Obs and Gynae Flashcards
(167 cards)
1
Q
What should be monitored when magnesium sulphate is given?
A
Respiratory rate and reflexs
2
Q
When should mothers be referred if they haven’t yet felt movements?
A
24 weeks
3
Q
Cut off for iron replacement post delivery?
A
<100g/L
4
Q
Smear testing intervals for different ages?
A
25-49 = every 3 years
50-64 = every 5 years
5
Q
When to stop the COCP in relation to planned surgery?
A
Stop 4 weeks before and restart 2 weeks after
6
Q
UKMEC 3 Criteria?
A
> 35yrs smoking <15/day
BMI >35
VTE in 1st degree relative <45yrs
Controlled hypertension
Immobility
BRCA1/2
Current gallbladder disease
7
Q
UKMEC 4 Citeria?
A
Migraine with aura
>35yrs smoking >15/day
History of stroke/VTE/HD
Breastfeeding <6 weeks postpartum
Uncontrolled hypertension
Current breast cancer
Antiphospholipid syndrome
Major surgery + prolonged immobilisation
8
Q
Phases of the menstrual cycle and hormone changes?
A
Follicular - FSH and oestrogen UP
Ovulation - LH spikes
Luteal - progesterone UP
9
Q
Which cancers is COCP protective for?
A
Endometrial, ovarian, colon
10
Q
Contraindications for ulipristal acetate (EllaOne)
A
Diseases of malabsorption, severe hepatic dysfunction, asthma, breastfeeding, drugs increasing stomach pH (PPIs)
11
Q
What is gravidity?
A
Number of pregnancies of any duration, regardless of the outcome
12
Q
What is parity?
A
Total number of pregnancies carried over the threshold of viability (24w)
13
Q
Which medication inhibits milk production?
A
Cabergoline
14
Q
Which types of cancer does the COCP increase the risk of?
A
Breast and cervical
15
Q
Time limits for different category c-sections?
A
Cat 1 - within 30 minutes
Cat 2 - within 75 minutes
Cat 3 - delivery required but mum and baby are stable
Cat 4 - elective c-section
16
Q
Indications for category 1 c-section?
A
Uterine rupture, major placental abruption, cord prolapse, fetal hypoxia, persistent fetal bradycardia
17
Q
Management of placental abruption <36 weeks (live fetus)?
A
No fetal distress: admit for corticosteroids, observe closley
Fetal distress: emergency c-section
18
Q
Management of placental abruption >36 weeks?
A
Fetal distress: emergency c-section
No fetal distress: vaginal delivery
19
Q
Bishop score meanings?
A
</=5 - spontaneous labour unlikely
8+ - cervix is ripe/favourable, high chance of spontaneous labour
20
Q
Guidelines for IOL if bishop score <6 or 6?
A
Vaginal prostoglandins or oral misoprostol
(Sometimes balloon induction)
21
Q
Guidelines for IOL if bishop score >6?
A
Amniotomy and IV oxytocin infusion
22
Q
Pharmacological interventions for reduced fetal movements before term?
A
Steroids - for lung maturity
Magnesium sulphate - for neuroprotection
23
Q
How can ovarian cancer cause raised urea and creatinine?
A
Renal tract obstruction due to tumour
24
Q
What is Sheehan’s syndrome?
A
Complication of PPH results in avascular necrosis of pituitary gland»hormones produced affected
25
What can Sheehan's syndrome cause?
Amenorrhoea
Reduced lactation
Adrenal insufficiency
Hypothyroidism
26
What is Asherman's syndrome?
Adhesions formed within the uterus following damage e.g. D&C, uterine surgery, pelvic infection
27
How to treat thrush in pregnancy?
Topical treatments only - cream or pessary
28
Blood tests results in menopause?
LH/FSH high
Oestrogen and progesterone low
29
How long to use contraception for after menopause?
>50 = 12 months after last period
<50 = 24 months after last period
30
Blood results for premature ovarian insufficiency?
High FSH/LH (on two samples 4-6 weeks apart)
Low oestrogen
31
Causes of premature ovarian insufficiency?
Idiopathic
Bilateral oophorectomy
Radio/Chemotherapy
Autoimmune disorders
Resistant ovary syndrome - FSH receptor abnormalities
32
What is included in the Rotterdam criteria?
Oligoovuation/anovulation
Hyperandrogenism (hirsutism/acne)
Polycystic ovaries on USS (>12 follicles or ovarian volume >10cm3)
33
Blood tests results in PCOS?
Raised LH:FSH ratio
Raised testosterone
Raised insulin
Low sex hormone-binding globulin
34
What is the combined test for Down's syndrome and positive results?
Beta-HCG - increased
PAPPA - decreased
35
What is the triple test for Down's syndrome and positive results?
Beta-HCG - increased
AFP - decreased
Serum oestriol - decreased
36
What is the quadruple test for Down's syndrome and positive results?
Beta-HCG - increased
AFP - decreased
Serum oestriol - decreased
+ Inhibin-A - increased
37
Is nuchal translucency increased or decreased with a higher chance of Down's?
Increased nuchal thickness = Down's more likely
38
Following screening, when are mothers offered antenatal testing for Down's syndrome?
If the risk is greater than 1 in 150
39
What tests will be offered in higher risk of Down's?
Non-invasive prenatal screening test (NIPT) - blood sample
or
Amniocentesis
or
Chorionic villus sampling
40
What is occult vs overt cord prolapse?
Occult (incomplete) = cord descends alongside presenting part but not beyond it
Overt (complete) = cord descends past the presenting part
41
Quadruple test results for edwards syndrome?
B-HCG low
AFP low
Oestriol low
Inhibin A normal
42
When women are at risk of pre-eclampsia what should they take during pregnancy?
Aspirin 75mg from 12 weeks
43
Management of postpartum thyroiditis?
Propranolol
44
Blood pressure threshold for immediate assessment in pregnant women?
160/110mmHg
45
Haemoglobin cut offs for iron supplementation?
Non-pregnant 115
1st trimester 110
2nd/3rd trimester 105
After childbirth 100
46
First line medication for hyperemesis gravidarum?
Antihistamine - cyclizine or promethazine
phenothiazines - prochlorperazine or chlorpromazine
47
Second line medication for hyperemesis gravidarum?
Ondansetron - risk of cleft palate in first trimester
Metoclopramide - don't use for more than 5 days (EPSEs)
Domperidone
48
Diagnostic triad for hyperemesis gravidarum?
5% weight loss
Electrolyte disturbance
Dehydration
49
Choice of fluids of dehydration in hyperemesis gravidarum?
0.9% saline + potassium
50
Intervention to reduce stillbirth in obstetric cholestasis?
Induction of labour 37-38 weeks
51
How long until different contraceptives are effective?
IUD = immediately
POP = 2 days
COCP, IUS, injection, implant = 7 days
52
How long to take folic acid for?
Until end of first trimester (12 weeks)
53
Which women should take higher dose of folic acid?
BMI >30
Diabetes
Sickle cell disease
Coeliac
Anti-epileptic drugs
FHx neural tube defects
Prev child with NTD
54
NOACs in pregnancy?
Switch to LMWH
55
Main complication of IOL?
Uterine hyperstimulation
56
When to offer external cephalic version?
36 weeks in nulliparous women
37 weeks in the others
57
Staging for ovarian cancer?
Stage 1 - Tumour confined to ovary
Stage 2 - Outside ovary but in pelvis
Stage 3 - Outside ovary but in abomen
Stage 4 - Distant metastasis
58
SSRI for postmenopausal symptoms?
Fluoxetine
59
What is lochia?
Passage of blood, mucus and uterine tissue that occurs during the puerperium
60
How long is normal for lochia to continue?
4-6 weeks
61
When should HTN in pregnancy be urgently referred/admitted?
>160/110
>140/90 + proteinuria/other organ involvement
62
Drugs for urge incontinence?
Oxybutynin/Tolterodine - antimuscarinincs
63
Which drug given for urge incontinence if worries of anticholinergic S/Es?
Mirabegron - beta-3 agonist
64
USS finding of ovarian torsion?
Whirlpool sign
65
Age bracket for breast cancer screening?
50-70 every 3 years
66
Risk factors for ectopic pregnancy?
Prev ectopic
IUD
Prev fallopian surgery
67
Risk factors for placental abruption?
ABRUPTION
Abruption (previous)
Blood pressure - HTN
Rupture of membranes
Uterine trauma
Polyhydramnios
Twins
Infection
Older age
Narcotic use
68
Risk factors for pre-eclampsia?
Pre-existing HTN
Prev. pre-eclampsia
SLE (autoimmune conditions)
Diabetes
CKD
>40 yrs
>35 BMI
69
Indications for OGTT?
BMI >30
Prev GDM
1st degree relative with DM
Prev macrosomic baby
Ethnicity - black Caribbean, south Asian, middle eastern
70
Examination findings for endometriosis (physical)?
Fixed retroverted uterus
Pelvic mass/endometriomas
Pelvic tenderness
71
Endometriosis increases risk of what?
Adhesions
Ectopic pregnancy
72
Endometrial cancer examination findings?
Uterine/adnexal mass
Fixed uterus
Abdominal distension
73
Surgical repair for cystocele?
Vaginal wall repair
74
Investigations for suspected misarriage?
B-HCG and repeat in 24 hours
75
Placenta praevia vs vasa praevia?
Fetal distress in vasa praevia
76
UTI treatment in pregnancy?
1st line Nitrofurantoin - not in 3rd trimester
2nd line - Amoxicillin or cefalexin
77
Stages of labour?
Latent first stage - up to 3cm dilated
Active first stage - up to full 10cm dilation
2nd stage - delivery of fetus
3rd stage - delivery of placenta
78
Most common types of cervical cancer?
Squamous cell carcinoma (80%)
Adenocarcinoma (20%)
79
Most common type of ovarian cancer?
Epithelial cell
80
Which HPV strains cause cervical cancer?
6 and 11
81
Criteria for annual mammograms?
1x first degree relative w/ BC <40yrs
1x first degree male relative
1x first degree w/ bilateral BC <50yrs
2x first degree w/ BC any age
1x first/second w BC + 1x first/second w ovarian cancer
3x first/second w/ BC at any age
82
Bacterial vaginosis key identifiers?
Clue cells
Fishy smell
Watery discharge
pH >4.5
83
Thrush key identifiers?
Curdy discharge
Itching
pH<4.5
84
Trichomoniasis key identifiers?
Strawberry cervix
Discharge
pH>4.5
85
Chlamydia key identifiers?
Purulent discharge
Gram -ve bacteria
Pelvic pain
86
Gonorrhoea key identifiers?
Gram -ve bacteria
Odourless discharge
87
BV treatment?
Metronidazole 5-7d
88
Thrush treatment?
Stat dose fluconazole 150mg PO
Clotrimazole topical
89
Chlamydia treatment?
Doxycycline for 7d
2nd line - azithromycin 3d
90
Gonorrhoea treatment?
Stat IM Ceftriaxone 1g
91
Pelvic inflammatory disease treatment?
IM Ceftriaxone
14 days doxycycline and metronidazole
92
Contraceptive choices in those after bariatric surgery?
No oral contraceptives - poor efficacy due to absorption
93
Which STIs present with painFULL genital ulcers?
Genital herpes and chancroid
94
Which STIs present with painLESS genital ulcers?
Syphilis and lymphogranuloma venereum
95
Which organism causes syphilis?
Treponema pallidum
96
Treatment for trichomoniasis?
Metronidazole PO
97
What is normal pH for vagina?
4.5
98
pH for Trichomoniasis?
Alkalotic - >4.5
99
Trichomoniasis infection symptoms?
Dyspareunia, itching, dysuria
Discharge - frothy/yellow-green
STRAWBERRY CERVIX
100
Differences between herpetic and chancroid ulcers?
Herpes = multiple small ulcers, going through different stages
Chancroid = solitary, well defined deep ulcer
101
What happens to BP during pregnancy?
Falls in first half of pregnancy before rising to pre-pregnancy levels before term
102
When is progesterone only pill a missed pill?
3 hours
103
If low lying placenta is found on 20 week scan, when is it reassessed?
32 weeks
104
When is the COCP effective immediately?
If started on days 1-5 of cycle
105
How long to wait between ulipristal and starting COCP?
5 days
106
In pre-eclampsia are patients hyporeflexic or hyperreflexic?
HypERreflexia is seen
107
What drug should be given in cord prolapse and why?
Terbutaline - decreases uterine contractions while waiting for emergency c-section
108
Definition of PPH?
>500mL blood loss within 24 hours of delivery of the baby
109
Degrees of perineal tear?
1 - no muscle involvement
2 - perineal muscle (nil sphincter)
3a - <50% external anal sphincter
3b - >50% external anal sphincter
3c - internal anal sphincter torn
4 - including rectal mucosa
110
What is a complete molar pregnancy?
Sperm fertilises an empty egg
111
What is a partial molar pregnancy?
Egg fertilised by 2 sperm (three sets of chromosomes)
112
Criteria for urgent breast referral (2-week wait)?
>30yrs + unexplained breast lump +/-pain
>50yrs + discharge/retraction/other changes of concern in one nipple
113
When would you do a non-urgent breast referral?
<30yrs with an unexplained breast lump with or without pain
114
Treatment for MgSO4 induced respiratory depression?
Calcium gluconate
115
When is VZIG given in pregnant women?
<20 weeks 7-14 days post exposure
116
Advice when switching from POP to COCP?
Additional protection needed for 7 days
117
Advice for flying when pregnant?
Singleton - up to 37 weeks
Multiple - up to 32 weeks
118
When should fibroadenomas be excised?
If >3cm
119
Which breast condition presents with green nipple discharge?
Duct ectasia
120
Which breast condition presents with bloody nipple discharge?
Duct papilloma
121
Routine cervical screening schedule?
25-49 every 3 years
50-64 every 5 years
122
When to refer HPV +ve but normal cytology on smear?
If still positive after 24 months > colposcopy
123
Which drugs should be avoided in breastfeeding?
Aspirin
Tetracyclines, chloramphenicol
Lithium
Benzodiazepines
Carbimazole
Amiodarone
124
Side effects of SERM drugs?
VTE risk
125
Management of mastitis?
1st line = continue breastfeeding
2nd line = Flucloxacillin 10-14d
2nd line if systemically unwell, if nipple fissure present, if symptoms do not improve after 12-24 hours of effective milk removal
126
Risk of complete molar pregnancy?
Gestational trophoblastic neoplasia
127
What percentage of molar pregnancy progress to GTN?
15%
128
TV USS findings diagnostic of miscarriage?
crown-rump length >7mm with no cardiac activity
129
How are women with existing T2DM managed during pregnancy?
Metformin and insulin (stop all other agents)
130
Classification of PPH?
Minor <1000mL
Major <1000mL
- Moderate 1000-2000mL
- Severe >2000mL
Primary <24 hours following birth
Secondary >24 hours - 12 weeks
131
Which liver enzyme is normal to be raised during pregnancy?
ALP
132
Signs of breast abscess on USS?
Mutlioculated, hypoechoic collection
133
Management of breast abscess?
Urgent referral for USS confirmation, drainage and culture
134
Blood tests for diagnosing menopause?
Two samples FSH 4 weeks apart = RAISED
135
Minimum time for pelvic floor training in stress incontinence?
Minimum 3 months
136
Symptoms of Syphilis?
Primary - chancre, NON-tender lymphadenopathy
Secondary - fevers, lymphadenopathy, rash, condylomata lata
Tertiary - gummas, aortic aneurysms, general paralysis of the insane
137
When is AFP increased in pregnancy?
Fetal abdominal wall defects (e.g. omphalocele)
138
APH definition?
Bleeding from the genital tract after 24 weeks pregnancy, prior to delivery of fetus
139
Risk factors for placenta previa?
Previous C-section/uterine surgery
Multiple pregnancy
140
When should anti-D be given in relation to miscarriage?
If miscarriage >12 weeks
141
Indications for anti-D immunoglobulins?
Delivery
TOP
Miscarriage >12w
Ectopic (if surgical)
External cephalic version
APH
Amniocentesis/CVS/FBS
Abdominal trauma
142
When is Ca-125 raised?
Ovarian cancer
Endometriosis
Adenomyosis
Fibroids
Liver disease
Pelvic infection
143
Which investigation diagnoses active syphilis infection?
VDRL
144
Most common cause of cord prolapse?
Artificial amniotomy
145
Definition of small for gestational age?
Below the 10th centile for their gestational age
146
What is gestation age measurement based on?
Estimated fetal weight (EFW)
Fetal abdominal circumference (AC)
147
Treatment for empirically treating suspected chlamydia/gonorrhoea?
Azithromycin 1g STAT
148
Guidance for semen sample?
Abstain from ejaculation for 3-7d
Avoid hot baths, sauna and tight underwear in lead up
Attempt to catch the full sample
Deliver sample within 1hr
Keep the sample warm before delivery
149
Three groups of causes for male inferility?
Pre-testicular
Testicular
Post-testicular
150
Examples of pre-testicular factors for male infertility?
LOW testosterone
Stress
Kallmann syndrome
Pathology of pituitary/hypothalamus
151
Examples of testicular factors for male infertility?
Mumps
Trauma
Undescended testes
Radio/Chemo/Cancer
152
Examples of post-testicular factors for male infertility?
Ejaculatory duct obstruction
Retrograde ejaculation
Absence of vas deferens (CF)
Scarring from epididymitis e.g. chlamydia
153
Causes of increased nuchal translucency
thickness?
Down's
Congenital heart defects
Structural abnormalities
154
Typical onset of postpartum psychosis?
Usually 2-3 weeks
155
What percentage of pregnant women does post partum depression affect?
5-15%
156
When does postpartum depression presentation peak?
~3 months
157
Causes of recurrent spontaneous miscarriage?
Infection
Chromosomal abnormalities
Uterine abnormalities
Antiphospholipid antibodies
158
4 main causes of post partum haemorrhage?
Tone (uterine atony)
Trauma (perineal tear)
Tissue (retained placenta)
Thrombin (clotting/bleeding disorder)
159
Symptoms of uterine fibroid degredation?
Often during pregnancy
Low grade fever
Pain
Vomiting
160
Uterine fibroid degredation treatment?
Conservative management:
Rest and analgesia
Resolve in 4-7 days
161
Combined and quadruple tests for Down's dates?
11-13+6 combined test
15-20 quadruple test
162
Triad of symptoms for disseminated gonococcal infection?
Tenosynovitis
Migratory polyarthritis
Dermatitis
163
Risk factors for IUGR?
Booking BMI
Pre-existing HTN
PMH of pre-eclampsia
Smoking/drugs
Multiple pregnancy
Previous IUGR
164
Primary vs secondary infertility?
Primary = never conceived
Secondary = previously conceived
165
Why bradycardia with IUD insertion?
Cervical shock = vasovagal reaction = reflex bradycardia
166
Most common type endometrial cancer?
Adenocarcinoma
167
Lymphogranuloma venereum treatment?
Doxycycline for 21 days
