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Obs and Gynae Flashcards

1
Q

Describe twin to twin transfusion syndrome

A

2 fetuses share a single placenta. One fetus receives less blood (donor) than the other (recipient) due to anomalies in the network of placental blood vessels. (1 may have fluid overload, other may be anaemic)

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2
Q

When is twin to twin transfusion syndrome tested for antenatally?

A

16-24 weeks

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3
Q

In what percentage of pregnancies is labour induced?

A

20%

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4
Q

Give 5 indications for induction of labour

A 
Prolonged pregnancy (1-2 weeks after EDD)
PROM with no labour 
DM in 38 wks+
Pre-eclampsia 
Rhesus incompatibility
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5
Q

What bishop score suggests that it labour is unlikely to start without induction?

A

5 or less

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6
Q

What bishop score suggests the cervix is favourable?

A

8+

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7
Q

What is the preferred method of induction?

A

Vaginal prostaglandin PGE2

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8
Q

What is a membrane sweep?

A

An adjunct to induction rather than an actual method of induction

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9
Q

When is membrane sweep offered?

A

Nulliparous - 40-41 weeks

Parous 41 weeks

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10
Q

What is the most common complication of induction of labour?

A

Uterine hyperstimulation

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11
Q

Describe uterine hyperstimulation

A

Prolonged and frequent uterine contractions

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12
Q

What is the treatment for uterine hyperstimulation?

A

Remove vaginal prostaglandins and stop oxytocin infusion.

Tocolysis with terbutaline

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13
Q

How many weeks can a test be positive for after termination of pregnancy?

A

4

HCG decreases by 50% every 2 days. Steep decline in 1st 2 weeks, steady decline in next 2 weeks

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14
Q

How many medical practitioners are required to approve a termination?

A

2

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15
Q

How many medical practitioners are required to do a termination?

A

1

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16
Q

What method of termination is used in less than 9 weeks gestation?

A

Mifepristone

48hrs later, prostaglandins

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17
Q

What method of termination is used in 9-13 weeks gestation?

A

Surgical dilation and suction

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18
Q

What method of termination is used in 15+ weeks gestation?

A

Surgical dilation and evacuation

OR late medical abortion (mini labour)

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19
Q

Who should be taking 5mg folic acid rather than 400mcg?

A
  • People on anti-epileptics
  • People with BMI 30+
  • People with partners with NTD, FHx of NTD or previous pregnancy with NTD
  • Women with diabetes
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20
Q

What is the gold standard investigation for endometriosis?

A

Laparsocopy

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21
Q

What would be seen on bloods in PCOS?

A 
High LH (Raised LH:FSH ratio)
High insulin
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22
Q

What is the investigation of choice for PCOS?

A

Pelvic USS

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23
Q

Describe the management of gestational diabetes with fasting glucose less than 7

A

1-2 weeks trial of diet and exercise
if not improved, add 1-2 weeks metformin
if not improved, add short acting insulin

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24
Q

Describe the management of gestational diabetes with fasting glucose more than 7

A

Short acting insulin

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25
Q

What is 1st line in symptomatic relief of endometriosis?

A

NSAIDS/Paracetamol

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26
Q

Is multiparity or nulliparity a RF for placental abruption?

A

Multiparity

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27
Q

What is amniotic fluid embolism?

A

When fetal cells/amniotic fluid enters into the mothers bloodstream and causes a reaction.

e.g shivering, sweating, coughing,cyanosis, hypotension, tachycardia

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28
Q

How do you manage amniotic fluid embolism?

A

Supportively

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29
Q

What maternal blood abnormality of phenytoin associated with?

A

Folic acid deficiency

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30
Q

What is used for DVT in pregnancy?

A

LMWH

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31
Q

How do you monitor the action of LMWH

A

Monitor anti Xa Activity

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32
Q

What is whirlpool sign on USS seen in?

A

Ovarian torsion

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33
Q

Give 4 contraindications to HRT?

A

Current/past breast cancer
Any oestrogen sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia

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34
Q

What type of HRT do you give to somebody with a uterus?

A

Combined - to avoid unopposed oestrogen

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35
Q

What type of HRT do you give to somebody without a uterus?

A

Oestrogen only

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36
Q

What is lochia?

A

Passage of blood, mucus and uterine tissue up to 6 weeks after delivery.
If after - investigate with USS

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37
Q

Can hepatitis B be transmitted via breastfeeding?

A

No! Unlike HIV

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38
Q

How long must methotrexate have been stopped in mum and partner before conception?

A

6 months

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39
Q

What should be given in PROM?

A

Antinatal corticosteroids
10 days of erythromycin
They should be admitted for 48hrs

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40
Q

What can shoulder tip pain be associated with?

A

Ectopic pregnancy - with peritoneal bleeding

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41
Q

What is Fitz Hugh Curtis syndrome?

A

A complication of PID involving peri-hepatic inflammation

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42
Q

What is Mittelschmerz?

A

Ovulation pains

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43
Q

What kind of cancer is the COCP protective against

A

Endometrial Cancer

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44
Q

What should you do when a woman comes in with reduced fetal movements?

A
  1. Confirm viability (auscultate with handheld doppler)

2. If viable, CTG

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45
Q

What is an epileptic of choice in pregnancy?

A

Lamotragine

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46
Q

How does smoking affect the risk of cervical cancer?

A

2X more likely

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47
Q

What are the 3 stages of postpartum thyroiditis?

A
  1. Thyrotoxicosis
  2. Hypothyroidism
  3. Normal thyroid
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48
Q

How is postpartum thyroiditis managed?

A

Propanolol for symptom control

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49
Q

How many days of abstinence must there be to do semen analysis?

A

3-5 days

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50
Q

What are the guidelines if a semen analysis comes back as abnormal?

A

Repeat the sample In 3 months. If it is still abnormal, refer to secondary care

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51
Q

What is the first line tocolytic agent in pre-term labour

A

Oral Nifedipine

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52
Q

What is the definition of a prolonged second stage of labour?

A

3hrs+ from full dilation

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53
Q

What is the next appropriate step in delivery during prolonged second stage of labour?

A

Forceps delivery

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54
Q

What is the treatment to prevent miscarriage in anti phospholipid syndrome?

A

Aspirin and LMWH

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55
Q

What is the advice around anti-epileptics and breastfeeding?

A

Most anti-epileptics can be used during breastfeeding - don’t change them

56
Q

After non-pharmacological uterine compression and catheterisation - what is the 1st line pharmacological management of PPH?

A

IV Syntocinon (5 Units)

57
Q

If a child loses more than 10% of birth weight in the 1st week, what do you do?

A

Refer to midwife led breastfeeding clinic

58
Q

How does ovarian cancer initially spread?

A

Local invasion within the pelvic region

59
Q

What 2 investigations can diagnose PPROM?

A
  1. Speculum

2. USS to look for oligohydramnios

60
Q

What definition is used to classify bleeding as ‘abnormally heavy’

A

An amount a woman considers to be excessive

61
Q

When are smear tests offered 3 yearly?

A

25-49 years

62
Q

When are smear tests offered 5 yearly?

A

50-64 years

63
Q

When do you stop receiving cervical screening invitations?

A

64 years+

64
Q

What can be used in patients with stress incontinence where pelvic floor exercises haven’t worked?

A

Duloxetine

65
Q

What drugs can be used in urge incontinence

A

Oxybutinin (antimuscarinic)

Mirabegron (beta-3-agonist)

66
Q

What should be done where there is diagnostic uncertainty surrounding incontinence?

A

Urodynamic studies

67
Q

What is the drug of choice for medical management of ectopic pregnancy?

A

Methotrexate

68
Q

What are the guidelines on pregnant women less than 20wks that have been exposed to chickenpox?

A
  1. Check for varicella antibodies

2. If not immune, give varicella-zoster immunoglobulin ASAP - effective up to 10 days post exposure

69
Q

What are the guidelines on pregnant women more than 20wks that have been exposed to chickenpox?

A
  1. Check for varicella antibodies

2. If not immune, give VZIG or antivirals (acyclovir) 7-14 days after exposure

70
Q

What imaging technique is preferred in diagnosing adenomyosis?

A

MRI Pelvis

71
Q

How should you treat women that are 20wks+ that develop chicken pox rash?

A

Oral acyclovir within 24hrs of rash

72
Q

What ovarian pathology is associated with Meigs’ syndrome?

A

Fibroma

73
Q

What is the ideal management of atypical endometrial hyperplasia in post menopausal women?

A

Total hysterectomy with bilateral saplingo-oophorectomy due to risk of malignant progression

74
Q

When is the anomaly scan?

A

18-20+6 weeks

75
Q

When is the early scan to confirm dates?

A

10-13+6 wks

76
Q

What is the surgical management of an ectopic pregnancy?

A

Salpingectomy

If there is contralateral tubal damage, offer salpingotomy

77
Q

Define premature ovarian failure

A

The onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years

78
Q

Why is cervical ectropion more common with COCP use?

A

Higher oestrogen levels

79
Q

Where is the most common location of an ectopic pregnancy?

A

Ampulla of the Fallopian tube

80
Q

What investigation is used to diagnose premature ovarian failure and menopause?

A

FSH Level - which will be high

81
Q

What should be avoided in UTI in the 3rd trimester?

A

Nitrofurantoin

82
Q

What should be avoided in the 1st trimester?

A

Trimethoprim (teratogenic in 1st trimester)

83
Q

How does trimethoprim work?

A

It inhibits dihydrofolate reductase and interferes with folate metabolism (hence 1st trimester contraindication)

84
Q

What is the main symptom of urinary overflow incontinence?

A

Bladder still palpable after urination

retention with urinary overflow

85
Q

What is the most common ovarian cancer?

A

Serous carcinoma (epithelial)

86
Q

What is the commonest type of ovarian cyst?

A

Follicular cyst

87
Q

When should patients treated for CIN1, CIN2 and CIN3 next be offered cervical screening?

A

6 months after treatment for a test of cure cervical sample in the community

88
Q

How often should women with HIV be followed up as part of the cervical screening programme?

A

Every year (annual cervical cytology)

89
Q

What is the 1st line management in lactation mastitis?

A

Conservative management - analgesia and encourage breastfeeding

90
Q

What should be done if symptoms of lactational mastitis do not improve after 12-24 hours?

A

Administer antibiotics.

Flucloxacillin or erythromycin - continue to breastfeed

91
Q

How can moderate PMS be treated?

A

New generation COCP e.g. Yasmin

92
Q

How can severe PMS symptoms be treated?

A

SSRI continuously OR just during the luteal phase

93
Q

What contraception is contraindicated in patients undergoing testosterone therapy?

A

COCP as oestrogen can antagonise the effect of testosterone

94
Q

What is used to classify the severity of nausea and vomiting in pregnancy?

A

Pregnancy-Unique Quantification of Emesis (PUQE) scoring system

95
Q

What is the recurrence rate of postnatal psychosis ?

A

25-50%

96
Q

What is the management of painless bleeding with no risk factors for ectopic pregnancy before 6 weeks gestation?

A

Expectant management.

They should do a repeat urine pregnancy test after 7-10 days and return if it is positive. A negative pregnancy test confirms miscarriage.

97
Q

What is the management of bleeding in more than or equal to 6 weeks gestation?

A

Referral to EPAU

98
Q

What should be done if late decelerations are seen on CTG?

A

Urgent fetal blood sampling

99
Q

What medication may be given to reduce the size of uterine fibroids?

A

GnRH agonist (e.g. Leuprolide)

100
Q

What type of contraception is contraindicated in previous obstetric cholestasis?

A

COCP - intrahepatic cholestasis worsens with multiple pregnancies and can recur with menstruation and oestrogen treatment

101
Q

How should you give misoprostol in medical management of miscarriage up to 7 weeks?

A

Orally

102
Q

How should you give misoprostol in medical management of miscarriage after 7 weeks?

A

Vaginally

103
Q

What is the treatment for magnesium sulfate overdose?

A

Calcium Gluconate

104
Q

What is 1st line medical therapy in PCOS?

A

Letrozole

Not clomiphene due to adverse effects on endometrial and cervical mucous

105
Q

What is caput succedaneum?

A

A puffy swelling that usually occurs over the presenting part and crosses suture lines in a neonate

106
Q

What is the advice around the COCP and surgery?

A

Stop 4 weeks before surgery and restart 2 weeks after surgery

107
Q

What is the course of action if GBS is detected via high vaginal swab in early pregnancy?

A

Intrapartum IV Benzylpenicillin only

108
Q

What is the advice about the MMR vaccine and pregnancy?

A

It should not be given to women that are pregnant or attempting to become pregnant

109
Q

Ectopic pregnancy in which location is most associated with an increased risk of rupture?

A

Isthmus

110
Q

What terminology is used to describe the head in relation to the ischial spine?

A

Station

111
Q

What does a station of +2 mean?

A

The head is 2cm below the ischial spine

112
Q

What is the management of ectopic pregnancy if there is foetal heartbeat?

A

Surgical management - salpingectomy or salpingostomy

113
Q

What is the threshold BHCG level where surgical management should be considered?

A

1500+

114
Q

What is the only effective treatment for large fibroids causing problems with fertility?

A

Myomectomy

115
Q

What is the most common cause of pulmonary hypoplasia?

A

Congenital diaphragmatic hernia

116
Q

What is the treatment for vaginal vault prolapse?

A

Sacrocolpopexy

117
Q

When should cervical screening in pregnancy be delayed to?

A

3 months post partum

118
Q

What is the most likely diagnosis in an older woman with labial lump and inguinal lymphadenopathy?

A

Vulval carcinoma

119
Q

How many days after birth is contraception not required?

A

21 days

120
Q

What is post term delivery a significant risk factor for?

A

Meconium aspiration

121
Q

When is the anomaly scan?

A

18-20+6 weeks

122
Q

Which HPV strains increase risk of cervical cancer?

A

16 and 18

123
Q

What is the first choice antibiotic in UTI in pregnancy?

A

Nitrofurantoin (avoid at term) 100mg for 7 days

124
Q

When is the early scan to confirm dates?

A

10-13+6 weeks

125
Q

What is Asherman’s Syndrome?

A

Characterised by intrauterine adhesions commonly as a result of previous uterine surgery such as dilation and curettage. It can lead to obstruction of the menstrual outflow tract which presents as 2y amenorrhoea

126
Q

What blood tests should women with severe pre-eclampsia have?

A

U&E, FBC, transaminases and bilirubin three times per week

127
Q

What is the threshold viral load for vaginal delivery in HIV positive mothers?

A

viral load less than 50

128
Q

What is used to treat Fitz-Hugh-curtis syndrome?

A

Ceftriaxone, doxycycline and metronidazole

129
Q

Which types of twins are associated with the greatest risk of complications?

A

Monochorionic-Monoamniotic Twins

130
Q

What is the treatment for meconium aspiration syndrome?

A

Admission to NICU for oxygen and antibiotic therapy

131
Q

How should asymptomatic bacteriuria be managed in pregnancy?

A

Oral Abx

132
Q

What is naegele’s rule?

A

The method of calculating the estimated delivery date in the FIRST antenatal appointment. Add 9 months to the LMP plus 7 days

obstetric ultrasound is usually performed at 12 weeks to establish the gestational age of the pregnancy more accurately

133
Q

In twin to twin transfusion syndrome, which twin is more likely to survive until birth?

A

The donor twin

134
Q

Which malignancy is tamoxifen a risk factor for?

A

Endometrial cancer

135
Q

What is the diagnostic triad for hyperemesis gravidarum?

A

5% pre-pregnancy weight loss
Dehydration
Electrolyte imbalance

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