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obs and gynae Flashcards

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1
Q

which drugs should be avoided in breastfeeding?

A

antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

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2
Q

what is the most common cause of pph?

A

uterine atony - failure of adequate uterine contractions

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3
Q

what is the gold standard investigation for suspected endometriosis?

A

laparoscopy

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4
Q

examination findings in endometriosis?

A

reduced organ mobility
tender nodularity in posterior vaginal fornix
visible vaginal endometriotic lesions (maybe)

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5
Q

what are the reasons to give 5mg folic acid dose?

A

DOCTor NTD
Diabetes
Obesity >30 bmi
Coeliac
Thalassaemia traits
or
NTD (fhx or previous preg)
also antiepileptic medx

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6
Q

what are the complications of hyperemesis gravidarum?

A

wernicke’s encephalopathy
mallory-weiss tear
central pontine myelinolysis
acute tubular necrosis
fetal: small for gestation age, pre-term birth

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7
Q

what should be given for suspected wernicke’s encephalopathy in hyperemesis?

A

pabrinex (iv vit B and C)

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8
Q

what can be given to manage unscheduled bleeding on nexplanon?

A

3 months COCP

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9
Q

does the POP need to be withheld after taking emergency contraception?

A

no - continue taking POP as normal

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10
Q

how long postpartum can smear testing take place?

A

3 months

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11
Q

what is dribbling incontinence in a patient from an area with limited obstetric services a sign of?

A

vesicovaginal fistula

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12
Q

how long before surgery should the COCP be stopped?

A

STOP(4 letters) the COCP (4 letters) 4 weeks before an OP

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13
Q

when should an OGTT at 24-28wks be done for GDM?

A
  • BMI of 30kg/m2
  • previous macrosomic baby 4.5kg
  • previous GDM
  • 1st degree relative with diabetes
  • family origin with high prevalence of diabetes (south asian, black caribbean and middle eastern)
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14
Q

in which patients should ogtt be done asap after booking?

A

pts with previous GDM

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15
Q

how many weeks should folic acid be taken for?

A

first 12 weeks of pregnancy (maybe beyond)

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16
Q

absolute contraindications for depo?

A

breast cancer (current = ukmec4, past = ukmec3)

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17
Q

what investigations are done in menorrhagia with pelvic pain/intermenstrual bleeding/postcoital bleeding/abnormal exam findings?

A

TVUSS

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18
Q

how long after medical TOP can a urine pregnancy test remain positive?

A

up to 4 weeks post TOP

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19
Q

what is the medical management of miscarriage?

A

vaginal misoprostol

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20
Q

what are the risk factors for hyperemesis?

A
  • multiple pregnancies
  • trophoblastic disease
  • hyperthyroidism
  • nulliparity
  • obesity
    (smoking = decreased incidence)
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21
Q

When switching from an IUD to COCP day 1-5 of cycle what additional contraception is required?

A

no additional contraception is needed if removed day 1-5 of cycle

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22
Q

when switching from IUD to COCP on day 7 onwards of the cycle, what additional contraception is needed?

A

7 days barrier contraception

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23
Q

what is the first line management for overactive bladder/urge incontinence?

A

bladder retraining

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24
Q

what is the first line management for stress incontinence?

A

pelvic floor training
then surgery/duloxetine

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25
what is the first line surgical approach to PPH?
intrauterine balloon tamponade (bakri catheter)
26
what are the mechanical approaches to tx of PPH?
rubbing uterine fundus catheterisation to prevent bladder distension and monitor urine output
27
what are the medical managements of PPH?
IV oxytocin ergometrine slow IV or IM carboprost IM (unless asthma) misoprostol sublingual
28
what is the management for premature ovarian insufficiency?
combined HRT or combined pill
29
how is DVT/PE treated in pregnancy?
LMWH
30
how is a non-metastasised endometrial adenocarcinoma treated in a 76yo?
total abdominal hysterectomy with bilateral salpingo-oopherectomy
31
important antenatal care points
8 - advise + bloods 10 - dating scan 11 - looks like chromosomes - down's - NUCHAL 16 - check hb 18 - anomaly scan 28 - 1st dose anti d and check hb 34 - 2nd dose anti d 38 and 41 - routine care = bpm urine dip and sfh
32
what are the 3 features of meig's syndrome
benign ovarian tumour ascites pleural effusion
33
how is thrush managed in pregnancy?
clotrimazole pessary (oral antifungals cause cong abnormalities)
34
what are the features of endometrial hyperplasia?
abnormal vaginal bleeding ie IMB/PMB
35
what is the most common complication of open myomectomy?
adhesions
36
how to remember mechanism of action of antiemetics
1,2,3 (CMO) 1. cyclizine - h1 receptors 2. metoclopramide d2 receptor 3. ondansetron 5ht3 receptor
37
when can the copper IUD be used as emergency contraception?
5 days after upsi or ovulation, whichever is latest
38
how is PCOS diagnosed?
2/3 - oligomenorrhoea - clinical and/or biochemical signs of hyperandrogenism - pcos on USS, oligomenorrhoea or amenorrhoea, and hirsutism
39
how is chickenpox treated in pregnancy?
>20wks -> oral acyclovir if presenting within 24h of rash nothing if over 24h and no signs of complications -> VZIG or IV antivirals if pre rash and 7-14 days post exposure
40
when can COCP be started in breastfeeding mothers postpartum?
6 weeks postpartum reduces breastmilk vol
41
how often should HIV+ women have smears?
annually
42
which are the preferred forms of contraception for women on anti-epileptics?
implant, depo-provera, IUD, IUS (on lamotrigine - can have POP)
43
causes of oligohydramnios?
prom fetal renal probs iugr post term gestation pre-eclampsia
44
how does vasa praevia present?
Rupture of membranes followed immediately by vaginal bleeding. Fetal bradycardia is classically seen
45
what is non invasive prenatal testing?
analysis of fragments of foetal dna in mother's circ high spec and sens, no risk miscarriage
46
how does placenta praevia present?
vaginal bleeding no pain non tender uterus lie and presentation may be abnormal
47
what is the management for chickenpox in pregnancy <20wks?
VZIG
48
what is first and second line for hyperemesis?
1. antihistamines - cyclizine or promethazine 2. ondansetron (slight inc risk cleft lip/palate) and metaclopramide (<5d)
49
what is the primary mechanism of action of the implant?
inhibits ovulation (also thickens cervical mucus)
50
what gestation should referral be made to FMU if no fetal movements are felt?
24wks
51
timings for cat 1,2,3 sections
1 - 30 mins 2 - 75 mins 3 - no specific time limit
52
what is the acute tx for cluster headaches?
100% o2 and subcut triptan
53
what is seen on imaging in normal pressure hydrocephalus?
ventriculomegaly out of proportion to sulcal enlargement
54
what is the mechanism of action of controlled hyperventilation in raised ICP?
reduces blood CO2 -> induces cerebral vasoconstriction
55
what are the features of pituitary apoplexy?
sudden onset headache visual field defects evidence of pit. insufficiency - eg hypotension (it is a sudden enlargement of a pituitary tumour 2o to haemorrhage or infarction
56
what medication can be used to reduce the number of relapses in MS?
moabs eg natalizumab
57
how soon after ullipristal acetate (ellaone) should regular hormonal contraception be resumed?
5 days
58
what extra contraception is needed when switching from POP to COCP?
7 days barrier
59
what extra contraception is needed when switching from COCP to POP?
2 days barrier
60
which cause of APH presents with painLESS bleeding?
placenta praevia (PPP = painless placenta praevia)
61
how does BV present?
- thin, white/grey homogenous discharge - clue cells on micro: stippled vaginal epithelial cells - vag pH >4.5 - positive whiff test (KOH) - fishy odour
62
how is BV treated?
oral metronidazole
63
how does trichomonas vaginalis present?
offensive, yellow/green, frothy discharge vulvovaginitis strawberry cervix
64
how is trichomonas vaginalis treated?
oral metronidazole
65
how does gonorrhoea present?
thin, purulent mildly odorous vaginal discharge dysuria, IMB, dyspareunia gram neg diplococcus swab
66
how is gonorrhoea managed?
IM ceftriaxone
67
what are the missed pill rules for COCP if only 1 pill is missed?
take last pill even if it means taking 2 in one day no additional contraception needed
68
what are the missed pill rules for COCP if 2 or more pills are missed?
- take last pill, leave any earlier ones - use condoms until re-established for 7 days - if pills missed wk1 - emergency contraception - if pills missed week 2 no need - if pills missed week 3 omit pill-free interval
69
what drug reverses respiratory depression caused by magnesium sulphate?
calcium gluconate
70
what is the most common type of ovarian pathology associated with Meigs' syndrome?
fibroma
71
what is the most common benign ovarian tumour in women under the age of 25 years?
dermoid cyst (teratoma)
72
what is the most common cause of ovarian enlargement in women of a reproductive age
follicular cyst
73
how long before POP becomes effective?
48h
74
how soon post partum can COCP be prescribed if not breastfeeding?
21 days due to inc risk VTE
75
which medication increases the risk of endometrial hyperplasia?
tamoxifen
76
what is used for VTE prophylaxis in pregnant women?
(if prev VTE) - lmwh throughout pregnancy - until 6wks PP
77
what indicates a need for aspirin during pregnancy? (75-150mg daily from 12wks)
≥ 1 high risk factors ≥ 2 moderate factors
78
what are high risk factors for htn in pregnancy?
hypertensive disease in a previous pregnancy chronic kidney disease autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome type 1 or type 2 diabetes chronic hypertension
79
what are moderate risk factors for htn in pregnancy?
first pregnancy age 40 years or older pregnancy interval of more than 10 years body mass index (BMI) of 35 kg/m² or more at first visit family history of pre-eclampsia multiple pregnancy
80
at what CRL would you expect to see cardiac activity?
over 7mm
81
what are hepatic adhesions specific for?
fitz-hugh-curtis syndrome - complication of PID
82
what medication is used to suppress lactation?
cabergoline
83
what is the first line tx for primary dysmenorrhoea?
NSAIDs eg mefenamic acid
84
what is an example of a tocolytic?
terbutaline
85
important things on CTG
VEAL CHOP Variable decels - cord compression Early decels - head compression Accelerations - okay Late decels - placental insufficiency
86
how does ovarian cancer spread initially?
local spread within the pelvis
87
when should women with autoimmune conditions (eg SLE, APS) take aspirin?
12wks - term - higher risk of PET
88
what is the advice for pregnant women who havent had MMR vaccine regarding rubella?
advise of risks advise stay away from anyone with rubella
89
what type of insulin is used in GD?
short acting only
90
which gynae medication can cause falls in the elderly?
oxybutynin
91
what type of contraception can people who have had gastric sleeve/bypass surgery not use?
no oral contraception - lack of efficacy
92
what are the indications for admission in hyperemesis?
continued n+v with ketonuria and/or wt loss greater than 5% despite tx with oral antiemetics
93
which blood test is used to monitor treatment of DVT treatment?
anti-Xa (tx with LMWH)
94
which contraceptives can women on enzyme inducing antiepileptics be on?
IUD, IUD, depo
95
which contraceptives can women on lamotrigine be on?
POP, implant, depo, IUD, IUS (ie not COCP)
96
what is adenomyosis?
endometrial tissue in myometrium more common in multiparous women towards end of repro years - dysmenorrhoea - menorrhagia - enlarged, boggy uterus mgt - gnrh agonists, hysterectomy
97
what TFTs would you expect in molar pregnancy?
high beta -> stimulates thyroid to produce T4 then T3 -> negative feedback on pituitary causing reduction in TSH
98
what is medical TOP at less than 9 weeks?
mifepristone then vaginal prostaglandins 48h later
99
what is medical TOP at less than 13 weeks?
surgical dilation and suction of uterine contents
100
what is medical TOP at more than 15 weeks?
surgical dilation and evacuation of uterine contents or late medical abortion (induces 'mini-labour')
101
which HPV viruses cause cervical cancer?
16, 18 and 33
102
what is the surgical management for vaginal vault prolapse (post hysterectomy)?
sacrocolpoplexy
103
what secretes hcg?
syncytiotrophoblasts

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