Obs and gynae Flashcards
(308 cards)
1
Q
As a result of the plasma volume changes in pregnancy what happens to Hb?
A
Hb falls due to dilution
2
Q
At which age is the vaccine for HPV given for HIV negative females?
A
11-13 years of age
3
Q
Can pregnant women with HIV deliver vaginally?
A
Yes, if viral load is less than 50
4
Q
Define a missed (delayed) miscarriage
A
A uterus which contains a dead foetus < 20 weeks
Sac with no foetal pole
Cervical os closed
5
Q
Define an incomplete miscarriage
A
Not all products have been expelled
Pain and bleeding, os open
6
Q
Define an inevitable miscarriage
A
Heavy bleeding with clots and pain
Cervical os is open
7
Q
Define polyhydramnios?
A
2-3L of amniotic fluid
8
Q
Define recurrent miscarriage
A
>3 consecutive spontaneous abortions
9
Q
Define SGA
A
Less than 10th percentile on USS
10
Q
During which stage does a chancre develop?
A
Primary
11
Q
How are fibroids diagnosed?
A
Transvaginal USS
12
Q
How can amenorrhoea be divided?
A
Primary and secondary
13
Q
How can fluid in the pouch of douglas be drained?
A
Via a needle through the posterior fornix of the vagina
14
Q
How can the lower segment of the uterus be defined?
A
Below uterovesicalperitoneal fold
Doesn’t contract; passively dilates
7cm above cervix
15
Q
How can the risk of cleft palate be reduced in pregnant women on phenytoin?
A
Give vitamin K in the last month of pregnancy
16
Q
How do the breasts attach to the skin?
A
Via suspensory ligaments
17
Q
How do you look at a CTG?
A
Determine
Risk
Contractions
Baseline
Rate
Variability
Accelerations
Decelerations
Overall
18
Q
How does depo provera work as contraception?
A
Inhibits ovulation
Effect on cervical mucus
Effect on endometrium
19
Q
How does IUS act as contraception?
A
Renders endometrium unfavourable for implantation
Thickens cervical mucus
Pre-fertilisation effects
20
Q
How does pregnancy increase the risk of thromboembolism, anatomically?
A
Uterus presses on IVC causing venous stasis in legs
21
Q
How does the implant act as contraception?
A
Inhibition of ovulation
Effect on endometrium
Effect on cervical mucus
22
Q
How is chlamydia diagnosed?
A
NAAT - vulvovaginal swab for females, first void urine for males
23
Q
How is depo given?
A
IM injection every 13 weeks
24
Q
How is gonorrhoea diagnosed?
A
Microscopy
Culture
NAATs
25
How is placenta praevia diagnosed?
USS
26
How is POP taken?
Daily at the same time
No break
27
How is syphilis diagnosed?
Dark ground microscopy
PCR
Serological testing
28
How is the COCP taken?
Daily for 21 days with 7 days off for a breakthrough bleed
29
How is the depo started beyond day 5?
Woman must be reasonably certain she is not pregnant and abstain/use condoms for 7 days
30
How long does the depo provera last?
14 weeks
31
How long does the implant last?
3 years
32
How long does the IUD last?
5 years
33
How long does the mirena last?
5 years
34
How should amenorrhoea be investigated?
FULL HISTORY
Gonadotrophins (low in hypothalamic, high in ovarian)
TFTs
Prolactin
Oestradiol
35
In pregnancy women with HIV, which factors reduce vertical transmission?
C section
Bottle feeding
Maternal antiretrovirals
Neonatal antiretrovirals
36
In what situations is anti-D given to mothers who are rhesus negative?
Women less than 12 weeks: uterine evacuation, ectopic prgenancies
All women with bleeding after 12 weeks
37
Is the BHCG low or high in Downs?
High
38
Is the PAPP-A low or high in Downs?
Low
39
Is thyroxine safe in pregnancy?
Yes
40
Label this diagram
41
Lable the hormones in this diagram
42
Name the pathway of the pudendal nerve
Exits pelviz via greater foramen
Passes posterior to sacrospinous ligament
Re-enters pelvis via lesser sciatic foramen
43
What age group has the highest incidence of cervical cancer?
25 - 29
44
What antibiotics are given during total abdo hysterectomy?
IV co-amoxiclav
45
What are complications from hyperemesis gravidarum?
Wernicke's
Mallory-Weiss tear
46
What are fibroids?
Benign smooth muscle tumours of uterus
47
What are follicular cysts due to?
Non-rupture of the dominant follicle
48
What are hypertensive pregnant women at risk of?
Pre-eclampsia
49
What are predisposing factors for vaginal candidiasis?
Diabetes
Antibiotic use
Steroids
Pregnancy
HIV
50
What are risk factors for an ectopic pregnancy?
Damage to tubes
IUCD
POP
IVF
Previous ectopic
Endometriosis
51
What are risk factors for endometrial cancer?
Obesity
Nulliparity
Unopposed oestrogen
Diabetes
PCOS
52
What are risk factors for necrotising enterocolitis?
Not breastfeeding
Prematurity
IUGR
Hypoxic ischaemic insult
53
What are risk factors for PPH?
Previous PPH
Increasing maternal age
Placenta problems
Prolonged labour
Polyhydramnios
Macrosomia
Pre-eclampsia
Emergency C-section
54
What are risk factors for shoulder dystocia?
DM
Obesity
Macrosomia
55
What are risk factors from cord prolapse?
Prematurity
Multiparity
Twins
Abnormal presentation
Placenta praevia
High foetal station
56
What are signs of foetal distress?
Reduced foetal movements
Meconium stained liquor
Increased lactate
57
What are signs of obstruction in labour?
Moulding
Caput medusa
58
What are some causes of foetal distress?
Placental abruption
Vasa praevia
Cord collapse
Uterine rupture
Foeto-maternal haemorrhage
Hypoxia
59
What are some causes of post-coital bleeding?
Infection
Cervical ectropion (COCP!!)
Polyps
Trauma
Cancer
60
What are some causes of primary amenorrhoea?
Turner's syndrome
Testicular feminisation
Congenital adrenal hyperplasia
Imperforate hymen
61
What are some causes of recurrent miscarriage?
APS
Poorly controlled DM
PCOS
Uterine abnormality
Parental chromosomal abnormalities
Smoking
62
What are some causes of secondary amenorrhoea?
Hypothalamic
PCOS (increased androgen levels)
Hyperprolactinaemia
Premature ovarian failure
Thyrotoxicosis
Intrasuterine adhesions
63
What are some of the causes of IMB?
Pregnancy related
Physiological
Vaginitis
Fibroids
Polyps
Tumours
64
What are the AFP, beta HCG and oestriol levels in Edward's syndrome?
AFP decreased
BHCG increased
Oestriol decreased
65
What are the causes of IUGR?
Multiple pregnancy
Malformation
Smoking
DM
Hypertension
Asthma
66
What are the causes of multiple second trimester miscarriages?
Bicornuate uterus
APS
SLE
Cervical incompetence
67
What are the causes of polyhydramnios?
Drugs
Diabetes
Rhesus
GI obstruction
Increased urine output
Poor swallowing
68
What are the common causes of PPH?
Retained placenta
Endometriosis
69
What are the complications of prematurity?
RDS
PDA
Intraventricular haemorrhage
Sepsis
70
What are the conditions of use of operative delivery?
Head engaged
Membranes ruptured
Cervix dilated
Empty bladder
71
What are the features of an amniotic fluid embolism?
Sudden dyspnoea
Hypotension
DIC
Pulmonary oedema
SOB
Chest pain
N&V
Collapse
72
What are the features of an ectopic pregnancy?
Constant lower abdo pain
Vaginal bleeding: may be dark brown
History of amenorrhoea
Shoulder tip pain/pain on defecation
Cervical excitation
73
What are the features of baby blues?
Anxious
Tearful
Irritable
74
What are the features of cervical cancer?
PCB
IMB
PMB
Change in vaginal discharge
75
What are the features of cervical ectropion?
Change in vaginal discharge
PCB
76
What are the features of endometrial cancer?
PMB
IMB
77
What are the features of endometriosis?
Chronic pelvic pain
Deep dyspareunia
Dysmenorrhoea
Subfertility
78
What are the features of fibroids?
May be asymptomatic
Menorrhagia
Cramping lower abdo pain
Bloating
Urinary symptoms
Subfertility
Bulky uterus
79
What are the features of PCOS?
Subfertility
Oligomenorrhoea
Acne
Hirsutism
Obesity
Acanthosis nigricans
80
What are the features of placenta praevia?
Shock in proportion with visible blood loss
Painless blood loss
Can be triggered by sex, usually unprovoked
PP high
Malpresentation common
81
What are the features of placental abruption?
DIC
Shock inconsistent with blood loss
Constant pain
Tense (woody) uterus
Abnormal CTG
82
What are the features of PND?
Similar to depression
83
What are the features of post natal psychosis?
Mood swings
Perception problems
84
What are the features of uterine rupture?
Pain
Intraperitoneal bleeding
Shock
Cessation of contractions
Foetal distress
85
What are the features of vaginal candidiasis?
Cottage cheese like discharge
Dysuria
Dyspareunia
Itch
Vulval erythema
86
What are the features of vulval carcinoma?
Lump/ulcer on labia majora
May be associated with itch/irritation
87
What are the hormones doing in PCOS?
Increased insulin, increased androgens (testosterone), increased LH, increased oestrogen, low progesterone, normal or low FSH
88
What are the indications for a c section?
Absolute CPD
Pre-eclampsia
Failure to progress
Cervical cancer
Placenta praevia
Postmaturity
Breech
Vaginal infection
IUGR
Foetal distress
89
What are the non-contraceptive benefits of the COCP?
Control of heavy, painful periods
Acne control
Endometriosis
Menstrual migraine (NO AURA)
Protection against ovarian and endometrial cancers
90
What are the oncogenic strains of HPV?
16
18
31
33
45
51
58
91
What are the risk factors for breech presentation?
Uterine malformations
Placenta praevia
Polyhydramnios
Foetal abnormality
Prematurity
92
What are the risk factors for cervical cancer?
HPV 16 & 18
Smoking
Early first time
COCP
93
What are the risk factors for placental abruption?
Hypertension
Trauma
Drugs
Smoking
94
What are the risk factors for vulval carcinoma?
Age \> 65
HPV
Immunosuppression
Lichen sclerosus
95
What are the side effects of combined hormonal contraception?
Unscheduled bleeding
Mood changes
Weight gain
96
What are the side effects of depo provera?
Weight gain
Delay in return of fertility
Irregular bleeding
Possible risk of osteoporosis
97
What are the side effects of IUD?
Heavy, prolonged menses
Pain/infection/PID in first 20 days
Perforation
Expulsion
Low ectopic risk
98
What are the side effects of the implant?
Irregular bleeding
Weight gain
Acne
Nerve damage
Deep insertion
99
What are the three layers of the uterus?
Perimetrium
Myometrium
Endometrium
100
What are the two main types of c section?
Lower segment
Classical (longitudinal incision)
101
What can be used to stop contractions in prematurity?
Tocolytics - nifedipine, indethemacin
102
What causes cervical ectropion?
Increased oestrogen levels
103
What causes Erb's palsy?
Shoulder dystocia
104
What changes does oestrogen cause in pregnancy?
Increases breast and nipple growth Increases water retention and protein synthesis
105
What changes does progesterone cause in pregnancy?
Decreases smooth muscle excitability Increases body temp
106
What chromosome is Downs?
21
107
What complications can occur in pregnancy with diabetics?
Polyhydramnios
Preterm labour
Stillbirth
Macrosome
IUGR
108
What conditions can amniocentesis diagnose?
Neural tube defects (increased AFP) Chromosome disorders Inborn errors of metabolism
109
What contraception cannot be given with carbamazepine?
No systemic progesterone
110
What do aminoglycosides cause in pregnancy?
Ototoxicity
111
What do early decelerations indicate on a CTG?
Increased vagal tone due to head compression
112
What do fluoroquinolones cause in pregnancy?
Cartilage damage
113
What do late decelerations indicate on a CTG?
Placental insufficiency --\> foetal distress
114
What do sulphonamides cause in pregnancy?
Kernicterus
115
What do tetracyclines cause in pregnancy?
Discoloured teeth
116
What do variable decelerations indicate on a CTG?
Umbilical cord compression/uterine contractions
117
What is AMH used for?
Assessing ovarian reserve prior to IVF
118
What does CMV cause?
Jaundice
Hepatosplenomegaly
Microcephaly
119
What does erythromycin cause in pregnancy?
Acute cholestatic hepatitis
120
What does metranidazole cause in pregnancy?
Mutagenesis
121
What does pearl index represent?
Number of contraceptive failures per 100 women per year
122
What does prolactin cause?
Enlargement of mammary glands
123
What does ribaviran cause in pregnancy?
Teratogenic
124
What dose of folic acid should be given to epileptic pregnant women?
5mg
125
What dose of folic acid should diabetic pregnant women get?
5mg
126
What drug is first-line for period pains?
NSAIDs
127
What drugs should be avoided in pregnancy?
SAFE Mums Take Really Good Care
Sulphonamides, sodium valproate
Aminoglycosides, ACEIs, ARBS
Fluoroquinolones
Erythromycin
Metronidazole, methotrexate
Tetracyclines, trimethoprim in 1st trimester
Ribaviran
Griseofulvin
Chloramphenicol
128
What drugs should be avoided in pregnancy?
Antibiotics: ciprfloxacin, tetracyclines, sulphonamides, chloramphenicol
Lithium
BZDs
Clozapine
Aspirin
Carbimazole
Sulphonylureas
Cytotoxic drugs
Amiodarone
129
What effects can SGA in adult life?
Hypertension
T2DM
130
What factors are associated with placenta praevia?
Multiparity
Lower segment scar
131
What genital changes occur in pregnancy?
Muscle hypertrophy of uterus up to 20weeks Vaginal discharge increases
132
What gestation is the booking visit done at?
8-12 weeks
133
What happens if HPV is positive in those with mild dyskariosis?
Colposcopy
Negative - back to normal screening
134
What happens if the patient misses one COCP?
Take missed pill as soon as remembered
Remaining pills taken as normal
Additional contraception not required
135
What happens if the patient misses one dose of POP and has UPSI?
Emergency contraception plus two days of extra protection
136
What happens if the patient misses two or more COCPs?
Take most recent missed pill
Take remaining pills at correct time
Use condoms until 7 pills have been taken consecutively
137
What happens in moderate dyskariosis on a smear?
Refer for colposcopy
138
What happens in severe dyskariosis on a smear?
URGENT colposcopy
139
What happens to BP in pregnancy?
Decreases in first half, rises to baseline in second half
140
What happens to coaguability in pregnancy?
Pregnancy is a hypercoaguable state
141
What happens to cortisol and prolactin in pregnancy?
Both increase
142
What happens to the CO in pregnancy and why?
Increases - stroke volume increases
143
What happens to the eGFR in pregnancy?
Increases
144
What happens to the plasma volume from 10 weeks of gestation?
Increases
145
What happens to the RBC volume in pregnancy?
Increases
146
What happens to TPR in pregnancy and why?
Decreases - progesterone has a vasodilatory effect
147
What happens when bordeline/mild dyskariosis is seen on a smear?
Test for HPV
148
What happens with a Bishops score of \<5?
PGE2 to induce
149
What investigation is done for persistent PCB?
Colposcopy
150
What investigations are done at every visit with community midwife?
Weight BP urinalysis palpation foetal heartbeat
151
What investigations are done in endometrial cancer?
Transvaginal USS - thickened endometrium
Hysteroscopy with biopsy
152
What investigations are done in gestational trophoblastic disease?
Highly increased BHCG
USS
Histology
153
What investigations are done in PCB/IMB?
Pregnancy test
Infection screen
Bloods
Transvaginal USS (if endometrium thickened \> biopsy)
154
What investigations are done in PCOS?
USS, hormone profile, GTT
155
What is a breech presentation?
Caudal end of fetus occupies lower segment
156
What is a chancre?
A painless ulcer
157
How does a complete molar pregnancy arise and is there an embryo?
All genetic material from the father
No foetal tissue
158
What is a galactocele?
Painless lump after stopping breastfeeding
159
What is a main cause of uterine rupture?
Classical C-section scar
160
How does a partial molar pregnancy arise and is there an embryo?
3 sets of chromosomes - two sperm, one egg
Embryo may be present at start
161
Define a threatened miscarriage
Painless vaginal bleeding \<24 weeks
Bleeding less than menstruation
Cervical os closed
162
What is an ectopic pregnancy?
Implantation of fertilised ovum outside the uterus
163
What is another name for fibroids?
Leiomyomas
164
What is antepartum haemorrhage?
Bleeding after 24 weeks and before delivery
165
What is caput succedaneum caused by?
Pressure against cervix and lower segment
Ventouse delivery causes a large one
166
What is caput succedaneum?
Oedematous swelling of scalp, superficial to cranial periosteum
167
What is cervical ectropion?
Eversion of epithelium on cervix (larger are of columnar epithelium on ectocervix)
168
What is choriocarcinoma?
Tumour that forms after molar pregnancy
169
What is complication of fibroids??
Red degenration - haemorrhage into the tumour
170
What is cord prolapse?
Umbilical cord descending ahead of presenting part
171
What is endometriosis?
Growth of ectopic endometrial tissue outside the uterine cavity
172
What is Erb's palsy?
Damage to upper brachial plexus resulting in a waiter's tip posture
173
What is hyperemesis gravidarum associated with?
Nulliparity
Multiple pregnancies
Gestational trophoblastic disease
Hyperthyroid
Obesity
174
What is hyperemesis gravidarum?
Excessive vomiting during pregnancy
175
What is lichen sclerosus?
Atrophy of epidermis of genitalia
176
What is phenytoin associated with in pregnancy?
Cleft palate
177
What is placenta accreta associated with?
Severe bleeding
PPH
Hysterectomy
178
What is placenta accreta?
Placenta invades the myometrium
179
What is placenta praevia?
Low lying placenta
Placenta lying wholly or partially in the lower uterine segment
180
What is placental abruption?
Detachment of placenta
181
What is post-maturity?
Babies born after 42 weeks
182
What is postpartum haemorrhage?
Blood loss of \>500mls
183
What is prematurity?
Babies born before 36+6
184
What is primary amenorrhoea?
Failure to start menses by 16
185
What is primary postpartum haemorrhage?
Occurs within first 24 hours
186
What is progesterone secreted by?
Corpus luteum Placenta
187
What is secondary amenorrhoea?
Cessation of established menstruation \> 6m
188
What is secondary PPH?
Occurs between 24hours - 12 weeks
189
What is shoulder dystocia associated with?
PPH and Erb's palsy
190
What is shoulder dystocia?
Impaction of anterior shoulder on pubic symphysis
191
What is sodium valproate associated with in pregnancy?
Neural tube defects - DONT USE UNLESS ABSOLUTELY NECESSARY
192
What is the AFP level in Down's syndrome?
Decreased
193
What is the aim for Hb levels in pregnancy?
110
194
What is the anti-emetic of choice in pregnancy?
Cyclizine
195
What is the antithyroid drug of choice in pregnancy?
PTU
196
What is the commonest type of ovarian cyst?
Follicular cyst
197
What is the drug management of fibroids?
Mirena, COCP, tranexamic acid, GnRH prior to surgery
198
What is the gram status of chlamydia?
It doesn't gram stain
199
What is the histological appearance of gonorrhoea?
Gram negative intracellular diplococci (kidney shaped pairs)
200
What is the investigation done for endometriosis?
Laparoscopy
201
What is the lymphatic drainage of the breast?
Axillary --\> supraclavicular --\> R lymphatic duct
Parasternal --\> same ones
202
What is the management of a breech presentation after 36 weeks?
ECV
C section
203
What is the management of a breech presentation before 36 weeks?
Many foetuses will turn spontaneously
204
What is the management of an ectopic pregnancy?
Methotrexate
TOP
Laparotomy
205
What is the management of baby blues?
Reassurance and support
206
What is the management of cervical ectropion?
Leave it
If troublesome symptoms - ablation
207
What is the management of chlamydia?
Azithromycin 1g stat
208
What is the management of cord prolapse?
Push back presenting part
Keep cord warm and moist
All fours position
C section
209
What is the management of endometrial cancer?
Total abdominal hysterectomy with bilateral salpingo-oophrectomy
210
What is the management of endometriosis?
NSAIDs
COCP
Mirena
211
What is the management of foetal distress?
Change position
IV fluids
Stop syntocinon
Scalp stimulation
Tocolysis
C section
212
What is the management of genital herpes?
Swab for PCR
Oral acyclovir
Consider topical idocaine if very painful
Saline bathing
Analgesia
213
What is the management of genital warts?
Podophyllotoxin
Imiquimod
Cryotherapy
Electrocautery
214
What is the management of gestational trophoblastic disease?
Suction
Cutterage
Supportive
Monitor BHCG for 6m
Contraception
215
What is the management of gonorrhoea?
500mg ceftriaxone IM + 1g azithromycin
216
What is the management of hyperemesis gravidarum?
Anti-histamines
Admission for IV hydration
217
What is the management of lichen sclerosus?
Topical steroids + emollients
218
What is the management of PCOS if the woman doesn't wish to get pregnant at this time?
Weight loss
COCP
219
What is the management of PCOS if the woman wishes to fall pregnant?
Weight loss
Clomifene citrate
Gonadotrophins
Laproscopic ovarian drilling
Assisted conception
220
What is the management of PND?
Reassurance & support
CBT
Paroxetine if severe
221
What is the management of post natal psychosis?
Admit into hospital
222
What is the management of PPH?
Uterine massage
IV syntocinon
IM carboprost
Ligation
223
What is the management of thromboembolism in pregnancy?
LMWH
224
What is the management of uterine rupture?
ABCDE
C-section
Hysterectomy
225
What is the management of vaginal candidiasis?
The 'zoles'; pessary or oral
226
What is the management of vasa praevia?
C section
227
What is the mode of action of COCP?
Inhibits ovulation via action on hypothalamic-pituitary-ovarian axis to reduce LH and FSH
Alters cervical mucus
Renders endometrium unfavourable for implantation
228
What is the mode of action of the POP?
Thickening of cervical mucus
Decreased endometrial receptivity to blastocyst
Reduction in cilia activity in Fallopian tube
229
What is the most common bacterial STI?
Chlamydia
230
What is the most common benign ovarian tumour in women under 30?
Dermoid cyst
231
What is the most common cause of PPH?
Uterine atony
232
What is the most widely used mode of contraception?
Withdrawal
233
What is the normal variability on a CTG?
5-25 bpm
234
What is the organism in syphilis?
Treponema pallidum
235
What is the pathophysiology of hypercoaguability in pregnancy?
Increase in factors VII, VIII, X and fibrinogen
Decrease in protein S
236
What is the pearl index of IUD?
0.6-0.8%
237
What is the pearl index of the implant?
0-0.1%
238
What is the pearl index of the mirena?
0.2%
239
What is the presentation of chlamydia in females?
PCB/IMB
Lower abdo pain
Dyspareunia
Mucopurulent cervicits
ASYMPTOMATIC (70%)
240
What is the presentation of chlamydia in males?
Urethral discharge
Dysuria
Urethritis
Epididymo-orchitis
ASYMPTOMATIC (50%)
241
What is the presentation of genital herpes?
Blistering and ulceration of external genitalia
Pain
External dysuria
Vaginal or urethral discharge
Local lymphadenopathy
Fever and myalgia (prodrome)
242
What is the presentation of gonorrhoea in females?
Asymptomatic (up to 50%)
Increased/altered vaginal discharge
Dysuria
Pelvic pain
243
What is the presentation of gonorrhoea in males?
Purulent urethral discharge
Dysuria
244
What is the presentation of lichen sclerosus?
Older women, itch down below, white plaques
245
What is the presentation of secondary syphilis?
Skin rash on palms and soles
Lesions of mucus membranes
Generalised lymphadenopathy
Patchy alopecia
Condylomata lata
246
What is the primary mode of action of the IUD?
Prevention of fertilisation
Inflamm response in endometrium
247
What is the risk of foetal loss in amniocentesis?
1%
248
What is the role of oestrogen in the menstrual cycle?
Negative feedback on LH and FSH
Thickening of endometrium
Thinning of cervical mucus
249
What is the surgical management of fibroids?
Myomectomy
Ablation
Hysterectomy
250
What is used as a landmark for a pudendal nerve block?
Ischial spine
251
What is used for a TOP before 13 weeks?
Surgical dilation and suction
252
What is used for a TOP before 15 weeks?
Surgical dilation and evacuation/late medical abortion with methotrexate
253
What is used for TOP before 9 weeks?
Mifepristone + prostaglandins 48 hours later
254
What is vasa praevia?
Foetal blood vessels run near internal opening of the uterus
255
What legal requirements are there for a TOP?
2 registered medical practitioners must sign a legal document
256
What may need to happen to the dose of lamotrigine in pregnancy?
May need to increase the dose
257
What nuchal thickness results in an increased risk of Down's syndrome?
\> 5-6mm
258
What should diabetic mothers be encouraged to do?
Breast feed
259
What should diabetic women avoid (wrt pregnancy)?
Unplanned pregnancies
260
What should hypertensive pregnant women be given to reduce the risk of pre-eclampsia?
Aspirin 75mg up until 12 weeks gestation
261
What should never be done in placenta praevia?
A digital exam
262
What test is used for screening for syphilis?
ELISA - IgG and IgM
263
What treatment is first-line for pregnant women with a Hb of \>80?
Oral iron
264
What type of cancer comprises the majority of vulval cancers?
SCCs
265
What type of PPH is normal?
Red --\> brown blood 1-2 weeks after birth
266
When are intrapartum antibiotics given?
For women with a previous GBS +ve baby
267
When can chlamydia be tested for following exposure?
14 days
268
When can smear tests be done after birth?
12 weeks
269
When can the depo provera be started without the need for additional contraception?
Up to and including day 5 of the cycle
270
When can the downs screen be done (combined test)?
11-13+6 weeks nuchal scan, BHCG, PAPP-A
271
When can you terminate a pregnancy up until?
24 weeks
272
When do baby blues occur?
3-7 days after birth
273
When do the majority of cord prolapses occur?
At artificial rupture of membranes
274
When do women receive continuous HRT?
If they have had a previous hysterectomy
275
When does a corpus luteum cyst occur?
When the corpus luteum breaks down
276
When does an amniotic fluid embolism occur?
Shortly after delivery/at end of the first stage
277
When does post natal depression occur?
Peaks 3m after birth
278
When does post natal psychosis occur?
2-3 weeks after birth
279
When does the blastocyst implant?
Day 6-10
280
When is a membrane sweep done for postmaturity?
40 week
281
When is amniocentesis performed?
16 weeks
282
When is anti-D given?
28 and 34 weeks
283
When is COCP contrainidicated after pregnancy?
Whilst breastfeeding
284
When is hyperemesis gravidarum most common?
Between 8 and 12 weeks
285
When is labour induced in postmaturity?
41-42 weeks
286
When is screening done for cervical cancer?
3 yearly from age 25
5 yearly from 50-65
287
Where do endometrial and ovarian cancers drain, lymphatically?
Para-aortic lymph nodes
288
Where does fertilisation occur?
Ampulla
289
Where does zygote implantation occur?
In body of the uterus
290
Where is an epidural done?
L3-L5 - anaesthetises the cauda equina
291
Where is nexplanon implanted?
Subdermally
292
Where is pain from the inferior aspect of the pelvic organs felt?
S2-S4 - perineal pain
293
Where is pain from the superior aspect of the pelvic organs felt?
T11-L2 - suprapubic pain
294
Where is the fertilised ovum commonly implanted in ectopic pregnancies?
Ampulla of fallopian tube
295
Which anti-epileptic is the least teratogenic?
Carbamazepine
296
Which chromosome is Edwards?
18
297
Which chromosome is Patau?
13
298
Which days are morst fertile in a cycle?
8-18
299
Which diabetic drugs are safe to use in pregnancy?
Metformin
Insulin
300
Which investigations are done at the booking visit?
FBC, Blood group, BMI, BP, urinalysis, scan for dates/abnormalities, bloods for blood borne viruses/rubella
301
Which neurotransmitter inhibits prolactin?
Dopamine
302
Which ovarian cyst is most likely to undergo torsion?
Dermoid cyst
303
Which population are fibroids more comon in?
Black women
304
Which ribs does the breast extend across?
2-6
305
Which STI is the 'great imitator'?
Syphilis
306
Which STIs can cause PID?
Chlamydia + gonorrhoea
307
Why are steroids given in premature births?
To help foetal surfactant production to reduce the chance of foetal respiratory distress at birth
308
Why is anti-D given?
To avoid sensitisation - mixing of foetal rhesus +ve blood with mums -ve blood and production of antibodies
