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Daisy Finals Revision > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

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1
Q

action taken if smear inadequate?

A

repeat in 3 months

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2
Q

first line mgt for menorrhagia?

A

IUS first line if requiring contraception
mefenamic acid or TXA first line if not requiring contraception - start on first day of period

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3
Q

what is sheehans syndrome?

A

hypopituitarism caused by ischaemic necrosis due to blood loss and hypovolaemic shock

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4
Q

features of sheehans syndrome?

A

agalactorrhoea
amenorrhoea
sx of hypothyroidism and hypoadrenalism

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5
Q

initial investigations for incontinence?

A

bladder diaries for min 3 days
vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
urine dipstick and culture
urodynamic studies

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6
Q

features of adenomyosis?

A

woman >30y
dysmenorrhoea
menorrhagia
enlarged, boggy uterus

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7
Q

investigations for women with suspected PCOS?

A

pelvic ultrasound, FSH, LH, prolactin, TSH, testosterone, sex hormone-binding globulin (SHBG)

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8
Q

risk factors for cervical ectropions?

A

COCP

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9
Q

risk factors for endometrial cancer?

A

PCOS

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10
Q

which cancers is nulliparity a risk factor for?

A

ovarian
breast
endometrial

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11
Q

which cancer is multiparity a risk factor for?

A

cervical

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12
Q

typical presentation of androgen insensitivity syndrome?

A

teenage girl
primary amenorrhoea
secondary sexual characteristics
blind ending vagina
-» 46XY

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13
Q

stress incontinence medication?

A

duloxetine

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14
Q

what malignancy does addition of progesterone to HRT increase the risk of?

A

breast

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15
Q

initial investigation when suspecting endometrial ca?

A

transvaginal uss

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16
Q

drug for medical mgt of ectopic?

A

methotrexate

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17
Q

most appropriate investigation to diagnose premature ovarian failure?

A

FSH level

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18
Q

genetic association with ovarian cancer?

A

BRCA1 and BRCA2

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19
Q

if 2nd repeat smear at 24 months is still hrHPV +ve?

A

colposcopy

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20
Q

first line management of endometriosis?

A

NSAIDs/paracetamol for symptomatic relief
COCP if that analgesia doesn’t help

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21
Q

what is the best way to detect ovulation?

A

day 21 progesterone (or 7 days before period starts)

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22
Q

what is a missed miscarriage?

A

gestational sac containing dead fetus before 20wks without sx of expulsion

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23
Q

what is an inevitable miscarriage?

A

heavy bleeding with clots and pain
cervical os open

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24
Q

features of ovarian hyperstimulation syndrome?

A

ovarian enlargement with multiple cystic spaces form
- inc in permeability of capillaries leads to fluid shift
can cause:
hypovolaemic shock
acute renal failure
VTE or arterial thromboembolism

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25
medical abortion management?
oral mifepristone followed by vaginal misoprostol
26
2nd line mgt of endometriosis if NSAIDs/COCP not controlled sx?
GnRH analogues
27
management for moderate PMS symptoms?
COCP
28
management of severe symptoms of PMS?
SSRI
29
diagnostic criteria for HG?
5% pre preg weight loss dehydration electrolyte imbalance (all 3 needed)
30
diagnostic criteria for PCOS?
infrequent or no ovulation (oligomenorrhoea) clinical or biochemical signs of hyperandrogenism or elevated free or total testosterone polycystic ovaries on US or inc ovarian volume
31
triad of features of meig's syndrome?
benign ovarian tumour ascites pleural effusion
32
where is ectopic pregnancy most likely to be found?
ampulla
33
where is the most dangerous location for ectopic pregnancy?
isthmus
34
fluids for patient with HG who is hypokalaemic?
IV normal saline with potassium
35
which antiemetic first line for hyperemesis?
antihistamines - cyclizine or promethazine phenothiazines - prochlorperazine or chlorpromazine
36
second line antiemetic for HG?
ondansetron (inc risk of cleft lip in first trimester) metoclopramide or domperidone (meto for 5 days max)
37
smears during pregnancy?
reschedule to occur at least 12 weeks post delivery
38
primary tx for stage 2-4 ovarian cancers?
surgical excision may be accompanied by chemo
39
medical tx for fibroids?
GnRH agonists
40
management for mag sulf induced respiratory depression?
calcium gluconate
41
booking visit?
8-12 weeks
42
dating scan to exclude multiples?
10-13+6 weeks
43
down syndrome screening inc nuchal scan?
11-13+6 weeks
44
info on anomaly and blood results, if hb <11 consider iron. BP and urine dip?
16 weeks
45
anomaly scan?
18-20+6 weeks
46
routine care no 1 for primips: BP urine dip, symphisis-fundal height
25 weeks and only if primip
47
routine care, if Hb<10.5 consider iron, first dose of anti-D to rhesus neg women
28 weeks
48
routine care number 2 (if primip)
31 weeks
49
routine care, second dose of anti-D to rhesus neg women, info on labour and birth plan
34 weeks
50
routine care, check presentation (offer ECV), info on breastfeeding, vit K and baby blues
36 weeks
51
routine care no 3 for primips discuss options for prolonged pregnancy
40 weeks
52
routine care, discuss labour plans and induction
41 weeks
53
GDM glucose levels?
fasting glucose >= 5.6mmol 2 hour glucose >= 7.8 5678
54
antibiotic prophylaxis for GBS in labour for women with pyrexia?
benzylpenicillin
55
4 Ts of PPH?
Tone - uterine atony Trauma eg perineal tear Tissue eg retained placenta Thrombin eg clotting/bleeding disorder
56
folic acid dose for pregnant obese women?
5mg
57
VTE prophylaxis for pregnant women with hx of VTE?
LMWH throughout pregnancy until 6 weeks postnatal
58
raised AFP represents?
neural tube defects
59
low AFP represents?
downs syndrome
60
when should you refer to an obstetrician for lack of fetal movements?
24 weeks
61
what is placenta accreta?
chorionic villi attach to the myometrium, rather than being restricted within the decidua basalis
62
what is placenta increta?
chorionic villi invade into the myometrium
63
what is placenta percreta?
chorionic villi invade through the perimetrium
64
ABC management for PPH?
- 2 cannulae 14g - lie woman flat - bloods inc group and save - commence warmed crystalloid infusion
65
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68
mechanical mgt of PPH?
palpate uterine fundus and rub to stimulate contractions catherisation to prevent bladder distension and monitor urine output
69
medical management of PPH?
1. IV oxytocin slow IV injection then infusion 2. ergometrine 3. carboprost IM (unless hx of asthma) 4. misoprostol sublingual ? TXA
70
surgical mgt of PPH?
1. intrauterine balloon tamponade when caused by uterine atony 2. B-lynch suture, ligation of the uterine arteries or internal iliac arteries 3. hysterectomy as life-saving procedure if uncontrolled haemorrhage
71
downs syndrome quadruple test results?
low AFP and oestriol high hCG and inhibin A (low AO high HI)
72
73
stage 1 of labour?
onset of true labour to when cervix is fully dilated latent = 0-3cm dilated, takes 6h active 3-10cm dilated, 1cm per hour
74
stage 2 of labour?
from full dilation to delivery
75
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77
which of previa and abruption is painful?
painless praevia agony abruption
77
stage 3 of labour?
from delivery of fetus to when placenta and membranes have been completely delivered
78
plan for delivery in patients with intrahepatic cholestasis?
induction of labour offered at 37-38wks due to inc risk of stillbirth
79
most important thing to assess prior to induction of labour?
bishop score
80
81
components of the bishop score?
- cervical position - cervical consistency - cervical effacement - cervical dilatation - foetal station
82
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84
second degree perineal tear?
injury to perineal muscle, not involving anal sphincter suturing on ward by experienced midwife or clinician
84
third degree tear?
injury to perineum involving anal sphincter complex 3a less than 50% EAS thickness torn 3b more than 50% EAS torn 3c IAS torn repair in theatre by suitably trained clinician
84
first degree perineal tear?
superficial damage with no muscle involvement no repair required
85
fourth degree tear?
injury to perineum involving anal sphincter complex and rectal mucosa repair in theatre by suitably trained clinician
86
rhyme for remembering dates for antenatal visits?
The first visit is from eight Check everything with mum is great Urine, bloods and rhesus state Give advice and educate From eleven to thirteen Is the best time to do the Down’s screen While you’re at it, check the dates At sixteen or ten plus six Do BP and multistix Second scan is at twenty To check the fingers and toes (Make sure there’s twenty.) Once again at twenty-eight Urine, blood and rhesus state Anti-D if appropriate Must give anti-D once more When the week is thirty-four And plan for the birth, what a chore Check the lie at thirty-six If breech offer a quick fix Last visit at thirty-eight All that is left it to wait
87
bishop score values meanings?
<5 - labour unlikely to start without induction >= 8 cervix is favourable - high chance of spontaneous labour
88
recurrence rate of postnatal psychosis?
25-50%
89
features of acute fatty liver of pregnancy?
usually 3rd trimester/immediately after delivery abdo pain n+v headache jaundice hypoglycaemia
90
severe acute fatty liver of pregnancy may result in?
pre-eclampsia
91
investigation results in acute fatty liver of pregnancy?
ALT elevated eg 500
92
management of delivery for women with grade III/IV placenta praevia?
ELCS at 37-38wks
93
placenta covering part of cervix grade?
grade III
94
placenta completely covering cervix?
grade IV
95
when is anti d given to rhesus negative women?
28 and 34 weeks
96

Daisy Finals Revision (25 decks)

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