications

Answer 98

``` Space occupying problems (premature labour, block vag delivery, miscarriage) Infertility Heavy bleeding - anemia Constipation UTI/Urine obstruction Red/carneous degeneration ```

Question 99

Red/carneous degeneration

Answer 99

Hemorrhage infarct of fibroid Occurs in preg Abdo pain, low grade fever, vom Conservative mgmt

Question 100

Postcoital bleeding causes

Answer 100

``` Idiopathic Cervical ectropion Cervical inflamm from infection (Chlamydia) Cervical ca Atrophic vaginitis Polyps Trauma ```

Question 101

Intermenstrual bleeding

Answer 101

Cervical ectropion/polyp/CA STI Endometrial polyp/Ca Iatrogenic contraception related bleeding

Question 102

Cervical ectropion

Answer 102

Columnar epi of endocervix displayed on ectocervix visible on speculum Caused by increased estrogen Cause discharge or postcoital bleed

Question 103

Cervical ectropion tx

Answer 103

silver nitrate | diathermy

Question 104

Cervical ectropion transformation zone

Answer 104

where the endo (columnar) meets the ecto (stratified squamous)

Question 105

Nabothian cyst

Answer 105

fluid filled cysts on surface of cervix, 1cm, harmless Squamous epi of ectocervix covers mucous secreting columnar epi - traps in cyst After childbirth or cervicitis secondary to pelvic infection Can biopsy to exclude pathology

Question 106

Asherman's Syndrome sx

Answer 106

amenorrhea dysmenorrhea infertility recurrent miscarriages

Question 107

Asherman's syndrome diagnosis

Answer 107

Sonohysterography (pelvic US after uterus filled w fluid) | Hysteroscopy is gold standard - can dissect adhesions during

Question 108

Endometriosis

Answer 108

Ectopic endometrial tissue outside the uterus Responds to menstrual cycle to causes sig pain during menstruation due to bleeding around local tissues in pelvis Can irritate local tissues - causing chronic pelvic pain - worse at certain times & w sex

Question 109

Endometriosis sx

Answer 109

``` Abdo/pelvic pain (cyclical) Deep dyspareunia Cyclical bleeding from other sites (hematuria) Fertility issues Endo tissue visible in vagina ```

Question 110

Endometriosis Ix

Answer 110

Laparoscopy for dx of abdo endometrial tisue

Question 111

Endometriosis mgmt

Answer 111

Analgesia COCP to reg cycle Progesterone to stop menstruation (depo) GnRH agonists - medical menopause Laparoscopic surgery - dissect/cauterize ectopic tissue Hysterectomy + bilat salpingo-oopherectomy last resort

Question 112

Ovarian cysts

Answer 112

PCOS trias | Do CA125 to rule out CA

Question 113

PCOS triad

Answer 113

Polycystic ovaries on scan anovulation hyperandrogenism

Question 114

Ovarian cysts sx

Answer 114

Asymptomatoc Pelvic pain Bloating Fullness Very large cysts (mucinous cystadenomas) can be felt as pelvic mass Can be acute if torsion, hemorrhage, or rupture

Question 115

Functional ovary cyst

Answer 115

Follicular cyst is developing follicle -Fail to rupture & release egg --> persist -Usually go away after a few cycles - harmless Corpus luteum cyst - after follicle releases egg and luteum faisl to break down

Question 116

Serous cystadenoma

Answer 116

benign tumour of epithelial cells

Question 117

Mucinous cystadenoma

Answer 117

benign tumour of epithelial cells, can become v big

Question 118

Dermoid cyst

Answer 118

benign ovarian tumour teratomas, fro germ cells filled w diff tissues Complication: torsion

Question 119

Ovarian cyst comps

Answer 119

rupture - bleed into peritoneum torsion hemorrhage cyst

Question 120

Meig's syndrome

Answer 120

older women Ovarian tumour is fibroma Assoc w pleural effusion + ascites Things resolve once removed

Question 121

PCOS sx

Answer 121

``` Weight gain hirsutism oligomenorrhea/amenorrhea Poor fertility Acanthosis nigricans Impaired glucose tolerance ```

Question 122

PCOS hormones

Answer 122

LH high LH:FSH high Insulin high Testosterone high

Question 123

PCOS rotterdam criteria

Answer 123

``` 2/3 to make dx SHOP String of pearls Hyperandrogenism Oligomenorrhea Prolactin Normal ```

Question 124

PCOS insulin resistance

Answer 124

high levels of insulin = higher levels of androgens | metformin can improve the insulin resistance, also lifestyle

Question 125

PCOS mgmt

Answer 125

Weight loss COCP Infertility: weight loss, metformin, clomifene

Question 126

Hirsutism mgmt (PCOS)

Answer 126

Co-cyprindiol (Dianette) - anti-androgen, contraception, VTE risk Topical eflornithine - facial hair Spironolactone, finasteride (5 alpha reductase inhibitor to decrease testosterone), flutamide (nonsteroidal antiandrogen)

Question 127

Premature Ovarian Failure

Answer 127

menopaise <40y Raised LH and FSH Causes: idiopathic, chemo/radio, autoimmune, Turners

Question 128

Menopause

Answer 128

12 mo after last period Contracep x 2y after LMP <50, 1y >50 Drop in E and P LH, FSH usually high in resp to drop in E & P

Question 129

Perimeno sx

Answer 129

``` hot flush emotional lability premenstrual syndrome irreg periods heavier/lighter periods vaginal dryness reduced libido ```

Question 130

Perimeno sx mgmt

Answer 130

``` HRT Tibolone (only after 12mo LMP) SSRI - fluoxetine/citalopram Clonidine CBT ```

Question 131

Tibolone

Answer 131

synthetic steroid w weak E, P and androgenic activity

Question 132

Clonidine

Answer 132

reduce hot flush (antihypertensive)

Question 133

HRT non-hormonal

Answer 133

Lifestyle SSRI - fluoxetine Venlafaxine - SNRI hot flush Clonidine

Question 134

HRT considerations

Answer 134

``` Perimeno - cyclical tx Post meno - continuous tx Local - topical Systemic Has uterus - add progesterone No uterus - no progesterone ```

Question 135

HRT estrogen + Prog

Answer 135

lowers risk endometrial CA increases risk breast CA Can give the P via mirena coil

Question 136

Risks of HRT

Answer 136

increases breast CA & endo CA risk Increase risk stroke, thrombosis Higher risk with longer use

Question 137

SE of HRT

Answer 137

bloating breast swell/tender weight gain headache

Question 138

Uterus develops from:

Answer 138

paramesonephric ducts (Mullerian ducts)

Question 139

Bicornuate uterus

Answer 139

2 horns of uterus Adverse preg outcomes but usually successful Miscarriage, premature, malpresentation

Question 140

Imperforate hymen

Answer 140

completely formed without any opening, menses sealed in vagina Intense cyclical pain/cramping assoc with menstruation but no bleeding Dx w exam, tx surgical incision If not tx - endometriosis

Question 141

Transverse vaginal septum

Answer 141

``` Septum wall forms across the vagina, either perforate or imperforate Perf: difficult sex and tampon Imperf: similar to imperf hymen Dx: exam, US, MRI Tx: surgical cirrection Comps: stenosis of vagina ```

Question 142

Vaginal agenesis

Answer 142

Vaginal hypoplasia - small Agenesis - absent due to failure of mullerian ducts to develop Assoc w absent uterus and cervix Ovaries stay

Question 143

Uterine prolapse 0

Answer 143

normal

Question 144

Uterine prolapse 1

Answer 144

above introitus >1cm

Question 145

Uterine prolapse 2

Answer 145

<1cm from introitus (above or below)

Question 146

Uterine prolapse 3

Answer 146

1 cm below introitus and >2cm of vagina above introitus

Question 147

Uterine prolapse 4

Answer 147

full eversion from vagina

Question 148

Rectocele

Answer 148

defect in posterior wall of vagina - constipation and urinary retention, pressure, pain

Question 149

Cystocele

Answer 149

Defect anterior vag wall | Can also be prolapse of urethra (urethrocele) or both bladder and urethra (cystourethrocele)

Question 150

Uterine prolapse sx

Answer 150

``` urinary, bowel, sexual dysfunc feeing of something coming down dragging/heavy sensation in pelvis Lump/mass worse on strain ```

Question 151

Uterine prolapse mgmt

Answer 151

Physio. Lifestyle for stress incont (reduced caffeine, incontinence pads). Tx sx with anticholinergic meds -oxybutinin. Vag estrogen cream. Pessary -ring/Gellhorn/cube/ donut/hodge. Remove and clean every 4 months. (can cause erosion and irritation) Surgery - hysterectomy, mesh repair controversial. Comps: infx, bleed, damage to bladder/bowel, chronic pain

Question 152

Urge incont

Answer 152

overactive bladder detrusor muscle

Question 153

Stress incont

Answer 153

weakness of sphincter allowing urine to leak during cough/laugh

Question 154

Causes of incontinence

Answer 154

age BMI prev preg vaginl deliveries

Question 155

Incontinence Ix

Answer 155

Diary dipstick + culture post-void residual volume w bladder scan Urodynamic tests

Question 156

Stress incont mgmt

Answer 156

``` weight loss avoid: caffeine/diuretic/overfilling bladder Pelvic floor exercises Duloxetine (SNRI) Surgery (tension free vaginal tape) ```

Question 157

Urge incont mgmt

Answer 157

``` bladder retraining (gradually increase time between voids) Antimuscarinic (oxybutinin, tolterodine) ```

Question 158

Bartholin's cyst

Answer 158

Unilateral 1-5cm resolve w good hygiene, analgesia, warm compress Can become abscess if infx - hot, red, tender, pus

Question 159

Bartholins abscess mgmt

Answer 159

``` Abx Swab of pus/fluid Staph/strep/e.coli/gonorrhea Fluclox or erythromycin if pen all Co-amox for broader coverage I&D needed sometimes ```

Question 160

Lichen Sclerosis

Answer 160

autoimmune labia, perianal, perineal skin fissures, cracks, erosions, hemorrhages under skin

Question 161

Lichen sclerosis sx

Answer 161

``` itch pain tight skin painful sex (superficial dyspareunia) Skin looks white, shiny, papules/plaques, tight and thin, raised. ```

Question 162

Lichen Sclerosis comps

Answer 162

pain and discomfort Bleeding 5% risk vulval cancer (SCC)

Question 163

Lichen Sclerosis tx

Answer 163

no cure biopsy if suspicious lesions topical steriods (dermovate) emollients

Question 164

Cervical CA pop

Answer 164

Young women | Peak reproductive years

Question 165

Cervical CA causes

Answer 165

``` HPV (16/18/33) Early sex Many partners Smoking HIV COCP ```

Question 166

Cervical CA presentation

Answer 166

Abnormal bleed (intermenstual, postcoital, post meno) Vag discharge Pelvic pain Urinary (dysuria, freq)

Question 167

Cervical CA stage 1

Answer 167

confined to cervix

Question 168

Cervical CA stage 2

Answer 168

uterus/upper 2/3 vagina

Question 169

Cervical CA stage 3

Answer 169

pelvic wall/lower 1/3 vag

Question 170

Cervical CA stage 4

Answer 170

bladder/rectum/beyond pelvis

Question 171

CIN 2

Answer 171

moderate dysplasia, likely to progress to CA if no tx

Question 172

CIN 3

Answer 172

severe dysplasia, will progress if no tx - cervical carcinoma in situ

Question 173

Smear w mild dyskaryosis

Answer 173

tested for HPV

Question 174

Smear screen

Answer 174

25-49 - 3y | 50-64 - 5y

Question 175

Smear mild (CIN 1)

Answer 175

continue routine screen, no other Ix unless HPV +

Question 176

Smear moderate dyskaryosis (CIN 2)

Answer 176

ref to colposcopy under 2w

Question 177

Smear severe dyskaryosis

Answer 177

suspected CA | refer colposcopy under 2w

Question 178

Smear inadequate

Answer 178

repeat

Question 179

Smear HPV +

Answer 179

refer colposcopy

Question 180

CIN + Stage 1A tx

Answer 180

colposcopy + excision/ablation

Question 181

Cervical ca: Stage 1B-2A w tumour <4cm

Answer 181

radical hysterectomy + removal of local LN

Question 182

Cervical ca: Stage 2B-4A or tumour >4cm

Answer 182

chemo + radio

Question 183

Cervical ca: Stage 4B

Answer 183

chemo/palliative

Question 184

HPV

Answer 184

most common cause Cervical ca Anal, vulval, vaginal, penis, mouth, throat cancers inhibits genes p53 and pRb Sexually transmitted

Question 185

HPB warts

Answer 185

6 and 11

Question 186

HPV cancer

Answer 186

16, 18, 33

Question 187

Gardasil against

Answer 187

HPV 6, 11, 16, 18

Question 188

Gardasil against

Answer 188

HPV 6, 11, 16, 18

Question 189

Endo CA risks

Answer 189

``` Age (60y peak) Long estrogen exposure (early period, late meno, HRT, no preg) Obesity HNPCC/Lynch syndrome Tamoxifen (breast CA SERM) DM PCOS ```

Question 190

Endo CA pres

Answer 190

post meno bleed | inter mentrsual bleed

Question 191

Endo Ca ix

Answer 191

tranvag US for endo thickness (norm <4mm) | Hysteroscopy with endo biopsy

Question 192

Endo CA mgmt

Answer 192

- total abdominal hysterectomy w bilat salpingo-ooph - Wertheim's hysterectomy includes the pelvic LNs - Radiotherapy - Progesterone - slow progression of Ca when surgery not appropriate

Question 193

Ovarian Ca pop

Answer 193

presents late, 60's

Question 194

Ovarian Ca RF

Answer 194

``` Age (peak at 60) BRCA1 and BRCA 2 genes (FH) More ovulations = greater risk (early periods, late meno, no preg) Ovesity HRT Smoking Breast feeding protective ```

Question 195

Ovarian CA pres

Answer 195

``` Bloating Pelvic pain Urinary sx weight loss abdo mass ```

Question 196

CA125 high in:

Answer 196

``` Ovarian Ca During menstruation Endometriosis Livery cirrhosis Benign ov cysts Fibroids ```

Question 197

Ovary ca Ix

Answer 197

CA125 Abdo/pelvic US Diagnostic laparoscopy

Question 198

Ovary staging system

Answer 198

FIGO

Question 199

Ovary Ca stage 1

Answer 199

only in ovary

Question 200

Ovary Ca stage 2

Answer 200

out of ovary but inside pelvis

Question 201

Ovary Ca stage 3

Answer 201

out of pelvis but in abdo

Question 202

Ovary Ca stage 4

Answer 202

spread out of abdo (distant mets)

Question 203

Ovary Ca mgmt

Answer 203

surgery | Chemo

Question 204

Krukenberg tumour

Answer 204

ovarian malig. secondary to mets from another site

Question 205

Vulval Ca

Answer 205

Usually SCC | Vulval Intraepithelial Neoplasia (VIN)

Question 206

Vulval Ca RF

Answer 206

advanced age HPV lichen sclerosus

Question 207

Vulval CA pres

Answer 207

``` pain itching discomfort discharge bleeding abnormal appearance or palpation on self exam LN in groin ```

Question 208

Vulval CA appearance

Answer 208

labia majora | irregular mass, fungating, ulcerating, bleeding

Question 209

Vulval Ca dx

Answer 209

biopsy

Question 210

Vulval Ca mgmt

Answer 210

``` urgent (2w) referral Incisional bx if low concern Sentinel node bx for LN spread Wide local excision to remove cancer Groin LN dissection to stage and clear CA nodes ```

Question 211

Bacterial Vaginosis

Answer 211

``` Lactobacilli - healthy bacteria produce lactic acid to keep pH low and prevent overgrowth Other bacteria (Gardnerella) overgrow and reduce lactobacilli - causing BV ```

Question 212

Bact Vag tx

Answer 212

metronidazole

Question 213

Bact vag mgmt

Answer 213

Vag swabs to exclude Clam/Gon | Avoid irrigation or cleaning w soaps that disrupt flora

Question 214

Bact Vag in preg

Answer 214

early delivery risk

Question 215

Bact Vag pres:

Answer 215

``` Fishy smelling watery/grey dischrge Dysuria High pH "Clue cells" Can increase risk of transmitting STI ```

Question 216

Candidiasis

Answer 216

More common in DM and immunosuppression

Question 217

Candidiasis pres

Answer 217

itchy thick, white discharge vulval and vaginal irritation

Question 218

Candidiasis mgmt

Answer 218

Clotrimazole cream 1 x clotrimazole pessary 1 x oral fluconazole (150mg)

Question 219

Gonorrhea

Answer 219

Gram - diplococcus Young, sexually active, multiple partners More sx than Chlam In endocervix

Question 220

Gonorrhea pres

Answer 220

Odourless, green, purulent discharge Dysuria Pelvic pain Testicular pain

Question 221

Gonorrhea dx

Answer 221

NAAT detects DNA of gon on endocervical swabs or urine | Endocervical swab for culture + sensitivity

Question 222

Gonorrhea tx

Answer 222

GUM clinic Single dose ceftriacone 500mg IM and azithromycin 1g oral Re-test for cure Contact tracing

Question 223

Chlamydia

Answer 223

Gram neg | Most common cause reversible infertility

Question 224

Chlamydia pres

Answer 224

PV discharge Pelvic pain Abnormal bleed Painful sex

Question 225

Chlamydia exam

Answer 225

Cervical excitation Pyrexia Purulent discharge Pelvic/abdo tender

Question 226

Chlam dx

Answer 226

Vulvovaginal swab female First catch urine men NAAT

Question 227

Chlam tx

Answer 227

GUM Doxycycline 7d Singe dose 1g azithromycin (better compliance) No need to re test

Question 228

Lymphogranuloma venereum

Answer 228

Lymphoid tissue around side of infx in those with Chlam | 3 stages

Question 229

Lymphogranuloma venereum stage 1

Answer 229

painless ulcer | on penis or vaginal wall or rectum

Question 230

Lymphogranuloma venereum stage 2

Answer 230

lymphadenitis - swelling, inflammation, pain of LN infected with bacteria.

Question 231

Lymphogranuloma venereum stage 3

Answer 231

where inflamm in rectum and anus - proctocolitis leads to anal pain and discharge

Question 232

PID

Answer 232

Inflammation, usually from infx, of organs of pelvis Usually from cervix infx Major cause infertility and pain

Question 233

PID bacteria

Answer 233

Chlamydia trachomatis | Neisseria gonorrhea

Question 234

PID presentation

Answer 234

``` pelvic pain/low abdo pain fever dysuria deep dyspareunia vag discharge abnormal bleeding menorrhagia cervical excitation ```

Question 235

PID mgmt

Answer 235

oral ofloxacin 400mg BD + oral metronidazole 400mg BD x 14d OR IM ceftriaxone 500mg single dose + oral doxycycline 100mg BD w oral metronidazole 400mg x 14d - treat based on clinical dx - consider removal of IUD - GUM referral

Question 236

Fits-Hugh-Curtis Syndrome

Answer 236

PID causes inflammation of liver capsule --> adhesions between liver + peritoneum RUQ pain referred to R shoulder tip if diaphragmatic irritation

Question 237

Herpes Simplex

Answer 237

HSV 1 - cold sores HSV 2 - genital herpes SOME overlap Can cause aphthous ulcers - stomatitis herpetiformis

Question 238

HSV pres

Answer 238

labial ulceration/vesicles pain no discharge ask re: sex contacts

Question 239

HSV dx

Answer 239

clinical | swab for viral PCR

Question 240

HSV mgmt

Answer 240

Acyclovir (oral in stomatitis and genital, topical for cold sores) Can require long term

Question 241

HSV + preg

Answer 241

Acyclovir can be used Neonatal HSC infx has high morb + mort Risk of vertical trans should be minimized - if lesions >28w - ELCS at term (6w for fetus to get passive imunity) - if recurrent genital herp is known- acyclovir **NO increased risk miscarriage

Question 242

% women conceive in 1st year

Answer 242

85%

Question 243

How many women struggle w fertility

Answer 243

1/7

Question 244

How long without conception for Ix

Answer 244

12 mo <35 | 6mo >35

Question 245

Causes of infertility

Answer 245

``` Sperm Ovulation Tubal Uterine Unexplained 40% a mix of male and female issues ```

Question 246

Advice for conception

Answer 246

``` folic acid 400mg/d healthy BMI No smoking or excessive alcohol Sex 2-3 times/week times intercourse not needed/recommended ```

Question 247

Infertility Ix

Answer 247

``` BMI Semen analysis Serum LH, FSH on day 2-5 Serum progesterone d21 Anti-mullerian hormone (anytime) US pelvis (structures, PCO) Screen for chlam/gon Hysterosalpingogram (patency of tubes and can help conception) Laparoscopy + dye test (patency of F tubes, adhesions, endometriosis) ```

Question 248

What day to take LH, FSH for infertility

Answer 248

d 2-5

Question 249

Infertility: high FSH

Answer 249

poor ovarian reserve

Question 250

Infertility: high LH

Answer 250

PCOS/ovarian failure

Question 251

Infertility BMI

Answer 251

High - PCOS | Low - amenorrhea

Question 252

When to take infertility progesterone

Answer 252

Day 21

Question 253

Infertility high progesterone

Answer 253

ovulation occurred and corpus luteum has formed and is secreting progesterone

Question 254

Infertility anti-mullerian hormone

Answer 254

Marker of ovarian reserve | Rls by granulosa cells in follicles - falls as eggs used up

Question 255

Anovulation mgmt

Answer 255

Ovarian drill for PCOS Clomifene d2-6 (or Letrozole) Gonadotrophins (LH, FSH) Metformin

Question 256

Clomifene

Answer 256

SERM Day 2-6 Stops neg feedback of E on hypothalamus - increases secretion of LH and FSH

Question 257

Letrozole

Answer 257

Aromatase inhibitor

Question 258

Metformin in infertility

Answer 258

If insulin insensitivity and obesity (PCOS) - increases likelihood of ovulation

Question 259

Infertility: tubal issues mgmt

Answer 259

Cannulation during hysterosalpingogram Laparoscopy to remove adhesions or endo IVF (30% success/cycle)

Question 260

Infertility: uterine factors mgmt

Answer 260

Surgery to correct polyps, adhesions, structural issues

Question 261

Infertility: sperm mgmt

Answer 261

surgical sperm retrieval intra-uterine insemination intracytoplasmic sperm injection (ICSI)

Question 262

Sperm analysis instructions

Answer 262

No ejac x 3d prior and at most 5d No hot baths/sauna/tight undies Get the full sample Deliver to lab within 1h

Question 263

Things affecting sperm sample

Answer 263

``` Hot baths tight undies smoking alcohol raised BMI Caffeine ```

Question 264

Normal semen volume

Answer 264

>1.5ml

Question 265

pH of semen

Answer 265

>7.2

Question 266

Concentration of sperm

Answer 266

>15million/ml

Question 267

Total # sperm

Answer 267

39million/sample

Question 268

Motility of sprm

Answer 268

>40% are mobile

Question 269

Vitality sperm

Answer 269

>58%

Question 270

% normal sperm in sample

Answer 270

>4%

Question 271

Ovarian hyperstimulation syndrome

Answer 271

Comp of infertility tx - promote development of eggs in ovaries Leads to multiple developing leuteinised ovarian cysts Release E, P and vascular endothelial growth factors

Question 272

Ovarian hyperstim syndrome ft

Answer 272

``` Abdo pain + bloating N/V Diarrhea Hypotension Ascites Reduced UO Prothrombotic state - VTE ``` Mild --> abdo pain, bloat Severe --> ascites, oliguria, hypoproteinameia, hematrocrit >45%

Question 273

Ovarian hyperstim mgmt

Answer 273

Supportive and tx complications (ascitic drainage, anticoag) | ICU

Question 274

Early Preg: folic acid + vits

Answer 274

400mcg/d before and until 12 weeks - NTD | Vitamin D

Question 275

Early Preg: avoid

Answer 275

``` Vitamin A supplements Eating liver/paté (teratogenic) Drinking Smoking (IUGR/preterm) Unpasteurized dairy/blue cheese (listeriosis) Uncooked poultry Contact sports Flying - increased VTE risk ```

Question 276

Early Preg: smoking risks

Answer 276

``` IUGR Miscarriage Stillbirth Pre-term labour Placental abruption Pre-eclampsia Cleft-lip/palate ```

Question 277

Ectopic presentation

Answer 277

Delayed menses, hx of sex Low abdo pain, constant in iliac fossa, worsening Vag bleed - light/spot ***shock if ruptured Lower abdo tender Cervical excitation Avoid palpating adnexa - can rupture preg

Question 278

Ectopic sites

Answer 278

``` 95% tubal (isthmus, ampulla, infundibular) Interstitial/Cornual Cervical Ovarian Abdominal ```

Question 279

Ectopic RF

Answer 279

``` PIPPA Previous ectopic IUD in situ PID Pelvic/tubal surgery Assisted reprod. ``` ``` Cervical STI (C/G) Smoking ```

Question 280

Ectopic blood tests

Answer 280

FBC Group Save hCG - normally doubles every 48h...if NOT doubling, likely ectopic "suboptimal rise in hCG"

Question 281

Ectopic Ix

Answer 281

US - HCG >1500 should see normal preg - HCG >150 and no IUP --> ectopic till proven otherwise IF <1500 and equivocal US --> serial HCG and US GS in adnexa, free fluid, no IUP

Question 282

Ectopic mgmt: expectant

Answer 282

``` Pain free Stable hCG <1500 Unruptured tubal ectopic <35mm No HR Able to attend F/U ```

Question 283

Ectopic mgmt: medical

Answer 283

``` MTX 50mg - interfere w DNA synthesis, kills trophoblast tissue Pain free Stable hCG <10,000 Unruptured tubal ectopic <35mm No HR Able to attend F/U ```

Question 284

Ectopic mgmt surgical

Answer 284

``` Laparoscopic w Salpingectomy or salpingostomy GOLD STAND Pain Unstable Tubal ectopic >35mm HR hCG >5000 Unable for F/U ```

Question 285

miscarriages

Answer 285

1/5 women

Question 286

Missed miscarriage

Answer 286

fetus died <20w, remains in uterus

Question 287

Threatened miscarriage:

Answer 287

Os closed FH seen bleeding

Question 288

Inevitable miscarriage

Answer 288

Os open FH seen bleeding

Question 289

Incomplete miscarriage

Answer 289

Os open No FH retained products of conception - infx risk. Need misoprostol pessary or evacuation of retained products of conception

Question 290

Complete miscarriage

Answer 290

Os closed No FH No products left

Question 291

Anembryonic preg

Answer 291

Gestational sac but no embryo in it | <25mm and no tissue - confirmed

Question 292

Recurrent miscarriage

Answer 292

3 in a row

Question 293

Causes of recurrent miscarriages

Answer 293

``` idiopathic (older women) Antiphospholipid syndrome Thrombophilia (2nd tri) Uterine abnormalities Genetic factors Chronic histiocytic intervillositis Chronic ill (DM, SLE) ```

Question 294

Recurrent miscarriage ix

Answer 294

Antiphospholipid Ab Pelvic US Genetic testing of parents (microarray)

Question 295

Termination of preg: medical

Answer 295

<9w | Mifepristone (anti progestogen) and misorpostol (prostaglandin)

Question 296

Termination of preg: surgical

Answer 296

<15w Cervical dilatation & suction of contents | <24w cervical dilatation & forcep evacuation

Question 297

Post TOP care

Answer 297

Bleeding + cramps | Use protection

Question 298

TOP complications

Answer 298

``` Infx Bleed Pain Failed abortion Damage to local structures ```

Question 299

Peak of hyperemesis grav

Answer 299

8-12w

Question 300

Cause of hyperemesis grav

Answer 300

high hCG More common in molar preg and multiples Worse in first preg + obesity

Question 301

RCOG hyperemesis grav criteria

Answer 301

>5% weight loss Dehydration Electrolyte imbalanace

Question 302

Hyperem grav mgmt

Answer 302

Assess severity w PUQE score Antiemetics - mild, + ginger Admission if severe

Question 303

Hyperem grav antiemetics

Answer 303

Prochlorperazine (stemetil) Cyclizine Ondansetron Metoclopramide (short term - occulogyric crisis)

Question 304

Hyperem grav admissions

Answer 304

``` Unable to tolerate antiemetics/keep fluids down Ketones in urine (>= +2) Electrolyte imbalances (hyponatremia) ```

Question 305

Hyperem grav admit tx

Answer 305

IV antiemetics IV rehydration Thiamine supplementation Thromboprophylaxis (LMWH, Teds)

Question 306

Complete mole

Answer 306

Dispermic: 2 sperm fertilize egg = triploid conceptus w 69ch Monospermic: 1 sperm fert egg, maternal CH lost, paternal doubles - 46chrom but all from dad No normal tissue

Question 307

Partial mole

Answer 307

2 sperm fertilize egg @ same time - new sell has 3 x chromosomes (69)- divides into a partial mole some fetal material ****1-3% choriocarcinoma, follow up w HCG

Question 308

Molar preg presentation

Answer 308

``` Severe morning sickness Vag bleed, no pain Increased enlargement of uterus Abnormally high hCG Thyrotoxicosis (tachy, HTN, sweat, anx) ```

Question 309

Molar preg Ix

Answer 309

US pelvis - snowstorm appearance, multiple cysts | Confirm w histology of mole

Question 310

Molar preg mgmt

Answer 310

``` Evacuate uterus - D&C Histology Ref to gestational trophoblastic disease centre Measure hCG to ensure return to normal Can metastasize ```

Question 311

Anemia screening

Answer 311

Booking (8-12w) | 28w

Question 312

Hb in preg

Answer 312

Falls due to increase plasma volume diluting it

Question 313

Bloods in early preg

Answer 313

FBC (normal >110 @ book, >105 @ 28w) Ferritin (12-300ng) B12 (>200ng) Folate (>4ng)

Question 314

Anemia mgmt preg

Answer 314

Ferrous sulphate 200mg TDS (If low ferritin but not anemic - supplementary iron) Low B12 --> test pernicious anemia (IF Ab) - B12 injections or tablets Low folate - 5mg daily

Question 315

Pre-eclampsia

Answer 315

>20w Preg induced HTN w proteinuria. HTN w end organ damage

Question 316

Pre-eclampsia triad

Answer 316

HTN Proteinuria Edema

Question 317

Preg induced HTN/Gestational

Answer 317

>20w

Question 318

Eclampsia

Answer 318

Pre eclampsia + seizures

Question 319

Target BP in Preg HTN

Answer 319

<135/85 | Over tx --> decreased placental perfusion

Question 320

HTN tx benefits

Answer 320

Reduces severe htn dev | Lowers stroke risk

Question 321

Anti-HTN in preg

Answer 321

Labetolol (1st) Nifedipine or methyldopa (2nd) MgSO4 during birth ACE/Diuretic --> congenital malformations

Question 322

Pre-eclampsia RF

Answer 322

``` Major (1): Pre existing HTN DM Prev gest HTN or PET CKD Autoimmune dx (SLE, antiphos) Moderate (1+): FAMOUS First preg Age 40+ Multi preg Obesity (BMI>35) Unusual gap (>10y) Significant FHx of pre eclamps ```

Question 323

Pre eclampsia dx

Answer 323

>140/90 on +1 occasion AND Proteinuria >0.3/24h Protein Cr ratio: 30, +2 on dipstick

Question 324

If have pre eclamps RF: prophylaxis

Answer 324

Aspirin 75-150mg OD from 12/40

Question 325

Pre eclamps monitoring

Answer 325

``` BP Sx Urine dipsticks Bloods (platelets, LFT (ALT), UE) Hb (low due to HELLP) Fetal mvmt Serial growth scans AFI Umbilical doppler ```

Question 326

Placental Growth Factor

Answer 326

Supports trophoblasts - offer between w 20-35 to those w chronic or gestational HTN Low levels - high risk Pre-E and IUGR

Question 327

Pre-eclamps fetal comps

Answer 327

IUGR Intra uterine death Premature delivery

Question 328

Pre eclamps maternal comps

Answer 328

``` SHAME Stroke HELLP Abruption Multi organ failure Eclampsia ```

Question 329

HELLP

Answer 329

Hemolysis Elevated Liver enzymes Low Platelets --> eventually DIC

Question 330

Eclampsia tx

Answer 330

1st: MgSO4 2nd: midazolam

Question 331

Pre eclamps US

Answer 331

At dx and every 2w

Question 332

Red flag eclampsia sx

Answer 332

Headache Vision change Epi/RUQ pain Breathlessness (ARDS)

Question 333

Red flag eclampsia signs

Answer 333

Peri-orbital edema Hyper reflexia Clonus

Question 334

Pre-eclamps delivery

Answer 334

>34w Maternal steroids up to 36w Delay delivery by 24h for steroids

Question 335

Maternal steroid injection benefits

Answer 335

Reduse intraventricular hemorrhage RDS necrotising enterocolitis

Question 336

Early delivery in pre eclamps

Answer 336

High BP Impaired renal or hepatic Fetal distress

Question 337

Eclampsia mgmt

Answer 337

ABC Manual uterine displacement or turn mom on side (aspiration and aorto-caval compression) Control fits: MgSO4 Control HTN: IV labetolol or hydralazine

Question 338

Rh +

Answer 338

no tx

Question 339

Rh -

Answer 339

Become sensitized if birth Rh+ baby | Next time: mom's Anti-D cross into fetus - hemolysis of baby

Question 340

Hemolytic disease of newborn

Answer 340

Mom Rh - and had Rh+ baby last time, this time Ab attack babies RBCs

Question 341

Anti-D injection

Answer 341

IM, 28w and at birth to Rh- mom After birth too if baby was Rh + **ANY time sensitization could occur (vag bleed, amniocentesis, trauma)

Question 342

Kleihauer test

Answer 342

Check how much fetal blood has passed to mom after sensitization event >20w to assess need for further Anti-D

Question 343

GDM risks to baby

Answer 343

``` SMASHH Shoulder dystocia Macrosomia Amniotic fluid excess Stillbirth Hypoglycemia, hypocalcemia, hypomag HTN, Hyperbili, hyperinsulin/hyperphos RDS ****NOT miscarriage or congential mal ```

Question 344

GDM usually starts

Answer 344

2nd tri

Question 345

Pre existing DM risks

Answer 345

congenital abnorm | Miscarriages

Question 346

Causes of issues in GDM

Answer 346

Mom hyperglycemia --> fetal hyperglycemis (causes polyhydramnios), baby gets hyperinsulinemia (causes fetal macrosomia--> shoulder dystocia) and then they are born w neonatal hypoglycemia

Question 347

Pre existing DM

Answer 347

5mg folic acid from preconception HbA1C <48 before trying to get preg Avoid preg if HbA1c >86 (sacral agenesis)

Question 348

Signs of pre existing DM

Answer 348

1st tri glycosuria high random blood sugar confirm w OGTT

Question 349

GDM RFs

Answer 349

``` Raised BMI (>30) Prev GDM Asian, Black, Mid East Prev macrosomic baby (>4.5kg) FHx DM OTHERs to screen: prev stillbirth, polyhydramnios, big for dates, PCOS) Macrosomia/Polyhydramnios currently LT steroid use ```

Question 350

Pre exising DM effects on preg

Answer 350

1st tri: increased insulin secretion + sensitivity - mom hyperglyc. 2nd tri: increase insulin resisit, need more insulin Acceleration of retinopathy Decreased renal func

Question 351

Pre existing DM mgmt

Answer 351

Stop ACE Manage w team Screen + monitor for vascular comps Early iability scan @ 8w

Question 352

OGTT process

Answer 352

``` Fast from midnight Fasting sugar test 75g glucose drink Measure at 1hr and 2hr Normal: 5, 6, 7, 8 <5.6 or (5.1) @ base, <7.8 @2 (or 8.5) ```

Question 353

GDM path

Answer 353

Increased glucose load + insulin resistance --> DM Placental lactogen + Placental progesterone increase in 2nd tri More calories and less exercise, more fat deposition Increased cortisol and Gh in preg All lead to insulin resistance

Question 354

Preg Scans

Answer 354

``` LMP 8-10 w: booking 11-13w: dating 20w: anomaly 24-28w: OGTT 28 + 34w: Anti-D ```

Question 355

GDM mgmt

Answer 355

Fasting <7: diet, lifestyle Fasting >7: insulin Fasting >6 + macrosomia: insulin

Question 356

Effects of GDM on mom

Answer 356

``` POP-SIS Polyhydramnios Operative delivery PET Sig ris recurrence Infx Sig trauma to vag ```

Question 357

Fetal hypoglycemia

Answer 357

Unwell G3 Seizure Brain dmg

Question 358

GDM meds

Answer 358

1st: Metformin - 500mg daily w food 2nd: Add single injection intermediate acting insulin (Isophane) or Glibenclamide 3rd: Short acting insulin before means (Novorapid)

Question 359

GDM mgmt + delivery

Answer 359

Growth scans: 28, 32, 36 | If not large, consider ELCS - if not, induce @ 38-40w

Question 360

Shoulder dystocia manoeuvers

Answer 360

``` McRoberts Rubin's Woodscrew Suprapubic pressure break clavicle Episiotomy CS + zavanelli ```

Question 361

Shoulder dystocia Mcroberts

Answer 361

flex (kneed to chest) + externally rotate hips to stretch symphysis and open pelvic outlet

Question 362

Shoulder dystocia suprapubic pressure

Answer 362

rotates fetal shoulder into wider oblique diameter or under pub symph

Question 363

Shoulder dystocia woodscrew

Answer 363

reach in and rotate shoulder | deliver posterior shoulder

Question 364

SGA

Answer 364

<10th centile for GA

Question 365

Causes of SGA

Answer 365

``` idiopathic pre eclampsia maternal smoking/alcohol anemia malnutrition infx multips constitutional Abnormal SGA (genetic, structure) ```

Question 366

Tyles of SGA

Answer 366

``` SWAN Starved small (FGR) Wrong small Abnormal small Normal small ```

Question 367

Wrong small SGA

Answer 367

normal growth velocity | = wrong dates

Question 368

Abnormal small

Answer 368

decreased growth velocity | = chromosomal, structural, infx, genetic

Question 369

Starved small (fetal growth restriction)/ IUGR

Answer 369

Decreased growth velocity | = placental dysfunc, maternal disease, pre-eclamps, drug/alcohol/coke

Question 370

Normal small

Answer 370

normal growth velocity | = genetic, constitutional

Question 371

Growth restriction comps

Answer 371

Now: perinatal mor(stillbirths), preterm birth, birth asphyxia Later: HTN, T2DM

Question 372

SGA symmetrical

Answer 372

abnormal small normal small wrong small

Question 373

SGA asymmetrical

Answer 373

``` Abdo smaller than head - brain sparing effect Starved small (IUGR) ```

Question 374

Neonatal SGA compa

Answer 374

hypoglycemis polycythemia (neonatal jaundice) Prem comps: intraventricular hemorrhage, RDS, Necrotising enterocolitis

Question 375

SGA RFs

Answer 375

``` >40 Miltiple preg BMI >35 Maternal dx (HTN, DM + vascular dx, Renal dx, antiphospho) Prev SGA Pre-eclamps Smoking Prev stillbirth Low levels PAPPA (preg assoc plasma prot A) ```

Question 376

SGA monitoring

Answer 376

Low risk - SF height Med risk - uterine artery doppler @ 20w High - serial US w artery doppler, Screen for pre eclamps - maybe Aspirin prophyl Serial scans: growth, AFI

Question 377

Arterial flow

Answer 377

Normal - mountains continuous Absent diastolic - mountains + space Reversed - mountains + valley

Question 378

Reversed end diastolic flow

Answer 378

Emergency - stillbirth likely Prepare early delivery Monitor (GTG, AFI, UAD) Steroids

Question 379

Indications maternal steroids

Answer 379

Planned pre term birthd PPROM Spontaneous preterm labour

Question 380

Maternal steroids

Answer 380

IM betamethasone 12mg 12hx2 or dexamthasone 12mg 24hx2 **may need extra insulin if DM

Question 381

Mat steroids reduces risk of

Answer 381

``` Intraventricular hem Patent ductus RDS Nec entero Fetal death ```

Question 382

MgSO4 benefits

Answer 382

``` Lower risk CP Imrpved blood flow, less hypoxic damage at delivery Give if delivery within next 12h 4g slow IV (15-20min) then 1g/h Main benefit 24-30w ```

Question 383

43yo, birth 6mo ago, 5cig, no conditions, prev heavy bleeding

Answer 383

IUD levonorgestrel - long duration - smoking CI COCP - copper IUD will make bleeding even heavier

Question 384

53yo, no period 16mo, sister BCA

Answer 384

None needed: >50 and over 12mo no period | IF <50 - would need contraception till 24mo no period

Question 385

50yp, on HRT for hot flush, having periods, uterine fibroids, not regular med

Answer 385

Prog implant - progest only when on HRT - no coil - fibroids - no injection >50 - bone density

Question 386

Less advised contraception >40

Answer 386

>40 - COCP | >45 depo provera

Question 387

COCP in perimeno

Answer 387

Maintain bone density reduce meno sx <30mcg ethinylestradiol better <40y

Question 388

Depo-Provera perimeno

Answer 388

Delay of return to fertility >40 of 1y | Loss of bone density

Question 389

<50 non hormonal contraception

Answer 389

IUD, condom | Stop after 2y amenorrhea

Question 390

>50 non hormonal contracep

Answer 390

stop after 1y amen | IUD, condom

Question 391

<50 COCP

Answer 391

Can continue till 50

Question 392

>50 COCP

Answer 392

switch to non-hormonal, progesterone only

Question 393

Depo provera <50

Answer 393

Continue till 50

Question 394

Depo >50

Answer 394

switch to non hormonal and stop after 2y amen OR | Prog only method

Question 395

Implant <50

Answer 395

can use beyond 50

Question 396

Implant >50

Answer 396

continue | if amenorrhea - check FSH and stop after 1y if FSH>30 or stop @55

Question 397

POP <50

Answer 397

can use beyond 50

Question 398

POP >50

Answer 398

continue | if amenorrhea - check FSH and stop after 1y if FSH>30 or stop @55

Question 399

Constraception on HRT

Answer 399

POP can be used if HRT has some progesterone | If not: IUS

Question 400

Postmeno w atypical endometrial hyperplasia tx

Answer 400

total hysterectomy w bilat salpingo-oopherectomy

Question 401

Post meno endo biopsy at what thickness

Answer 401

>5mm

Question 402

Endometrial hyperplasia w/o atypia tx

Answer 402

high dose progesterone, repeat sample in 3-4mo | Levonorgesterel IUS

Question 403

Booking visit

Answer 403

Genera;: diet, alcohol, smoking, alcohol folic acid, vit D, antenatal classes BP, urine dip, BMI Bloods: FBC, Blood group, Rh, red cell Ab, hemoglobinopathis Hep B, syphilis HIV Urine culture - bacteriuria

Question 404

10-13+6 w visit

Answer 404

Scan to confirm dates | Exclude multiples

Question 405

11-13+6w visit

Answer 405

DS screen including nuchal scan

Question 406

16w visit

Answer 406

Routine: BP, urine dip info on anomaly scan Hb<11 --> iron

Question 407

25 w visit

Answer 407

Only if first baby | Routine: BP, urine dip, SF height

Question 408

18-20+6w visit

Answer 408

anomaly scan

Question 409

31 w visit

Answer 409

only if first | Routine: BP, urine dip, SF height

Question 410

34w visit

Answer 410

Routine: BP, urine dip, SF height Second dose Anti-D Labour plan

Question 411

28w visit

Answer 411

Routine. BP, urine dip, SFH Screen anemia and RBC Ab Hb <10.5 - iron First Anti-D dose

Question 412

36 w visit

Answer 412

Routine: BP, urine dip, SFH check presentation, ECV if breech Info on Breast feed, vit K, baby blues

Question 413

38w visit

Answer 413

Routine: BP, urine dip, SF height

Question 414

40w visit

Answer 414

Only if first | Discuss options for prolonged preg

Question 415

41w visit

Answer 415

Routine: BP, urine dip, SF height | Discuss IOL

Question 416

Cord prolapse mgmt

Answer 416

``` have woman go on knees + elbows push fetus back up (not cord) Tocolytics IF PAST INTROITUS - keep warm and moist, dont push it back Emergency CS ```

Question 417

Cord prolapse comps

Answer 417

cord compression cord spasm fetal hypoxia

Question 418

Cord prolapse RF

Answer 418

``` prematurity multiparity polyhydramnios twins cephalopelvic disproportion Abnormal presentation (breech) Placenta previa Long cord high fetal station artificial ROM ```

Question 419

PPROM Ix

Answer 419

Sterile speculum exam for fluid i posterior vag vault | US for oligohydramnios

Question 420

PPROM maternal complications

Answer 420

chorioamnionitis

Question 421

MgSO4 induced resp depression tx

Answer 421

calcium gluconate

Question 422

Nipple pain causes

Answer 422

poor latch blocked duct (continue BF, massage, change positions) nipple candidiasis (miconazole cream mom, nystatin suspension baby) Mastitis engorgement Raynauds

Question 423

When to tx mastitis

Answer 423

systemically unwell nipple fissure sx not improved 12-24h post milk removal culture shows infx

Question 424

Mastitis tx

Answer 424

flucloxacillin 10-14d Continue BF If no tx, can develop breast abscess needing I&D

Question 425

Breast engorgement

Answer 425

fever x 24h red breast painful, difficulty feeding expression makes it better

Question 426

Raynauds nipple

Answer 426

intermittent pain during/after feeding blanching followed by cyanosis/redness Pain leaves when colour returns Tx: minimize cold, use heat packs, avoid caffeine, no smoking

Question 427

Ovarian Ca tx

Answer 427

surg + platinum based chemo

Question 428

Female genital mutilation T1

Answer 428

partial/total removal of clitoris/prepuce

Question 429

Female genital mutilation T2

Answer 429

partial/total removal of clitoris + labia minora +/1 majora

Question 430

Female genital mutilation T3

Answer 430

narrowing of vaginal orifice w covering seal by positioning labia minor/major over it +/- clitoris excision infibulation

Question 431

Female genital mutilation T4

Answer 431

all other harmful procedures: pricking, piercing, incising, scraping,cauterization

Question 432

Ectopic most common site

Answer 432

ampulla of F tube

Question 433

Ectopic ++ dangerous location

Answer 433

isthmus

Question 434

Contraceptive implant MOA

Answer 434

**inhibit ovulation alter cervical mucus ? thin endo

Question 435

COCP MOA

Answer 435

*inhibit ovulation

Question 436

POP MOA

Answer 436

*thicken cervical mucus

Question 437

Desogestrel only pill MOA

Answer 437

*inhibit ovulation | thickens mucus

Question 438

Injection contraception (medroxyprogesterone acetate)

Answer 438

* inhibit ovulation | thickens mucus

Question 439

Copper coil MOA

Answer 439

decrease sperm motility + survival

Question 440

IUS MOA (levonorgestrel)

Answer 440

*prevent endo prolif | thickn mucus

Question 441

Plan B - Levonorgestrel MOA

Answer 441

inhibit ovulation

Question 442

Plan B ulipristal MOA

Answer 442

inhibit ovulation

Question 443

Plan B IUD MOA

Answer 443

*toxic to sperm + ovum | inhibits implantation

Question 444

Premature ovarian failure

Answer 444

no menses for 1y <40 | Can start w irregular cycles

Question 445

Premature ovarian failure sx

Answer 445

``` hot flush vaginal dryness vag atrophy sleep disturbance irritability high FSH (>40) and LH Low E (<100) ```

Question 446

Prem ovarian fail causes

Answer 446

``` idiopathic (and fhx) Bilateral oopherectomy Radiotherapy Chemo Infx (mumps) Autoimmune Resistant ovary syndrome (FSH receptor abn) ```

Question 447

Amiodarone in BF

Answer 447

no

Question 448

ABX ok in BF

Answer 448

penicillin cephalosporins trimethoprim

Question 449

Anti epileptics OK i BF

Answer 449

Sod val | carbamazepine

Question 450

Asthma meds ok in BF

Answer 450

salbutamol | theophyllines

Question 451

Psych drugs OK in BF

Answer 451

TCA | Antipsychotics (NOT CLOZAPINE)

Question 452

HTN drugs ok in BF

Answer 452

BB | hydralazine

Question 453

Anticoags ok in BF

Answer 453

warfarin | heparin

Question 454

Abx bad in bf

Answer 454

ciproflox tetracycline chloramphenicol sulphonamides

Question 455

Psych drugs bad in bf

Answer 455

lithium | benzoss

Question 456

Bad in BF drugs

Answer 456

``` aspirin carbimazole mtc sulfonylureas cytotoxic drugs amiodarone ```

Question 457

Cholestasis in preg comps

Answer 457

stillbirth

Question 458

Cholestasis in preg mgmt

Answer 458

``` IOL @ 37-38w ursodeoxycholic acid Vit K supplement emollients for itch Antihistaine - sleep Vit K - if clotting abnormal ```

Question 459

Cholestasis in preg sx

Answer 459

Itch on palms + soles, abdo jaundice sometimes raised bilirubin

Question 460

1st degree tear

Answer 460

vaginal mucosa | no muscle

Question 461

2nd degree tear

Answer 461

subcutaneous/submucosal tissue | perianal muscle, no sphincter

Question 462

3rd degree tear

Answer 462

external anal sphincter 3a: <50% EAS 3b: >50% EAS 3c: IAS

Question 463

4th degree tear

Answer 463

through external anal sphincter + iAS, into rectal mucosa

Question 464

RF for perianal tears

Answer 464

``` primigravida large babies precipitant labour shoulder dystocia forceps ```

Question 465

Prev baby with early or late onset GBS disease

Answer 465

maternal IV abx prophylaxix w benzylpenicillin ASAP (or clindamycin if allerg)

Question 466

neonatal infx <4d

Answer 466

GBS

Question 467

co-amoxiclav in preg - comps

Answer 467

nec enterocolitis

Question 468

GBS RF

Answer 468

prematurity prolonged ROM prev sibling GBS ifx maternal pyrexia (2ndary to chorioamnionitis)

Question 469

missed/incomp Miscarriage medical mgmt

Answer 469

vaginal misoprostol alone, could do oral too should start to expel in 24h Give analgesia + antiemetics

Question 470

Miscarriage expectant mgmt

Answer 470

wait 7-14d | if not, go to med or surg

Question 471

When to use medical/surg mgmt miscarriage

Answer 471

risk of hemorrhage (late 1st tri, coagulops) prior adverse/traumatic experice w preg infx

Question 472

Surg mgmgt miscarriage

Answer 472

``` vacuum aspiration (LA) evacuation of retained prod (GA) ```

Question 473

Large for gestational age

Answer 473

Macrosomia | >4kg

Question 474

LGA causes

Answer 474

``` Constitutional GDM Prev macrosomia Maternal obesity or rapid weight gain Overdue Male Incorrect dating Polyhydramnios Fibroids ```

Question 475

Macrosomia risks to mom

Answer 475

``` Shoulder dystocia failure to progress perianal tear instrumental deliv PPH Uterine rupture ```

Question 476

Macrosomia risk to baby

Answer 476

Birth injury (erbs palsy, clavicular fracure, fetal distress, hypoxia) Neonatal hypoglycemia Obesity

Question 477

Chickenpox in preg

Answer 477

``` Dangerous Varicella pneumonitis - lung infx Fetal varicella syndrome - devt abnorm Severe neonatal varicella - if infx at dleiv TEST IgG if not sure re immunity ```

Question 478

Mom lacks varicella immunity

Answer 478

IV varicella immunoglobulins within 10d of exposure

Question 479

Rubella in preg

Answer 479

``` congenital rubella syndrome - sensorineural deafness - congenital health disease - cataracts Screened at booking DONT get vaccine, its live ```

Question 480

Rubella vaccine in preg

Answer 480

NO

Question 481

Chorioamnionitis

Answer 481

Infx of amniotic sac + fluid | Life threatening

Question 482

Chorioamnionitis pres

Answer 482

fever abdo pain sepsis (tachy tachy hypotension) fetal compromise on CTG

Question 483

Chorioamnionitis tx

Answer 483

Sepsit 6 | Early delivery

Question 484

Twins antenatal care

Answer 484

5mg folic iron sup vit D

Question 485

Twin scanning

Answer 485

2 weekly from 16w in monochorionic | 4 weekly scans from 20w in dichorionic

Question 486

Delivery date diamniotic

Answer 486

37-38w | Give steroids

Question 487

Delivery method twins

Answer 487

Monoamniotic : ELCS @ 32-34w | Diamniotic: vaginal if presenting twin cephalic, second will need CS

Question 488

Twins complications

Answer 488

``` Anemia Polyhydramnios HTN IUGR Prematurity Increased perinatal mortality Malpresentation PPH Twin Twin Transufion Syndrome ```

Question 489

TTTS

Answer 489

recipient gets majority of blood - overloaded (w polyhydramnios) Donor starved, anemic Laser tx to destroy connection

Question 490

DS screen combined test

Answer 490

first line most accurate 11-14w US nuchal translucency (>6mm DS) Meternal bloods (bHCG higher = risk, PAPPA - lower = risk)

Question 491

DS screen triple test

Answer 491

``` 15-20w Only materna bloods hCG AFP - lower = more risk Serum estriol - lower = risk ```

Question 492

DS quadruple test

Answer 492

15-20w | Same as triple (HCG, AFP, E) + Inhibin A (high = risk)

Question 493

DS amniocentesis

Answer 493

If risk >1/150 - offer amniocentesis or chorionic villus sampling

Question 494

Chorionic villus sampling

Answer 494

Biopsy of placental tissue | Done <15w

Question 495

Amniocentesis

Answer 495

US aspiration amniotic fluid | Later in preg

Question 496

Placenta previa

Answer 496

Lying low Minor - not covering internal os Major - covering internal os

Question 497

Placenta Previa RF

Answer 497

``` prev CS older structural abnormal (eg fibroids) Parity D&C/surgery ```

Question 498

Placenta previa mgmt

Answer 498

``` rest avoid sex avoid vag exam/speculum US 34w to assess position - repeat every 2w if still close to os ELCS @37w or vag if passage clear ```

Question 499

Placenta previa pres

Answer 499

``` painless bright red blood soft uterus Normal FHR HCT relfects blood loss Abn presentation ```

Question 500

Placental abruption pres

Answer 500

painful dark red blood shock, abnormal CTG, woody abdomen HCT not consistent w blood loss

Question 501

Placenta previa comps

Answer 501

hemorrhage (ante/post partum)

Question 502

Uterine causes of antepartum hemorrhage

Answer 502

Placental abruption Placenta previa Vasa previa Marginal bleed

Question 503

Cervical causes of antepartum hemorrhage

Answer 503

show cervical CA Cervical polyp/ectropion

Question 504

Vaginal causes of antepartum hemorrhage

Answer 504

trauma | infection

Question 505

Placental abruption

Answer 505

premature separation of placenta from uterus

Question 506

Placental abruption RF

Answer 506

``` idiopathic smoking pre eclampsia trauma prev abruption Cocaine Thombophilia Twins Deficient endo (prev CS, endometritis, curettage) ```

Question 507

Concealed abruption

Answer 507

Os remains closed, hemorrhage stays in uterine cavity - underestimate severity

Question 508

Abruption mgmt

Answer 508

Rescuss Deliver (unstable/featle distress/heavy bleed-CS, stable/no distress - induce @ 37) Anti-D if Rh- Watch for PPH

Question 509

Obstetric cholestasis pres

Answer 509

3rd tri itchy on palms/ soles/ abdo No rash Abnormal LFTs and bile acids

Question 510

Acute fatty liver of preg

Answer 510

rapid accumulation of fat in hepatocytes in 3rd tri Acute hepatitis Immediate admission and delivery - high risk liver fail and mortality for both

Question 511

Acute fatty liver pres

Answer 511

``` Malaise N/V jaundice Abdo pain LFT: high ALT ```

Question 512

VTE RF

Answer 512

``` Smoking Parity >3 Age > 35 BMI > 30 Reduced mobility Mltip preg Hx VTE FHx VTW Low risk thrombophilia ```

Question 513

Braxton hicks

Answer 513

practice ctx irregular, from 3rd tri Mild & crampy to srong

Question 514

Labour signs

Answer 514

Show (mucus plug) ROM Regular, painful ctx

Question 515

IOL

Answer 515

``` over dates (12d) Macrosomia reduced fetal mvmt pre-eclampsia PROM ```

Question 516

Bishop score

Answer 516

``` determine whether to induce labour 5 things, 0-3 score each <5 = labour needs induction - fetal station - cervix position - cervix dilatation - cervix effacement - cervix consistency ```

Question 517

IOL 1st line options

Answer 517

membrane sweep | vaginal pessary - prostaglandins

Question 518

Membrane sweep

Answer 518

Finger in Stim cervix Should start labour within 48h

Question 519

IOL vaginal pessaries

Answer 519

Prostaglandin E2 | Hospital setting for monitoring before allowing back home

Question 520

IOL 2nd line

Answer 520

oxytocin infusion

Question 521

Continuous CTG indications

Answer 521

``` sepsis oxytocin meconium pre-eclampsia (>160/110) antepartum hemorrhage ```

Question 522

CTG reading

Answer 522

``` DR C BRAVADO Define Risk (low/high) Ctx (freq/dur) Baseline Rate (brady/tachy/n) Variability (5-10bpm) Acceleration (present/absent) Deceleration (early/late/var) Overall (reassuring/not) ```

Question 523

CTG findings

Answer 523

``` DR ( PET/GDM/42+w) Ctx (5/10m = hyperstim) Baseline (110-160) Vari (5-15bpm) Accel (2 in 20min - 15bpm change for 15s) Decel (abnormal) ```

Question 524

Syntocinon

Answer 524

synthetic oxytocin IOL, stimulate ctx CAN also be used post birth for bleeding Increases conc. of Ca inside muscles cells

Question 525

Ergometrine

Answer 525

stimulate ctx of uterus during labour. V often after birth. | Works on alpha adrenergic, dopaminergic, serotonin R as stimulant on uterine muscles

Question 526

Syntometrine

Answer 526

Syntocinon + ergometrine | Stim labour + uterine ctx, bleeding after birth

Question 527

Active mgmt 3rd stage

Answer 527

Helps avoid PPH - Empty bladder - IM syntocinon after birth - Cord clamp 1m after birth (delayed) - Palpate abdomen, wait till uterine ctx to deliver placenta - Deliver placenta w gentle traction, while other hand pushes placenta up to avoid prolapse - Examine placenta

Question 528

Failure to progress

Answer 528

2 ctx/10min Syntocinon 1st line, titrated up @ 30min intervals Aim for 4ctx/10min

Question 529

CS layers

Answer 529

``` Skin Fat Rectus sheath Rectus muscle Peritoneum Abdominal cavity ```

Question 530

ELCS

Answer 530

spinal anesthetic | after 39w usually

Question 531

ELCS indications

Answer 531

``` prior CS Placenta previa Breech Cephalopelvic disproportion Choice IUGR Post-dates Uncontrolled HIV Cervical CA ```

Question 532

Emergency CS cat 1

Answer 532

immediate threat to life of mom or baby, target delivery time 30min

Question 533

Emergency CS cat 2

Answer 533

no imminent threat but required urgently due to compromise of mom/baby - 75min

Question 534

Emergency CS cat 3

Answer 534

delivery needed but mom and baby stable

Question 535

Emergency CS cat 4

Answer 535

elective

Question 536

CS comps

Answer 536

anesthetic risk surgical: bleeding, infx, pain, VTE Damage to structures: ureter, bladder, bowel, blood vessels Effect on abdo organs: ileus. adhesions, hernias Effects on future preg: repeat CS, uterine rupture, placenta previa, stillbirth Baby: lacerations, TTTN

Question 537

VBAC

Answer 537

Possible as long as the cause of the initial CS unlikely to reoccur Assess likelyhood of success (75% usually) Risk uterine rupture 0.5%

Question 538

VBAC contraindications

Answer 538

prev uterine rupture classical CS scar placenta previa

Question 539

Post CS VTE prophylaxis

Answer 539

10d LMWH if emergency | Elective doesnt need LMWH unless other health issues

Question 540

Age of viability

Answer 540

23w | 10% chance of survival

Question 541

Extreme prematurity

Answer 541

<24w

Question 542

Very preterm

Answer 542

28-34

Question 543

Moderate/late preterm

Answer 543

34-37w

Question 544

Term

Answer 544

>37w

Question 545

Prophylaxis of preterm labour

Answer 545

Progesterone pessary/gel - decrease activity of myometrium, prevent cervix remodelling Cervical cerclage - stitch in cervix to support + keep closed, can remove at labour or term

Question 546

Progesterone pessary indications

Answer 546

<25mm cervix length on US between 16-24 weeks gestation

Question 547

Cervical cerclage indications

Answer 547

<25mm cervix length on US between 16-24 weeks gestation who have prev. premature birth

Question 548

PPROM

Answer 548

preterm prelabour rupture of membranes

Question 549

PPROM dx

Answer 549

speculum - AF in vagina Amnisure (PAMG-1 placental alpha microglobin 1) prophylactic abx - erythromycin x 10d can delay birth

Question 550

Preterm labour but no ROM

Answer 550

<30w clinical exam enough to offer mgmt | >30w TVUS to assess cervix length - <15mm = mgmt OR fetal fibronectin

Question 551

Preterm labour w no ROM mgmt

Answer 551

fetal monitoring (CTG) Tocolysis Maternal steroids MgSO4

Question 552

Tocolysis

Answer 552

Stop uterine ctx Nifedipine used Used to buy time

Question 553

Antenatal steroids

Answer 553

<36w | Lung maturity

Question 554

MgSO4 in preterm

Answer 554

protect fetal brain, reduce risk of CP Use in 24h around delivery if <34w ***WATCH FOR TOXICITY

Question 555

Uterine rupture

Answer 555

incomp: peritoneal lining around uterus intact complete: lining ruptures, contents of uterus into peritoneal cavity Hemorrhage

Question 556

Uterine rupture tx

Answer 556

emergency laparotomy

Question 557

Uterine rupture RF

Answer 557

``` VBAC Prev uterine injury High BMI High parity IOL ```

Question 558

Shoulder dystocia Rubins

Answer 558

pressure on posterior part of babies anterior shoulder to help deliver under the symph pub

Question 559

Shoulder dystocia Zavanelli + CS

Answer 559

pushing babies head back up so it can be delivered by CS

Question 560

Shoulder dystocia comps

Answer 560

Fetal hypoxia (CP) Erbs palsy (brachial plexus) Perineal tears PPH

Question 561

Cord prolapse mgmt

Answer 561

``` emergency CS presenting part of baby pushed back up to get it off the cord lie in left lateral position or all 4s tocolysis while waiting Dont push the cord back in ```

Question 562

Indications for instrumental delivery

Answer 562

failure to prog fetal/maternal distress control of head in various position

Question 563

Risks of instrumental delivery

Answer 563

increased hemorrhage | Increased need for episiotomy

Question 564

Ventouse comp

Answer 564

cephalohematoma

Question 565

Forceps comp

Answer 565

facial nerve palsy, fat necrosis leading to hardened lumps on cheeks

Question 566

PPH defns

Answer 566

500ml vaginal | 1L CS

Question 567

PPH RF

Answer 567

``` Prev PPH Multiple Grand multipara (5+ vag del) Large baby Failure to progress in 2nd stage Pre eclampia Retained placenta ```

Question 568

PPH 4 T's

Answer 568

Tone - atonic uterus Trauma - genital tract, inversion Tissue - retained placenta Thrombin - bleeding disorder

Question 569

PPH preventative measures

Answer 569

treat anemia in ante-natal period Empty bladder - full reduced ctx Oxytocin in 3rd satge Tranexamic acid IV during CS 3rd stage if high risk

Question 570

PPH mechanical tx

Answer 570

rub uterus | catheterize

Question 571

PPH medical tx

Answer 571

``` Syntocinon/ergometrince stat 40u synt in continuous infuion Carboprost - prostaglandin analogue stim ctx(caution in asthma) Misoprostol - ctx Tranexamic acid - reduce bleed ```

Question 572

PPH surgical tx

Answer 572

balloon tamponade B-Lynch suture (suture around uterus to compress it) Uterine artery ligation Hysterectomy - last resort

Question 573

Uterine Inversion

Answer 573

Fundus drops down through cervix - cause of PPH Life threatening Can happen if puling too hard on umbilical cord

Question 574

Uterine inversion mgmt

Answer 574

Johnson's maneuver - use hand to push it back up

Question 575

UKMEC 1

Answer 575

no restriction in use

Question 576

UKMEC 2

Answer 576

advantages > disadvantagea

Question 577

UKMEC 3

Answer 577

dis>adv

Question 578

UKMEC 4

Answer 578

Unacceptable risk

Question 579

COCP MOA

Answer 579

prevent ovulation thicken mucus thin endometrium 99%

Question 580

COCP types

Answer 580

Monophasic phasic every day

Question 581

COCP monophasic

Answer 581

identical pills x 21d nothing x 7d Gap: withdrawal of hormones leading to menses Yasmine: ethinylestradiol, drospirenone Microgynon: ethinylestradiol, leveonotgestrel.

Question 582

COCP phasic

Answer 582

pills have varying amounts of hormones to closer match the changes occuring over the month Logynon

Question 583

COCP every day

Answer 583

monophasic but includes 7 sugar pills | Microgynon ED

Question 584

COCP SEs

Answer 584

``` breakthorugh bleed headache/migraine Breast tender Libido change Acne (improve/worsen) ```

Question 585

COCP risks

Answer 585

HTN Thombosis Increased BCa (reduced endo, ova, cerv)

Question 586

COCP contraindications

Answer 586

``` >35 + smoker Pregnancy Prev VTE Prev Stroke/heart disease Uncontrolled HTN FH thrombosis (<45y) Migraine + aura BCa ```

Question 587

COCP missed 1 pill

Answer 587

Most recent ASAP (even 2 at same time) | No extra protection

Question 588

COCP missed >1 pill

Answer 588

Most recent one ASAP Additional ctcp until 7 pill days straight D1-7 - need Plan B if UPSI D8-14 - no plan B needed D15-21 - no plan B needed and go straight into next pack without week off

Question 589

When to starts COCP

Answer 589

1st day of period - will protect right away | Other times - need 7d barrier

Question 590

POP

Answer 590

Take continuously, no pill free times Good in breast feeding Good if E contraindicated

Question 591

POP MOA

Answer 591

thickens mucus prevents ovulation 99%

Question 592

POP timing

Answer 592

Traditional: within 6h window daily - up to 3hr late (Micronor, norgeston - levono) Cerazette (desogestrel): take within 24h window - can be 12h late and still work

Question 593

POP side effects

Answer 593

``` Irreg bleed or amenorrhea (3packs) Breast tender Headache Libido change Acne ```

Question 594

Copper Coil MOA

Answer 594

reduce sperm motility and survival

Question 595

Copper coil benefits

Answer 595

5y Insert anytime in cycle, effective immediately No hormones - safe for VTE risk or hormone cancers

Question 596

Copper coil drawbacks

Answer 596

``` Increase period and intermenstrual bleeding Uterine perforation PID Ectopic preg Fall out ```

Question 597

Copper coil uses

Answer 597

emergency contraception w/in 5 d of intercourse

Question 598

Mirena coil (levonorgestrel) MOA

Answer 598

Thickens mucus Reduce endo lining prevent implant

Question 599

Mirena benefits

Answer 599

5y, >99% make periods lighter or stop GOOD for ppl on HRT who need prog. Good for endometriosis

Question 600

Mirena drawbacks

Answer 600

``` spotting/irregular bleed/menorrhagia/dysmenorrhea Alternative ctcp needed 7d Uterine perf PID ectopic fall out ```

Question 601

Mirena other uses

Answer 601

first line tx for menorrhagia HRT endometriosis - atrophy

Question 602

Progesterone implant MOA

Answer 602

``` In subcut tissue of upper arm 3y Inhibits ovulation Thickenc mucus thins endometrium ```

Question 603

Progesterone implant benefits

Answer 603

``` Effective (99%) no need to remember Improve dysmenorrhea Makes periods lighter/stop No affect on bone mineral density No risk of thrombosis ```

Question 604

Progesterone implant drawbacks

Answer 604

Minor operations with LA to insert/remove Worse acne Can have menorrhagia Reduced libido

Question 605

Depo Provera MOA

Answer 605

``` 3 monthly IM @ GP Good if cant have COCP or can't remember Medroxyprogesterone acetate prevents ovulation thickens mucus ```

Question 606

Depo provera fertility

Answer 606

can take 12mo to return

Question 607

Depo provera starting

Answer 607

first day of cycle | If later, need 7 days barrier

Question 608

Depo Provera side effects/risks

Answer 608

``` Ammenorrhea (light/stop) Irregular/spotting (first 3 shots) Weight gain Acne OSTEOPOROSIS ```

Question 609

Sterilization

Answer 609

Consider it permanent | Reversal only 25-50% successful

Question 610

Female sterilization

Answer 610

``` Laparoscopy under GA During CS Flocking (filshie clips), tying/cut, remove tubes >99% effective Alternative ctcp until next menstruation ```

Question 611

Male sterilization

Answer 611

Vasectomy - cutting vas deferens to prevent sperm reaching semen Under LA, 15-20min >99% effective Need ctcp for 2mo and semen testing to confirm sterility

Question 612

Ctcp post birth

Answer 612

``` Not needed until 21d post delivery POP safe in breastfeeding Avoid COCP in BF Lactational amenorrhea (full BF with no periods) - 98% effective If no BF - any contraception is fine ```

Question 613

EC - levonorgestrel

Answer 613

POP - inhibits implantation, and sometimes ovulation Single dose, 72h SE: vom, if <2h - repeat dose Can trigger/worsen depression **careful if prior ectopic or malabsorption syndromes

Question 614

EC - Ulipristal

Answer 614

Progesterone receptor modulator Single dose, 120h Abdo pain/diarrhea/vom - <3h then repeat **careful in uncontrolled asthma, avoid BF for 1w

Question 615

EC - IUD

Answer 615

Copper coil - 5d UPSI or 5d estimated ovulation Toxic to sperm Inhibit fert & implant Most effective Can lead to PID, prophyl ABX Keep in until after next period or long term

Question 616

6w postnatal check

Answer 616

GP, same time as newborn check - Gen wellbeing - Mood - Bleeding - Scar healing - Ctcp - BF - Fasting blood if GDM - BP (if HTN/PreE) - Urine dip (protein)

Question 617

Postpartum anemia

Answer 617

``` Optimize anemia in preg FBC day after birth: -<100 - oral iron (ferrous sulphate 200 TDS -<80 - iron infusion + oral iron - <70 - blood transfusion + oral ```

Question 618

Mastitis cause

Answer 618

Staph aureus accumulation of milk in duct, bacteria can enter nipple and into duct. regularly expressing milk can prevent this.

Question 619

Mastitis + abscess

Answer 619

I & D

Question 620

Mastitis sx

Answer 620

pain + tender erythema local warmth, inflammation Fever

Question 621

Mastitis mgmt

Answer 621

conservative: expressing, analgesia Abx if fever + infs (flucloxacillin, erythromycin if pen allergy) - sample of milk for culture+sens Continue BF

Question 622

Postnatal depression

Answer 622

1/10 women, peak 3mo after birth

Question 623

Baby blues

Answer 623

majority of women in week following | Esp primips

Question 624

Puerperal sychosis

Answer 624

1/1000 few weeks following birth

Question 625

Postpartum thyroiditis stages

Answer 625

1: hyperthyroid (<3mo) 2: hypo (3-9) 3: normal within 1 y

Question 626

Postpartum hyperthyroid tx

Answer 626

Symptomatic control w propranolol

Question 627

Postpartum hypothyroid tx

Answer 627

levothyroxine

Question 628

Sheehan's presentation

Answer 628

Hypo-pit - decreased lactation (prolactin) - amenorrhea (LH, FSH) - adrenal insuff (ACTH) - hypothyroid (TSH)

Question 629

Sheehan mgmt

Answer 629

manage each deficiency in turn

Question 630

PPH initial mgmt

Answer 630

``` Resus ABC/call for help/Team approach O2/ recovery position IV access Fluids/blood Baseline bloods (FBC, coag, X) Catheterize ```

Question 631

PPH specific measures

Answer 631

``` Rub up uterine ctx oxytocic agent EUA/remove products/repair tears Balloon tamponade B-Lynch suture Internal iliac ligation HHysterectomy IR ```

Question 632

PPH agents

Answer 632

Syntocinon - IM, IV Ergo - IM Carbo Miso - rectal

Question 633

PPH follow up

Answer 633

explain to pt and partner HDU Risk of recurrence & Mx in next preg - avoid anemia, active mgmt 3rd stage

Question 634

Mgmt 1st tri bleed

Answer 634

Always HCG before doing US

Question 635

Early preg failure sx

Answer 635

``` Int low abdo pain, bleeding, preg Bleeding worsens till pass tissue Can be asymptomatic HCG falls or plateaus US findings ```

Question 636

US poor indicators

Answer 636

irregular gestational sac absent yolk sac retroplacental clot failure of pole to grow - confirms EPF

Question 637

Emrbyo @ 5-4w

Answer 637

gestational sac present if HCG >1500-2000

Question 638

Embryo @ 5-6w

Answer 638

yolk sac in gestational sac if >10mm Gestational sac > 18mm --> see embryo Cardiac activity when embryo >5mm

Question 639

Ectopic physical exam

Answer 639

Closed cervix Adnexal fullness/tender Peritoneal signs (rupture) Unstable vitals (rupture)

Question 640

miscarriage HCG

Answer 640

plateau/ falling

Question 641

Miscarriage US

Answer 641

irregular GS Retroplacental hemorrhage Fetal pole w no HR

Question 642

Methotrexate for ectopic: imp

Answer 642

Avoid sun Avoid leafy greens/kegumes/prenatal vits Toxicity: stomatitis, myelosuppresion, iatrogenic hepatitis, pneumonitis, stevens johnson

Question 643

Molar preg Ca

Answer 643

1-3% partial moles | 15% complete

Question 644

Molar preg RF

Answer 644

Extremes of age Southeast asia/India Prev mole

Question 645

Asses low BP post surg

Answer 645

``` Colour/consciousness Pani/light headed/cold BP/HR/RR/Temp/CapRefill Urine output Examine abdo: distension/hematoma Inspect PV bleeding/clots Drug chart - opiates Epidural/spinal anesthesia Operative record for blood loss ```

Question 646

Causes low BP post surg

Answer 646

Hemorrhage (abdo/pelvic) Inadequate fluids/underestimated blood loss Meds/Anesthesia related

Question 647

Low BP post op mgmt

Answer 647

``` Elevate bed Increase fluids Additonal venflon FBC/G&X/U&E/Coag O2 Ask for Registrar ```

Question 648

Mgmt if suspect post op hemorrhage

Answer 648

``` Inform theatre staff inform consultatn HDU Explain and reassure pt Inform next of kin ```

Question 649

Placental migration

Answer 649

lower uterine segment develops - placenta migrates upwards

Question 650

Mgmt previa +abruption

Answer 650

ABC IV FBC, G/X, Coag PA - deliver mmediate

Question 651

Premature

Answer 651

``` <37w <34 more sig 1/3 after ROM 1/3 medically indicated 1/3 idiopathic/spont ```

Question 652

Premature RF

Answer 652

``` Hx preterm del Mutips Interpreg interval <6m Hx cervical surg Short cervix <25mm Infx - bacteriuria, UTI, BV ```

Question 653

Premature mgmt

Answer 653

Progesterone suppository/pessary

Question 654

Membranes ruptured?

Answer 654

``` Sterile speculum Nitrazine reaction of fluid Ferning Oligohydramnios by US Amnisure ```

Question 655

Premature infx?

Answer 655

GBS status STI status UTI Chorioamnionitis

Question 656

Labour defn

Answer 656

Regular cts effacement >80% dilatation>2cm

Question 657

Assessing likelihood of preterm delivery

Answer 657

Fetal fibronectin | US cervical length

Question 658

Fetal fibronectin

Answer 658

if neg, unlikely to deliver in 7014d If pos, less sure itll happen DONT do if bleeding ir within 24h of sex/DVE/endovag US

Question 659

Preterm labour mgt

Answer 659

Antenatal steroids tocolysis (<34w w atociban) transfer GBS prophyl (benzylpen)

Question 660

GBS screen

Answer 660

35-37w | if neg w/in 5 weeks of delivery dont need prophylaxis

Question 661

Whn to GBS prophyl

Answer 661

GBS bacteriuria during current preg previous birth of infant w GBS +GBS swab in late gestation unknown GBS status at onset of labout AND GBS rf (membrane rupture >18h, labour <37w, fever)

Question 662

Assess fluid leak @ 28 w

Answer 662

Hx/Physical Sterile speculum, amnisure, US Admit, keep baby in there G&H, CRP, FBC, vag swab, MSU, start oral erythromycin...buy time Counsel re risks - baby to NICU, RDS, bronchopulmonary dysplasia, feeding issues, necrtotising enterocolitis Counsel re chorioamnionitis (need to deliver) Cord prolapse PA Try to ge her to 34-35w

Question 663

Preterm bay risks

Answer 663

RDS bronchopulmonary dysplasia feeding issues necrtotising enterocolitis

Question 664

Assess fluid leak @ 38w

Answer 664

Hx, confirm amnisure and US 24h assuming no GBS If nothing by 24 hours - accelerate Abx @ 18h

Question 665

PPROM infx

Answer 665

13-60%

Question 666

PPROM 24-34w

Answer 666

Steroids Abx(ampicillin/erythromycin]) Monitor: temp, techy, uterine tenderness, NST, AFI, BPP)

Question 667

PPROM risks

Answer 667

``` Prematurity infx/chorioamnionitis Pulm hypoplasia orthopedic problems abnormal presentation bleeding/PA cord prolapse ```

Question 668

PPROM >34w

Answer 668

induce labour

Question 669

Premature baby mgmt

Answer 669

Level 3 NICU Continuous monitoring Malpresentation comon Avoid vacuum

Question 670

PROM at term mgmt

Answer 670

consider infx risk GBS prophyl IOL?

Question 671

Delivery time for twins

Answer 671

Every baby cecreases gestational age at delivery by 3-4 weeks

Question 672

Multips comps

Answer 672

``` HTN GDM Systems overload Preamature birth PPH Operative deliveries TTTS ```

Question 673

Instrumental delivery requirements

Answer 673

``` FORCEPS Full analgesia/anesthesia, no Force Os fully dilated Rom Contractions adequate Episiotomy, Empty bladder Position of fetus, Pelvis ok Skill of operator ```

Question 674

Sevre pre eclampsia mgmt

Answer 674

Admit prevent seizures Lower BP (cerebral hem) Expidite delivery

Question 675

Severe pre eclampsia maternal eval

Answer 675

Vitals, neuro, DTRs 15-60min until stable Foley catheter - output + dipstick hourly NST monitor FBC, BUN, Cr, AST, ALT, LDH, Electrolytes, uric acid Give: MgSO4, BP meds

Question 676

MgSO4 MOA

Answer 676

slows neuromuscular conducton, reduce CNS irritablity

Question 677

Magnesium tox

Answer 677

``` Thera (4-8) Loss of patellar reflex (8-10) Somnolence 12 RespDep 17 Paralysis 17 Cardiac arrest >30 ```

Question 678

Antihypertensives

Answer 678

Aim for 90-110 diastolic Labetalol (BB) Hydralazine (vasodilate) Alt: CCB nifedipine, methyldopa

Question 679

when to do CS in severe pre eclamps

Answer 679

continuous seizures fetal distress unfavourable cevix sevre prematuriy

Question 680

Postpartum mgmt pre eclamps

Answer 680

rapid improvement rsk of seizure in first 24h Continue monitoring MgSO4 levels, BP, urine watch for fluidoverload

Question 681

Seizure mgmt

Answer 681

protect airway prevent injury MgSO4 plan delivery

Question 682

Postpartum endometritis

Answer 682

``` Fevere uterine tender foul discharge Tachy Risk of: Bacteremia, sepsis/ adhesions/ abscess ```

Question 683

postpartum endometritis RF

Answer 683

``` prolonged ROM multiple exams instrumentation anemia low SES CS ```

Question 684

Endometritis tx

Answer 684

IV abx | clindamycin/gentamicin +/- ampicillin

Question 685

Breast engorgement

Answer 685

``` gradual onset bilateral gen swell gen pain feels well no fever ```

Question 686

Plugged duct pres

Answer 686

``` gradual onset unilateral localswell localpain feels well no fever ```

Question 687

Mastitis pres

Answer 687

``` sudden onset unilatera local swell localpain feels unwell fever ```

Question 688

Causes of abnormal bleeding

Answer 688

``` PAADD Preg (exclude this first) Anatomy (vulvar, vag, cervical, uterine) Anovulation (irreg menses, stress, obesity) Diseases (endocrin) Drugs ```

Question 689

Abn bleed - vulval

Answer 689

excoriation dysplasia atrophy

Question 690

Abn bleed vagina

Answer 690

vaginitis | atrophy

Question 691

Abdn bleed cervix

Answer 691

ectropion (normal eversion of trans zone, OCP use causes, post coital bleed, no tx) cervicitis (intermenses spotting, post sex - from G/C, dysplasia, BV, trich) Cervical polyp - benign, neoplasia, remove + cauterize

Question 692

Abn bleed iterus

Answer 692

fibroids adenomyosis endo polyp

Question 693

Fibroid types

Answer 693

``` Pedunculated intracavitary - resect w hysteroscope intramural submucous subserous MYOMECTOMY ```

Question 694

Fibroid workup

Answer 694

physical US MRI

Question 695

fibroids

Answer 695

- common, asymptomatic, a lot in African, can have heavier menses and intermenstrual spotting Pelvic pain, pressure, dyspareunia

Question 696

Adenomyosis

Answer 696

extension of endometrial glands into uterine muscle - from trauma (myomectomy/CS) Sx: dysmenorrhea

Question 697

Endometrial polyp

Answer 697

benign growth of endo glands Can be passed in menses Assoc w: metrorrhagia

Question 698

Endometrial hyperplasia

Answer 698

Abnormal proliferation of endo glands

Question 699

RF endo hyperplasia

Answer 699

Excessive unopposed estrogen (obesity, PCOS) Chronic anovulation Tamoxifen

Question 700

Tamoxifen

Answer 700

SERM reduce risk of recur shrink tumour lower risk in high risk women

Question 701

Tamoxifen side effects

Answer 701

``` meno-like sx: hot flush night sweat vaginal dryness weight gain fluid retention Irreg loss of periods Leg swelling Nausea Vag discharge ```

Question 702

Endo hyperplasia Tx

Answer 702

D&C | Progestin (oral or local, Mirena) - only if not worried about malignancy

Question 703

Endo hyperplasia malignancy risk

Answer 703

simple (1%) complex (3%) simple + atypia (10%) complex + atypia (27%)

Question 704

Abn bleed - anovulation causes

Answer 704

``` Hyperandrogen -PCOS -Congenital adrenal hyperplasia -Androgen producing hormones Hypothalamus -Anorexia -Immaturity -Hypo/Hyperthyroid -Cushing's -Stress -Excercise ```

Question 705

Abn bleed - disease

Answer 705

Malig Coag Thyroid Liver/renal

Question 706

Abn bleed - drugs

Answer 706

``` OCP Copper IUD Depo Provera HRT Steroids (ameno) Chemo (ameno) Antipsych (ameno) Anticonvuls (ameno) ```

Question 707

Abn bleed tests

Answer 707

``` Preg test Anatomy: exam, cervical cytology/culture, bx) Anov: TSH, prolactin etc Disease Drugs: hx ```

Question 708

Sigh: hirsutism

Answer 708

PCOS

Question 709

sign: acanthosis nigricans

Answer 709

DM

Question 710

sight: buffalo hump

Answer 710

cushings

Question 711

How to check for ovulation

Answer 711

progesteron D21 and home LH ovulation kit

Question 712

Anotomical causes of bleeding Ix

Answer 712

Exam - visualized lesions, size of uterus Imaging - US (endo thick, uterus sze, adnexa) Endo bx: >35 w prolonged E or other risk of hyperplasia. >40 w anovulatory bleeding. Any post-meno bleed

Question 713

Mgmt menorrhadia

Answer 713

``` NSAID (reduce PG-->vascoconstric-t-->less blood) Hormone CTCP (COCP, DP, Mirena) GnRH agonist (Depo lupron) - 3 month injection, chemical meno, add oral progest to decrease SEs, halts menses, shrink fibroids, ONLY for 6 mo - bone density) ```

Question 714

Polyp removal

Answer 714

hysteroscope

Question 715

Endometrial ablation

Answer 715

<10-12cm in size

Question 716

Uterine artery embolization

Answer 716

shrink fibroids | helpful for pressure/pain sx

Question 717

Myomectomy

Answer 717

pt who desires future childbrearing | risk of re growth

Question 718

Hysterectomy

Answer 718

dependent on syze and surgeon | Vag/abdo/lap

Question 719

Varicella

Answer 719

Contageous Resp droplets Latent infx Risk fetal injury <2% even in 1st 1/2 of preg - circular limb scars

Question 720

Most likely comp of varicella in preg

Answer 720

Pneumonia | Give VZ IgG

Question 721

Varicella at delivery

Answer 721

Infx at deliver - neonate at risk Disseminated muccocutaneous infx Visceral infx Give baby VZ IgG

Question 722

Herpes zoster

Answer 722

Latent varicella No risk to baby Tx Acyclovir

Question 723

Parvovirus transmission

Answer 723

resp drop | blood trans

Question 724

Parvovirus pres

Answer 724

erythema infectiosum -slapped cheek Transient aplastic anemia

Question 725

Parvovirus effects

Answer 725

crosses placenta (33% chance) Suppress fetal bone marrow Dx - MCA doppler Highest risk 1st tri

Question 726

Parvovirus dx

Answer 726

Mom: Serology IgM + IgG, PCR Fetal: US, MCA doppler

Question 727

Parvo tx

Answer 727

single transfusion, or sometimes 3 small transfusions

Question 728

Hep B

Answer 728

DNA virus Danger of co-infx w hep D Need universal screening

Question 729

Serology for Vacinated Hep B

Answer 729

+Hep B surface Ab

Question 730

Serology acute infx hepB

Answer 730

anti-core Ab IgM

Question 731

Serology HepB infx

Answer 731

Hep B surface antigen

Question 732

Serology hepB high infectivity

Answer 732

Hep E antigen

Question 733

HepB Mgmt

Answer 733

Immunoprophylaxis not fully protective if mom has high viral load Tenofovir 28 w from del

Question 734

Hep C

Answer 734

``` RNA virus More prevalent than B or A Chronic liver disease Chronic carrier state Perinatal transmission low unless HIV Vag delivery OK ```

Question 735

Hepatitis baby mgmt

Answer 735

Baby bath no scalp elcetrodes no instruments baby IgG right away and then 3 vaccines (HepB no IgG or shots)

Question 736

Peurperium

Answer 736

Uterus involutes - 12d Lochia (decidua) passes - 4-6w Ovulation/menses - resumes in non BF within 6w CVS: CO, BP normal by 2w Coag: fibrinolysis normal within 30min, pro-coag state remains Met: insulin resistance goes immediately