Obs/ Gynae Flashcards

Question

How does the implantable contraceptive work?

Answer 1

Etonogestrel Primary: Inhibits ovulation Also thickens cervical mucus Irregular bleeding Lasts 3 years

Answer 2

Decreases sperm motility and survival

Answer 3

(Levonorgestrel) Primary: prevents endometrial proliferation Also thickens cervical mucus Irregular bleeding

Answer 4

A type of progestogen-only pill that also inhibits ovulation

Answer 5

May be detected during routine cervical cancer screening Abnormal vaginal bleeding- postcoital, intermenstrual or postmenopausal Vaginal discharge

Answer 6

16, 18 and 33

Answer 7

HPV 16, 18 and 33 Smoking HIV Early first intercourse, many sexual partners High parity Lower socioeconomic status COCP

Answer 8

Post menopause

Answer 9

Excess oestrogen- nulliparity, early menarche, late menopause, unopposed oestrogen (HRT without progestogen) Metabolic syndrome- obesity, diabetes, polycystic ovarian syndrome Tamoxifen Hereditary nonn-polyposis colorectal carcinoma

Answer 10

Multiparity, COCP, smoking

Answer 11

Classic symptom- postmenopausal bleeding- slight before becoming heavier Others- Premenopausal women with menhorrhagia or intermenstrual bleeding Pain uncommon Vaginal discharge unusual

Answer 12

Women older than 55 presenting with post menopausal bleeding reffered using cancer pathway First line- trans vaginal ultrasound Hysteroscopy with endometrial biopsy

Answer 13

Surgery- total abdominal hysterectomy High risk patients may have postoperative radiotherapy Progestogen therapy in frail elderly women not suitable for surgery

Answer 14

Seperation of normally sited placenta from uterine wall, causes maternal haemorrhage into intervening space

Answer 15

Proteinuric hypertension Cocaine use Multiparity Maternal trauma Increasing maternal age

Answer 16

Shock out of keeping with visible loss Pain constant Tender, tense uterus Normal lie and presentation Fetal heart- absent/distressed Coagulation problems Beware pre-eclampsia, DIC, anuria

Answer 17

Return to normal recall unless- Test of cure pathway Untreated CIN1 pathway Follow up borderline changes in endocervical cells Follow up incompletely excised cervical cancer

Answer 18

Samples examined cytologically If cytologically abnormal- colposcopy If cytology normal- repeat test in 12 months

Answer 19

This includes the following results: Borderline changes in squamous or endocervical cells. Low-grade dyskaryosis. High-grade dyskaryosis (moderate). High-grade dyskaryosis (severe). Invasive squamous cell carcinoma. Glandular neoplasia

Answer 20

Repeat after 12 months If the repeat test is now hrHPV -ve → return to normal recall If the repeat test is still hrHPV +ve and cytology still normal → further repeat test 12 months later: If hrHPV -ve at 24 months → return to normal recall if hrHPV +ve at 24 months → colposcopy

Answer 21

Repeat within 3 months If two consecutive inadequate- colposcopy

Answer 22

Via IM every 12 weeks

Answer 23

Irregular bleeding Weight gain Potential increase of osteoporosis- only use in adolescents if no other contraception is suitable Not quickly reversed and fertility may return after varying time Contraindications- breast cancer

Answer 24

Advancing age Previous pregnancy and childbirth High BMI Hysterectomy Family history

Answer 25

Overactive bladder- detrusor overactivity Stress incontinence- cough/laugh Mixed incontinence- both urge and stress Overflow incontinence- bladder outlet obstruction Functional incontinence

Answer 26

Bladder diaries kept for minimum of 3 days Vaginal examination Urine dipstick and culture Urodynamic studies

Answer 27

Bladder retraining- lasts six weeks Bladder stabilising drugs- antimuscarinics are first line- oxybutinin, tolterodine or darifenacin. No oxybutinin in frail old women Mirabegron useful if concern over anticholinergic side effects in elderley patients

Answer 28

Pelvic floor muscle training- at least 8 contractions performed 3 times a day for mimimum of 3 months Surgical procedures Duloxetine if decline surgery

Answer 29

Change in periods- length of menstrual cycles, dysfunctional uterine bleeding may occur Vasomotor symptoms- hot flushes, night sweats- usually occur daily and may continue for 5 years Urogenital changes- vaginal dryness and atrophy, urinary frequency Psychological- anxiety and depression, short term memory impairment Longer term complications- osteoporosis, increased risk of ischaemic heart disease

Answer 30

8-12 weeks (ideally < 10 weeks)

Answer 31

Booking visit General information e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes BP, urine dipstick, check BMI Booking bloods/urine FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies Hepatitis B, syphilis HIV test is offered to all women Urine culture to detect asymptomatic bacteriuria

Answer 32

Early scan to confirm dates, exclude multiple pregnancy

Answer 33

Down's syndrome screening including nuchal scan

Answer 34

Information on the anomaly and the blood results. If Hb < 11 g/dl consider iron Routine care: BP and urine dipstick

Answer 35

Anomaly scan

Answer 36

Routine care: BP, urine dipstick, symphysis-fundal height (SFH)

Answer 37

Routine care: BP, urine dipstick, SFH Second screen for anaemia and atypical red cell alloantibodies. If Hb < 10.5 g/dl consider iron First dose of anti-D prophylaxis to rhesus negative women

Answer 38

Routine care as above

Answer 39

Routine care as above Second dose of anti-D prophylaxis to rhesus negative women* Information on labour and birth plan

Answer 40

Routine care as above Check presentation - offer external cephalic version if indicated Information on breast feeding, vitamin K, 'baby-blues'

Answer 41

Routine care as above Discussion about options for prolonged pregnancy

Answer 42

Routine care as above Discuss labour plans and possibility of induction

Answer 43

COCP Nexplanon (implantable contraceptive) Intrauterine system (Mirena) Depo provera (injectable contraceptive)

Answer 44

Progesterone only pill

Answer 45

1. Hypertension 2. Gestational diabetes

Answer 46

BMI of > 30 kg/m² Previous macrosomic baby weighing 4.5 kg or above Previous gestational diabetes First-degree relative with diabetes Family origin with a high prevalence of diabetes (South Asian, black Caribbean and Middle Eastern)

Answer 47

Oral glucose tolerance test (OGTT) Previous gestational diabetes: OGTT performed asap and at 24-28 weeks if first normal Women with any other RFs offered at 24-28 weeks

Answer 48

Fasting glucose is >= 5.6 mmol/L 2-hour glucose is >= 7.8 mmol/L

Answer 49

Newly diagnosed seen in a joint diabetes and antenatal clinic within a week Women taught about self monitoring blood glucose Diet advice If the fasting plasma glucose level is < 7 mmol/l a trial of diet and exercise should be offered If glucose targets are not met within 1-2 weeks of altering diet/exercise metformin should be started If glucose targets are still not met insulin should be added to diet/exercise/metformin Gestational diabetes is treated with short-acting, not long-acting, insulin If at the time of diagnosis the fasting glucose level is >= 7 mmol/l insulin should be started If the plasma glucose level is between 6-6.9 mmol/l, and there is evidence of complications such as macrosomia or hydramnios, insulin should be offered Glibenclamide should only be offered for women who cannot tolerate metformin or those who fail to meet the glucose targets with metformin but decline insulin treatment

Answer 50

Weight loss for women with BMI of > 27 kg/m^2 Stop oral hypoglycaemic agents, apart from metformin, and commence insulin Folic acid 5 mg/day from pre-conception to 12 weeks gestation Detailed anomaly scan at 20 weeks including four-chamber view of the heart and outflow tracts Tight glycaemic control reduces complication rates Treat retinopathy as can worsen during pregnancy

Answer 51

Fasting- 5.3 mmol/l 1 hour- 7.8 mmol/l 2 hour- 6.4 mmol/l

Answer 52

Extreme morning sickness

Answer 53

Between 8 and 12 weeks but may persist up to 20 weeks

Answer 54

Increased levels of beta-hCG eg ( multiple pregnancies, trophoblastic disease) Nulliparity Obesity Family or personal history of NVP Smoking associated decreased incidence of hypermesis

Answer 55

Continued nausea and vomiting and is unable to keep down liquids or oral antiemetics Continued nausea and vomiting with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics A confirmed or suspected comorbidity (for example she is unable to tolerate oral antibiotics for a urinary tract infection)

Answer 56

5% pre-pregnancy weight loss Dehydration Electrolyte imbalance

Answer 57

Pregnancy-Unique Quantification of Emesis (PUQE)

Answer 58

Simple measures Rest and avoid triggers e.g. odours Bland, plain food, particularly in the morning Ginger P6 (wrist) acupressure First-line medications Antihistamines: oral cyclizine or promethazine Phenothiazines: oral prochlorperazine or chlorpromazine Second-line medications Oral ondansetron Oral metoclopramide or domperidone- metoclopramide may cause extrapyramidal side effects so not to be used for more than 5 days Admission for IV hydration Normal saline with added potassium used to rehydrate

Answer 59

Triad of- dehydration, weight loss, electrolyte imbalance AKI Wernicke's encephalopathy Oesophagitis, Mallory-Weiss tear Venous thromboembolism Fetal outcome- little adverse effect- maybe low birth weight, slight increase prem

Answer 60

Emergency hormonal contraception- levonorgestrel, ulipristal Intrauterine device (IUD)

Answer 61

Levonorgestrel Ulipristal

Answer 62

Taken as soon as possible- efficacy decreases with time Must be taken within 72 hours of unprotected sexual intercourse (UPSI) Single dose of 1.5mg should be doubled for those with BMI over 26 or weight over 70kg If vomiting occurs within 3 hours dose should be repeated Can be used more than once in a menstrual cycle if clinically indicated Hormonal contraception can be started immediately after using levornogestrel

Answer 63

30mg dose take as soon as possible, no later than 120 hours after intercourse Don't use with levonorgestrel Ulipristal may reduce the effectiveness of the hormonal contraceptive. Contraceptive with the pill, patch or ring should be started, or restarted, 5 days after having ulipristal. Barrier methods used during this time. Caution exercised in patients with severe asthma Ulipristal can be used more than once in the same cycle Breastfeeding delayed one week after ulipristal, no restrictions with levonorgestrel

Answer 64

Copper IUD most effective method of emergency contraception and offered to all women if they meet criteria Must be inserted within 5 days of UPSI If more than 5 days, may be fitted up to 5 days after the likely ovulation date Prophylactic antibiotics may be given if patient at high risk of STI 99% effective no matter where used in cycle May be left in situ for long term contraception. If to be removed, kept until at least next period

Answer 65

A pregnancy test will be positive Transvaginal ultrasound is the investigation of choice

Answer 66

Expectant management Medical management- methotrexate- patient must attend follow up Surgical management- salpingectomy or salpingotomy

Answer 67

Size <35mm Unruptured Asymptomatic No fetal heartbeat hCG <1000IU/L Compatable with another intrauterine pregnancy Involves closely monitoring patient over 48 hours and if B-hCG levels rise again or symptom manifest intervention performed

Answer 68

Size <35mm Unruptured No significant pain No fetal heartbeat hCG<1500 IU/L Not suitable if intrauterine pregnancy Medical management involves using methotrexate and only done if patient willing to attend follow up Methotrexate is teratogenic no pregnacy 3 months after

Answer 69

Size >35mm Can be ruptured Pain Visible fetal heartbeat hCG >5000IU/L Compatible with another intrauterine pregnancy Surgical management can involve salpingectomy or salpingotomoy Salpingectomy is the first-line for women with no other risk factors for infertility Salpingotomy considered for women with risk factors for infertility such as contralateral tube damage- Around 1 in 5 women who undergo a salpingotomy require further treatment (methotrexate and/or salpingectomy)

Answer 70

New-onset hypertension Proteinuria Oedema

Answer 71

New-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy, AND 1 or more of the following: Proteinuria Other organ involvement (see list below for examples): e.g. renal insufficiency (creatinine ≥ 90 umol/L), liver, neurological, haematological, uteroplacental dysfunction

Answer 72

Eclampsia- also altered mental status, blindness, stroke, clonus, severe headaches or persistent visual scotomata Fetal complications- Intrauterine growth retardation Prematurity Liver involvement- elevated transaminases Haemorrhage- placental abbruption, intra-abdominal, intro-cerebral Cardiac failure

Answer 73

Hypertension- typically >160/110 and proteinuria Proteinuria: dipstick ++/+++ Headache Visual disturbance Papilloedema RUQ/epigastric pain Hyperreflexia Platelet count < 100 * 106/l, abnormal liver enzymes or HELLP syndrome

Answer 74

High risk factors Hypertensive in previous pregnancy CKD Autoimmune disease DM T1/T2 Chronic hypertension Moderate risk factors First pregnancy Over 40 Pregnancy interval over 10 years BMI 35 or more FH pre eclampsia Multiple pregnancy

Answer 75

Women with the following should take aspirin 75-150mg daily from 12 weeks gestation until the birth ≥ 1 high risk factors ≥ 2 moderate factors

Answer 76

Emergency secondary care assessment for any woman with suspected pre-eclampsia Women with blood pressure ≥ 160/110 mmHg are likely to be admitted and observed

Answer 77

Oral labetalol first line. Nifedipine if asthmatic, hydralazine may also be used

Answer 78

Chronic pelvic pain Secondary dysmenorrhoea- pain often starts days before bleeding Deep dyspareunia Subfertility Non-gynaecological: urinary symptoms e.g. dysuria, urgency, haematuria. Dyschezia (painful bowel movements) On pelvic examination reduced organ mobility, tender nodularity in the posterior vaginal fornix and visible vaginal endometriotic lesions may be seen

Answer 79

Laparoscopy is gold standard

Answer 80

NSAIDs and/or paracetamol are first line If analgesia doesn't work then COCP or progestogens (medroxyprogesterone acetate) If analgesia does not improve symptoms or fertility a priority refer to secondary care

Answer 81

GnRH analogues Drug therapy has no significant impact on fertility rates Surgery If trying to conceive can use laparoscopic excision or ablation of endometriosis

Answer 82

After day 21

Answer 83

Progesterone only pill (POP) Can start POP anytime postpartum After day 21 additional contraception for first 2 days Combined oral contraceptive pill (COCP) Absolute contraindication if breastfeeding <6 weeks post partum UKMEC 2 if 6 weeks-6 months postpartum and breastfeedng Not used in the first 21 days due to increase VTE risk post partum After day 21 additional contraception for first 7 days IUD or IUS inserted within 48 hours of childbirth or after 4 weeks Lactational amenorrhoea method (LAM) is 98% effective if the woman is fully breast feeding, amenorrhoeic and < 6 months post-partum

Answer 84

Increased risk preterm birth, low birth weight and small for gestational age babies

Answer 85

Edinburgh postnatal depression scale 10-item questionnaire, with a maximum score of 30 Indicates how the mother has felt over the previous week Score > 13 indicates a 'depressive illness of varying severity' Includes a question about self-harm

Answer 86

'Baby-blues' Postnatal depression Puerperal psychosis

Answer 87

Typically 3-7 days after giving birth and more common in primips Mothers are characteristically anxious, tearful and irritable Reassurance and support

Answer 88

10% women Most cases start within a month and peak at 3 months Features similar to depression Support and reassurance CBT may be helpful Sertraline and paroxetine may be beneficialif symptoms are severe

Answer 89

Onset 2-3 weeks after birth Severe swings in mood (similar to bipolar) and disordered perception (auditory hallucinations) Admission to hospital- ideally mother and baby unit 25-50% risk of recurrence following future pregnancies

Answer 90

Fetal varicella syndrome

Answer 91

5x risk pneumonitis

Answer 92

Skin scarring Eye defects (microphthalmia) Limb hypoplasia Microcephaly Learning disabilities Other risks Shingles in infacy Severe neonatal varicella

Answer 93

If doubt about mother previously having chicken pox maternal blood should be checked for varicella antibodies If the pregnant woman <= 20 weeks gestation is not immune to varicella she should be given varicella-zoster immunoglobulin (VZIG) as soon as possible VZIG effective up to 10 days after exposure If the pregnant woman > 20 weeks gestation is not immune to varicella then either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure

Answer 94

Specialist advice Risk of serious chicken pox infection (maternal), fetal varicella risk and the safety of aciclovir in pregnancy Oral aciclovir given if pregnant woman is ≥ 20 weeks and presents within 24 hours of onset of the rash If the woman is < 20 weeks the aciclovir should be 'considered with caution'

Answer 95

UKMEC 1: a condition for which there is no restriction for the use of the contraceptive method UKMEC 2: advantages generally outweigh the disadvantages UKMEC 3: disadvantages generally outweigh the advantages UKMEC 4: represents an unacceptable health risk

Answer 96

More than 35 years old and smoking less than 15 cigarettes/day BMI > 35 kg/m^2* Family history of thromboembolic disease in first degree relatives < 45 years Controlled hypertension Immobility e.g. wheel chair use Carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2) Current gallbladder disease

Answer 97

More than 35 years old and smoking more than 15 cigarettes/day Migraine with aura History of thromboembolic disease or thrombogenic mutation History of stroke or ischaemic heart disease Breast feeding < 6 weeks post-partum Uncontrolled hypertension Current breast cancer Major surgery with prolonged immobilisation Positive antiphospholipid antibodies (e.g. in SLE)

Answer 98

Diabetes mellitus diagnosed > 20 years ago is classified as UKMEC 3 or 4 depending on severity

Answer 99

Postpartum haemorrhage (PPH) is defined as blood loss of > 500 ml after a vaginal delivery and may be primary or secondary Primary PPH occurs within 24 hours

Answer 100

4 Ts: Tone (uterine atony): the vast majority of cases Trauma (e.g. perineal tear) Tissue (retained placenta) Thrombin (e.g. clotting/bleeding disorder)

Answer 101

Previous PPH Prolonged labour Pre-eclampsia Increased maternal age Polyhydramnios Emergency Caesarean section Placenta praevia, placenta accreta Macrosomia

Answer 102

PPH life threatening- senior members of staff involved immediately ABC approach Mechanical: Palpate the uterine fundus and rub it to stimulate contractions Catheterisation to prevent bladder distension and monitor urine outpur Medical: IV oxytocin (syntocinon): slow IV injection followed by an IV infusion Ergometrine slow IV or IM (unless hypertension history) Carboprost IM (unless history of asthma) Misoprostol sublingual Surgical: Intrauterine balloon tamponade first line surgical management B-lynch suture, ligation uterine arteries etc If severe uncontrolled then hysterectomy sometimes performed

Answer 103

24 hours- 6 weeks due to retained placental tissue or endometritis

Answer 104

Take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day No additional contraceptive protection needed

Answer 105

Take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day The women should use condoms or abstain from sex until she has taken pills for 7 days in a row If pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1 If pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception If pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

Answer 106

Hypertensive in previous pregnancy CKD Autoimmune disease DM T1/T2 Chronic hypertension

Answer 107

First pregnancy Over 40 Pregnancy interval over 10 years BMI 35 or more FH pre eclampsia Multiple pregnancy

Answer 108

Input from expert Add low molecular weight heparin

Answer 109

Hospitalisation, surgery, comorbidities or thrombophilia

Answer 110

Age > 35 Body mass index > 30 Parity > 3 Smoker Gross varicose veins Current pre-eclampsia Immobility Family history of unprovoked VTE Low risk thrombophilia Multiple pregnancy IVF pregnancy 4+ warrants immediate treatment with LMWH continued until 6 weeks postnatal

Answer 111

Direct oral anticoagulants (DOACs) Warfarin

Answer 112

New onset hypertension diagnosed after 20 weeks without significant proteinuria

Answer 113

Mild 140-149 over 90-99 Moderate 150-159 over 100-109 Severe >160 over >110

Answer 114

Pre-existing HTN- over 140/90 before pregnancy or before 20 weeks, no proteinuria/oedema If already on an ACE/ARB stop Pregnancy induced HTN- occuring in second half of pregnancy (after 20 weeks), no proteinuria, no oedema, resolves following birth Pre-eclampsia- pregnancy induced hypertension in association with proteiuria, oedema may occur

Answer 115

1st- Oral labetalol (not for asthmatics) 2nd- Oral nifeddipine

Answer 116

If less than 3 hours late no action required, continue as normal If more than 3 hours late (i.e. more than 27 hours since the last pill was taken) action needed

Answer 117

If less than 12 hours late no action required, continue as normal If more than 12 hours late (i.e. more than 36 hours since the last pill was taken) action needed - see below

Answer 118

Action required, if needed: take the missed pill as soon as possible. If more than one pill has been missed just take one pill. Take the next pill at the usual time, which may mean taking two pills in one day continue with rest of pack extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours

Answer 119

Two or more minor risk factors or one red flag antibiotic therapy with benzylpenicillin and gentamicin. One minor risk observe for 24 hours Red flags: Suspected or confirmed infection in another baby in the case of a multiple pregnancy Parenteral antibiotic treatment given to the woman for confirmed or suspected invasive bacterial infection (such as septicaemia) at any time during labour, or in the 24-hour periods before and after the birth [This does not refer to intrapartum antibiotic prophylaxis] Respiratory distress starting more than 4 hours after birth Seizures Need for mechanical ventilation in a term baby Signs of shock

Answer 120

Prematurity Prolonged rupture of the membranes Previous sibling GBS infection Maternal pyrexia e.g. secondary to chorioamnionitis

Answer 121

Benzylpenicillin

Answer 122

Previous GBS in a pregnancy (or offer testing late in pregnancy and antibiotics if positive) Women with a previous baby with early or late onset GBS disease Preterm labour regardless of GBS status Women with pyrexia of >38 during labour

Answer 123

Primigravida Large babies Precipitant labour Shoulder dystocia Forceps delivery

Answer 124

First degree- superficial no muscle involvement, do not require repair Second degree- injury to perineal muscle but not involving anal sphincter, requires suturing Third degree- injury to perineum involving anal sphincter complex, require repair in theatre Fourth degree- injury to perineum involving anal sphincter complex and rectal mucosa, repair on theatre

Answer 125

May be asymptomatic Menorrhagia Bulk related symptoms- lower abdo pain, cramping, bloating, urinary symptoms Subfertility Rare features- polycythemia secondary to autonomous production of erythropietin

Answer 126

Transvaginal ultrasound

Answer 127

Asymptomatic- review periodically Treatment to shrink: Medical- GnRH agonists- use for short periods loss of bone density Surgical: Myomectomy- performed abdominally, laparoscopically or hysteroscopically Hysteroscopic endometrial ablation Polycythaemia due to autonomous production of erythropoietin

Answer 128

1st Levonorgestrel intrauterine system (LNG-IUS) NSAIDs- mefeanamic acid Tranexamic acid COCP Oral progestogen Injectable progestogen

Answer 129

1. Thyrotoxicosis 2. Hypothyroidism 3. Normal thyroid function (but high recurrence rate in future pregnancies) Thyroid peroxidase antibodies are found in 90% of patients

Answer 130

Thyrotoxic phase- propanolol for symptom control Hypothyroid phase- treat with thyroxine

Answer 131

Contraceptives - time until effective (if not first day period): instant: IUD 2 days: POP 7 days: COC, injection, implant, IUS

Answer 132

Irregular vaginal bleeding is the most common

Answer 133

Up to and including day 5 immediate, otherwise 2 days and use condoms inbetween If switching from COCP immediate protection if continued from end of pill packet

Answer 134

Galactosemia Viral infections

Answer 135

The following drugs can be given to mothers who are breastfeeding: Antibiotics: penicillins, cephalosporins, trimethoprim Endocrine: glucocorticoids (avoid high doses), levothyroxine* epilepsy: sodium valproate, carbamazepine asthma: salbutamol, theophyllines Psychiatric drugs: tricyclic antidepressants, antipsychotics** Hypertension: beta-blockers, hydralazine Anticoagulants: warfarin, heparin Digoxin

Answer 136

The following drugs should be avoided: Antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides Psychiatric drugs: lithium, benzodiazepines Aspirin Carbimazole Methotrexate Sulfonylureas Cytotoxic drugs Amiodarone Clozapine

Answer 137

Androgen insensitivity syndrome

Answer 138

Primary amenorrhoea Little or no axillary and pubic hair Undescended testes causing groin swellings Breast development may occur as a result of the conversion of testosterone to oestradiol

Answer 139

US findings Menopausal status CA125 levels

Answer 140

Fetal macrosomia (association with maternal diabetes) High maternal BMI DM Prolonged labour

Answer 141

Senior help called immediately McRoberts manoeuvre should be perfromed- this manoeuvre entails flexion and abduction of the maternal hips, bringing the mother's thighs towards her abdomen this rotation increases the relative anterior-posterior angle of the pelvis and often facilitates a successful delivery.

Answer 142

Potential complications include: Maternal: Postpartum haemorrhage Perineal tears Fetal: Brachial plexus injury Neonatal death

Answer 143

Sertraline

Answer 144

Nausea Breast tenderness Fluid retention and weight gain

Answer 145

Increased risk of breast cancer- increased by progesterone Increased risk of endometrial cancer- oestrogen by itself not given to women with a womb- reduced by the addition of progesterone Increased risk VTE- increased by addtion of progesterone, transdermal HRT does not increase VTE risk Increased risk of stroke Increased risk of ischaemic heart disease

Answer 146

If past 28 weeks- 1. Handheld doppler to confirm fetal heartbeat 2. If not detected immediate ultrasound offered 3. If present CTG used for at least 20 mins to monitor fetal HR If fetal movements not felt by 24 weeks referral should be made

Answer 147

Phenytoin Methotrexate Pregnancy Alcohol excess

Answer 148

Macrocytic, megaloblastic anaemia Neural tube defects

Answer 149

All women should take 400mcg of folic acid until 12th week of pregnancy Women at higher risk of NTD should take 5mg folic acid from before conception until 12th week of pregnancy

Answer 150

Either partner has a NTD, FH or previous prgnancy with NTD Woman taking antiepileptic drugs, coeliac disease, DM or thalassaemia Woman is obese 30 BMI or more

Answer 151

Development of seizures in association with pre-eclampsia

Answer 152

Magnesium sulphate

Answer 153

Urine output, reflexes, respiratory rate and oxygen saturations

Answer 154

Calcium gluconate is the first-line treatment for magnesium sulphate induced respiratory depression

Answer 155

Treatment should continue for 24 hours after last seizure of delivery

Answer 156

Fluid restriction to prevent fluid overload

Answer 157

In older women Lump or ulcer on labia majora Inguinal lymphadenopathy May be associated with itching/irritation

Answer 158

Anything slowing ovum's passage to the uterus: Damage to tubes (pelvic inflammatory disease, surgery) Previous ectopic Endometriosis IUCD Progesterone only pill IVF (3% of pregnancies are ectopic)

Answer 159

>35mm hCG over 5000IU/L

Answer 160

This is when fetal cells/ amniotic fluid enters the mothers bloodstream and stimulates a reaction

Answer 161

During labour, after delivery in the immediate post partum or during caesarean insection

Answer 162

Symptoms include: chills, shivering, sweating, anxiety and coughing. Signs include: cyanosis, hypotension, bronchospasms, tachycardia, arrhythmia and myocardial infarction.

Answer 163

Critical care unit

Answer 164

Uterine atony

Answer 165

Synthetic oxytocin

Answer 166

A benign ovarian tumour Ascites Pleural effusion

Answer 167

Surface derived tumours Germ cell tumours Sex cord-stromal tumours Metastasis

Answer 168

1. Rescan at 32 weeks 2. No need to limit activity or intercourse unless they bleed 3. If still present at 32 weeks then scan every 2 weeks 4. Final ultrasound at 36-37 weeks to determine method of delivery- elective aesarean section for grades III/IV between 37-38 weeks, trial of vaginal may be offered if grade I 5. If know placenta praevia goes into labour prior to the electve caesarean secton emergency caesarean section should be performed due to PPH risk

Answer 169

1. Admit 2. ABC approach to stabilise woman 3. If not able to stabilise- emergency caesarean section 4. If in labour or term reached- emergency caesarean section

Answer 170

Transvaginal utrasound

Answer 171

Painless Praevia Agony Abruption

Answer 172

Painless and bright red

Answer 173

Pain and dark red

Answer 174

Excessive pain during the menstrual period

Answer 175

No underlying pelvic pathology. Usually appears within 1-2 years of menarche. Pain typically starts just before or within a few hours of period starting Suprapubic cramping pains which may radiate to the back or down the thigh

Answer 176

1st- NSAIDs such as mefenamc acid and ibuprofen 2nd- COCP

Answer 177

Develops many years after the menarche. Is the result of underlying pathology. Pain usually starts 3-4 days before the onset period. Causes incude: Endometriosis Adenomyosis Pelvic inflammatory disease Intrauterine devices (copper coil, inrauterine system (mirena) may help) Fibroids

Answer 178

Refer to gynae Depends on cause

Answer 179

High HCG Low PAPP-A Nuchal translucency- thickened

Answer 180

Between 11 weeks and the end of the 13th week

Answer 181

From the 15th week onwards

Answer 182

The combined test is now standard- tests should be done between 11-13+6 weeks Combined is- nuchal translucency measurement, serum B-HCG and pregnancy-associated plasma protein A (PAPP-A) Trisomy 18 and 13 give similar results to Down's but HCG lower Quadruple test If women book later in pregnancy quadruple test should be offered between 15-20 weeks

Answer 183

Alpha-fetoprotein Unconjugated oestriol Human chorionic gonadotrophin Inhibin A

Answer 184

Nuchal translucency measurement Serum B-HCG Pregnancy-associated plasma protein A (PAPP-A)

Answer 185

Alpha-fetoprotein- low Unconjugated oestriol- low HCG- high Inhibin A- high

Answer 186

Both tests return a lower chance or higher chance result Lower chance- 1 in 150 or more High chance- 1 in 150 or less

Answer 187

If a woman has a higher chance result she will be offered a second screening test (NIPT) or a diagnostic test (amniocentesis or chorionic villus sampling (CVS). Given NIPT non-invasive and highly sensitive and specific this is preffered choice

Answer 188

Analyses small DNA fragments that circulate in the blood of a pregnant woman cffDNA derives from placental cells Analysis of cffDNA allows early detection chromosomal abnormalities Sensitivity and specificity are very high for trisomy 21 (>99%)- similarly high for other chromosomal abnormalities

Answer 189

5mg folic acid instead of 400mcg

Answer 190

Thrush- very common 80% caused by Candida albicans

Answer 191

DM Drugs- antibiotics, steroids Pregnancy Immunosuppression- HIV

Answer 192

Cottage cheese, non offensive discharge Vulvitis- superficial dyspareunia, dysuria Itch Vulval erythema, fissuring, satellite lesions

Answer 193

High vaginal swab- not indicated if the clinical features consistent with candidiasis

Answer 194

Local or oral 1st- Oral fluconazole Clotrimazole 500mg intravaginal pessary as single dose if oral therapy contraindicated If there are vulval symptoms consider adding topical imidazole in addition to an oral or intravaginal antifungal If pregnant only local treaments may be used

Answer 195

4 or more episodes per year Compliance checked Confirm candidiasis with high vaginal swab Blood glucose to exclude diabetes Consider induction maintinence regime- Induction: Oral fluconazole every 3 days for 3 doses Maintinence- oral fluconazole weekly for 6 months

Answer 196

Sudden onset unilateral lower abdominal pain. May coincide with exercise N+V common Unilateral, tender adnexal mass on examination

Answer 197

Adnexal torsion

Answer 198

RFs Ovarian mass Being reproductive age Pregnancy Ovarian hyperstimulation syndrome

Answer 199

Usually sudden onset of deep seated colicky abdominal pain Vomiting and distress Fever in minority Vaginal examination shows adnexial tenderness Ultrasound may show whirlpool sign Laparoscopy both diagnostic and theraputic

Answer 200

Pelvic pain, fever, deep dyspareunia, vaginal discharge, dysuria and menstrual irregularities Cervical excitation may be found on examination

Answer 201

Sensorineural deafness Congenital cataracts Congenital heart disease (e.g. patent ductus arteriosus) Growth retardation Hepatosplenomegaly Purpuric skin lesions 'salt and pepper' chorioretinitis Microphthalmia Cerebral palsy

Answer 202

Suspected cases should be discussed immediately with the local Health Protection Unit IgM antibodies raised in women recently exposed to the virus Difficult to differentiate between rubella and parvovirus B19

Answer 203

Discuss with local Health Protection Unit If a woman has no immunity advise to keep away from people who might have rubella Non-immune mothers should be offered the MMR vaccination in the post-natal period- MMR should not be given to known pregnant mothers or ones trying to get pregnant

Answer 204

11-13+6 weeks

Answer 205

15-20 weeks

Answer 206

Irregular heavy bleeding

Answer 207

Levonorgestrel within 72 hours Ulipristal within 120 hours

Answer 208

Administer tocolytics and steroids

Answer 209

Weight reduction Metformin, clomifene or a combination should be used to stimulate ovulation Clomifene 1st, metformin more used in overweight

Answer 210

Weight reduction COC may help regulate cycle if contraception required

Answer 211

COC may help 2nd Eflornithine

Answer 212

The attachment of the placenta to the myometrium. Placenta does not properly seperate during labour higher risk of post partum haemorrhage

Answer 213

Accreta: chorionic villi attach to the myometrium Increta: chorionic villi will invade into the myometrium Percreta: chorionic villi will invade through the perimetrium

Answer 214

Most common liver disorder in pregnancy

Answer 215

Pruritis- often in palms and soles Clinicallydetectable jaundice Raised bilirubin

Answer 216

Ursodeoxycholic acid is used for symptomatic relief Weekly liver function tests Women are typically induced at 37 weeks

Answer 217

Abdominal pain Nausea & vomiting Headache Jaundice Hypoglycaemia Severe disease may result in pre-eclampsia

Answer 218

ALT is typically elevated e.g. 500 u/l

Answer 219

Support care Once stabilised- delivery

Answer 220

Transvaginal ultrasound

Answer 221

Heavy menstrual bleeding >80ml per menses

Answer 222

Full blood count Transvaginal ultrasound scan if symptoms suggest structural or histological abnormality (intermenstrual or post coital bleeding, pelvic pain/pressure symptoms)

Answer 223

Either mefenamic acid (particularly with dysmenorrhoea) or tranexamic acid Both started on first day of period

Answer 224

1st- intraterine system (Mirena) 2nd- COCP 3rd- long acting progestogens (depo provera)

Answer 225

Irregular, solid tumour Ascites At least 4 papillary structures Strong blood flow

Answer 226

Follicular cysts- commonest type ovarian cyst Corpus luteum cyst- more likely to intraperitoneal bleed than follicular

Answer 227

Low dose aspirin started at 12-14 weeks

Answer 228

In all cases as more effective especially if ovulation has just occured (14 days) as other two stop ovulation Unless contraindicatted

Answer 229

Subfertility and infertility Menstrual disturbances- oligomenorrhoea and amenorrhoea Hirsutism, acne Obesity Acanthosis nigricans

Answer 230

Pelvic ultrasound- multiple cysts on the ovaries Baseline investigations- FSH, LH, Prolactin, TSH, testosterone, sex hormone-binding globulin Raised LH:FSH ratio Prolactin normal to mildly elevated Testosterone normal to mildly elevated SHBG normal to low Check impaired glucose tolerance

Answer 231

Rotterdam criteria- PCOS diagnosis made if 2 of the following 3 are present: Infrequent/no ovulation Clinical and biochemical signs of hyperandrogenism (hirsutism, acne or elevated levels of testosterone) Polycystic ovaries on ultrasound scan

Answer 232

>30 with dysmenorrhoea, menorrhagia and an enlarged boggy uterus

Answer 233

Endometrial tissue within the myometrium More common in multiparous women towards the end of their reproductive years

Answer 234

Dysmenorrhoea Menorrhagia Enlarged, boggy uterus

Answer 235

1st- Transvaginal ultrasound MRI is alternative

Answer 236

Symptomatic treatment- tranexamic acid to manage menorrhagia GnRH agonists Uterine artery embolisation Hysterectomy- definitive treatment

Answer 237

210,000 mIU/ml If higher suggests a molar pregnancy- complete hydatidiform mole

Answer 238

Vaginal bleeding Uterus size greater than expected for gestational age Abnormally high hCG Ultrasound: Snow storm appearance of mixed echogenicity

Answer 239

Urine output, reflexes, respiratory rate and oxygen saturations

Answer 240

Between 25-64 years 25-49 years- 3-yearly 50-64 years- 5-yearly Cervical screening not offered to patients over 64

Answer 241

Cervical screening in pregnancy delayed until 3 months post partum unless missed screening/previous abnormal smears Women never sexually active before are low risk so may want to opt out

Answer 242

Complete hydatidiform mole Partial hydatidiform mole Choriocarcinoma

Answer 243

Bleeding in first or early second trimester Exaggerated symptoms of pregnancy- hyperemesis Uterus large for dates Very high hCG Hyertension and hyperthyroidism my be seem (hCG can mimick TSH)

Answer 244

Urgent referral to specialist centre- evacuation of uterus performed Effective contraception recommended to avoid a pregnancy in the next 12 months

Answer 245

Waiting for spontaneous miscarrige Wait 7-14 days for miscarrige to complete spontaneously If expectant management unsuccessful then medical or surgical management offered Situations where medical or surgical: Increased risk of haemorrhage- late first trimester or coagulopathies Previous adverse/ traumatic pregnancy- stillbirth, miscarrige, antepartum haemorrhage Evidence of infection

Answer 246

Tablets to expedite the miscarrige Vaginal misprostol- prostaglandin analogue Contact doctor if bleeding not stopped within 24 hours Given antiemetics and pain relief

Answer 247

Surgical procedure under local or general anaesthetic Vacuum aspiration (suction curettage) or surgical management in theatre Vacuum aspiration done under local anaesthetic as an out patient

Answer 248

anti-D prophylaxis

Answer 249

Mifepristone (anti-progestogen) followed 48 hours later by prostaglandins (e.g. misoprostol) to stimulate uterine contractions Takes hours/days to complete Pregnancy test required at 2 weeks to confirm the pregnancy has ended. Should detect the level of hCG (rather than positive or negative)- termed a multi level pregnancy test

Answer 250

Transcervical procedures- vacuum aspiration, electric vacuum aspiration and dilitation and evacuation Following surgical abortion an intrauterine contraceptive can be inserted immediately after evacuation of the uterine cavity

Answer 251

Choice between medical and surgical offered up to and including 23+6 weeks gestation After 9 weeks medical abortions less common- increased likelihood of products of conception seen and decreased success rate Before 10 weeks medical abortions usually done at home

Answer 252

Stop immediately and give alternative antihypertensives (labetalol) while awaiting specialist review

Answer 253

systolic > 140 mmHg or diastolic > 90 mmHg Increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic Then catagorise into pre-existing, pregnancy induced or pre- eclampsia Proteinuria/oedema

Answer 254

Hypoechoic masses

Answer 255

Snow-storm appearance

Answer 256

Large loop excision of the transformation zone (LLETZ)

Answer 257

It should be taken for the full duration of pregnancy

Answer 258

Either partner has NTD, previous pregnancy NTD or FH NTD Woman taking antiepileptic drugs, has coeliac, diabetes or thalassemia Obese 30+ BMI

Answer 259

4 3 2 1 4 blood (FBC, rhesus, blood group, alloantibodies) 3 virus (hepB, HIV, syphilis) *rubella no more* 2 UTI (dipstick, culture) 1 full physical examination (breast, BMI, BP)

Answer 260

Class 1 (hypogonadotropic hypogonadal anovulation) - notably hypothalamic amenorrhoea (5-10% of women) Class 2 (normogonadotropic normoestrogenic anovulation) - polycystic ovary syndrome (80% of cases) Class 3 (hypergonadotropic hypoestrogenic anovulation) - premature ovarian insufficiency (5-10% of cases). In this class, any attempts at ovulation induction are typically unsuccessful and therefore usually require in-vitro fertilisation (IVF) with donor oocytes to conceive

Answer 261

Exercise and weight loss Letrozole Clomiphene Gonadotrphin therapy

Answer 262

Ovarian hyperstimulation syndrome (OHSS) is one of the potential side effects of ovulation induction Hypovolaemic shock Acute renal failure Venous or arterial thromboembolism

Answer 263

Prolonged pregnancy, e.g. 1-2 weeks after the estimated date of delivery Prelabour premature rupture of the membranes, where labour does not start Maternal medical problems: diabetic mother > 38 weeks pre-eclampsia obstetric cholestasis Intrauterine fetal death

Answer 264

Use to assess whether the induction of labour is required Score of <5 indicates labour unlikely to start without an induction Score of ≥ 8 indicates high chance of spontaneous labour

Answer 265

Look up table Cervical postition 0- posterior 1- intermediate 2- anterior Cervical consistency 0- firm 1- intermediate 2- soft Cervical effacement 0- 0-30% 1- 40-50% 2- 60-70% 3- 80% Cervical dilitation 0- <1 cm 1- 1-2 cm 2- 3-4 cm 3- >5 cm Fetal station 0- -3 1- -2 2- -1, 0 3- +1,+2

Answer 266

Options- 1st- Membrane sweep Vaginal prostoglandin E2 (PGE2)- dinoprostone Oral prostoglandin E1- misoprostol Maternal oxytocin Amniotomy Cervical ripening balloon if the Bishop score is ≤ 6 vaginal prostaglandins or oral misoprostol mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean if the Bishop score is > 6 amniotomy and an intravenous oxytocin infusion

Answer 267

If the Bishop score is ≤ 6 vaginal prostaglandins or oral misoprostol Mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean If the Bishop score is > 6 amniotomy and an intravenous oxytocin infusion

Answer 268

Uterine hyperstimulation: Prolonged and frequent uterine contractions Fetal hypoxia Uterine rupture Management: Removing the vaginal prostaglandins if possible and stopping the oxytocin infusion if one has been started Consider tocolysis

Answer 269

It's Not My Time Indomethacin Nifedipine Magnesium sulphate Terbutaune

Answer 270

Intense pain Ruptured endometriosis, fluid in abdomen

Answer 271

Rock, Paper, Scissors --> Median, Radial, Ulnar

Answer 272

Fetus alive and under <36 weeks Fetal distress: emergency caesarean No fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation Fetus alive and >36 weeks Fetal distress: immediate caesarean No foetal distress: deliver vaginally Foetus dead- induce vaginal delivery

Answer 273

Pruritus - may be intense - typical worse palms, soles and abdomen Clinically detectable jaundice occurs in around 20% of patients Raised bilirubin is seen in > 90% of cases

Answer 274

Induction of labour at 37-38 weeks is common practice but may not be evidence based Ursodeoxycholic acid Vitamin K supplementation

Answer 275

MORE folic acid (5mg) for: M- Metabolism diseases- Diabetes and Coeliac O- Obesity (BMI >30) R- Relative (Family or personal Hx of NTDs) E- Epilepsy (on anti-epileptic meds) (+Thalassaemia and Sickle Cell- less likely in exams) Antipsychotics too

Answer 276

EdwardIAn- inhibin A stands out Alpha fetoprotein- low Unconjugated oestriol- low hCG- low Inhibin A- normal

Answer 277

Alpha fetoprotein- low Unconjugated oestriol- low hCG- high Inhibin A- high

Answer 278

Alpha fetoprotein- High Unconjugated oestriol- normal hCG- normal Inhibin A- normal

Answer 279

Anyone with risk factors for pre-eclampsia- 1 high risk or two moderate risks High risk factors: 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 Moderate risk factors: 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

Answer 280

The umbilical cord descending before the presenting part of the uterus

Answer 281

Prematurity Multiparity Polyhydraminos Twin pregnancy Cephalopelvic disproportion Abnormal presentation- breech, transverse lie

Answer 282

At artificial rupture of the membranes

Answer 283

Obstetric emergency Presenting part of the fetus may be pushed back into the uterus to avoid compression If cord past the level of introitus, there should be minimal handling and it should be kept warm and moist to avoid vasospasm Ask patient to go on all fours until immediate caesarian ready Tocolytics may be used to reduce the uterine contractions Retrofilling the bladder with 500-700ml of saline may be helpful Instrumental vaginal possible if cervix fully dilated and head is low

Answer 284

Intrauterine device Intrauterine system Both last for 5 years

Answer 285

Implantable contraceptive Contraindications- current breast cance- UKMEC 4

Answer 286

Similar to neuroleptic malignant sydrome

Answer 287

Miscarriage Ectopic pregnancy Implantation bleeding

Answer 288

Latest traditional can be- 3 hours Latest desogestrel can be- 12 hours

Answer 289

Longitudinal lie Transverse Lie Oblique

Answer 290

Women who have had previous pregnancy most common Fibroids and pelvic tumours Twins or triplets Prematurity Polyhydraminos Foetal abnormalities

Answer 291

Abnormal foetal lie detected during routine antenatal appointments Abdominal examination Ultrasound scan

Answer 292

Pre-term rupture membranes (PROM) Cord-prolapse

Answer 293

Before 36 weeks none most resolve After 36 weeks: Active management- external cephalic version (ECV) of the foetus- can be late in pregnancy or early in labour- contraindications- maternal rupture in last 7 days, multiple pregnancy (except 2nd twin), major uterine abnormality. Elective caesarean section

Answer 294

Copper intrauterine device

Answer 295

POP anytime- contraception used first two days COCP- UKMEC 4 if less than 6 weeks post partum, UKMEC2 6 weeks to 6 months, not in first 21 days as VTE risk, after 21 days additional contraception for first 7 days IUD or IUS can be used within 48 hours of childbirth or after 4 weeks Lactationnal amenorrhoea method 98% effective if fully breastfeeding, amenorrhoeic and <6 months post partum

Answer 296

Give Pabrinex (B vitamins) Wernicke's encephalopathy can come from vomiting (hyperemesis gravidarum)

Answer 297

External cephalic version (ECV)

Answer 298

If less then 36 weeks reassureit might move round If over 36 weeks give external cephalic version (ECV) a go If it fails offer planned caesarean or vaginal delivery

Answer 299

Where caesarean delivery is required Antepartum haemorrhage within the last 7 days Abnormal cardiotocography Major uterine anomaly Ruptured membranes Multiple pregnancy

Answer 300

Admit for IV saline with potassium replacement

Answer 301

Just vaginal misoprostol Contact doctor if bleeding not stopped in 24 hours Misoprostol expels products of contraception, don't need mifepristone to end pregnancy as would be the case in an abortion

Answer 302

Vaccum aspiration Surgical management

Answer 303

Menopausal symptoms and loss off mineral bone density Used in fibroids

Answer 304

On Passmed

Answer 305

Stop lactation reflex- stop suckling Supportive measures- well supported bra and analgesia Cabergoline is the medication of choice

Answer 306

GnRH analogues to try and reduce the size of the fibroid (uterus) before surgery- particularly for hysterectomy COCP not taken 4-6 weeks before surgery due to VTE risk

Answer 307

12 months since last period Women under 50 who menopause require contraception for 2 years, over 50 only 1 year

Answer 308

If menopause happened over 50- 1 year If menopause happened under 50- 2 years

Answer 309

Lower segment caesarean- now over 99% of cases Classic caesarean- longitudinal incision

Answer 310

Absolute cephalopelvic disproportion Placenta praevia grades 3/4 Pre-eclampsia Post-maturity IUGR Fetal distress in labour/prolapsed cord Failure of labour to progress Malpresentations: brow Placental abruption: only if fetal distress; if dead deliver vaginally Vaginal infection e.g. active herpes Cervical cancer (disseminates cancer cells)

Answer 311

Category 1- immediate threat to life of mother or baby- suspected uterine rupture, cord prolapse, foetal hypoxia, persistent fetal bradycardia- to be delivered within 30 mins Category 2- Maternal or fetal compromise not immediately life threatening - delivery should occur within 75 minutes Category 3- delivery required but mother and baby stable Category 4- elective caesarean

Answer 312

Previous uterine rupture Classical caesarean scar

Answer 313

Elevated prolactin 10-20 mins after episode can differentiate between general tonic clonic/partial and non-epileptic pseudo seizure Serum prolactin raised in true seizures Tongue biting in true seizures

Answer 314

Pelvic thrusting Family member with epilepsy Much more common in females Crying after seizure Don't occur when alone Gradual onset

Answer 315

pelvic thrusting family member with epilepsy much more common in females crying after seizure don't occur when alone gradual onset

Answer 316

1st- NSAIDs such as mefenamic acid and ibuprofen COCP is 2nd line

Answer 317

Ectocervix transformation. Caused by elevated levels of oestrogen (pregnancy. COCP, ovulatory phase) Features: Vaginal discharge Post coital bleeding Ablative treatment

Answer 318

Uterine fibroids are sensitive to oestrogen and can grow during pregnancy If growth outstrips blood supply can undergo red degeneration This presents with low grade fever, pain and vomiting Conservative management- rest, analgesia- should resolve within 4-7 days

Answer 319

Surgery Total abdominal hysterectomy with bilateral salpingo-oophorectomy Patients with high risk disease may have post operative chemotherapy

Answer 320

Enterocele and vaginal vault prolapse Urinary retention may occur acutely

Answer 321

All types of incontinence Bladder diaries Vaginal examination to exclude prelvic organ prolapse Urine dipstick and culture Urodynamic studies

Answer 322

Yes, can't use with UKMEC 3COCP, POP UKMEC2 implant

Answer 323

Before 115 First trimester Hb less than 110 g/l Second/third trimester Hb less than 105 g/l Postpartum Hb less than 100 g/l Normocytic or microcytic anaemia a trial of oral iron should be considered as the first step, and further investigations only required if no rise in haemaglobin after 2 weeks.

Answer 324

Normocytic or microcytic Oral ferrous sulphate or ferrous fumarate Treatment continued for 3 months after iron deficieny corrected to allow iron stores to be replenished

Answer 325

For 3/4 weeks Do a pregnancy test with hCG level 2 weeks after the termination to confirm

Answer 326

Levornogestrel- imediately Ulipristal- 5 days after taking- barrier methods used during this period Ulipristal used with caution in asthmatics Both can be used more than once in a menstrual cycle

Answer 327

<6 weeks- if no pain or risk factors then expectant management, return if bleeding develops, repeat pregany test in 7-10 days >6 weeks if bleeding refer to the early pregnancy assesment unit for a transvaginal ultrasound scan

Answer 328

IV normal saline with potassium chloride Treat hypokalaemia

Answer 329

Bladder retraining

Answer 330

Syntocinon and ergometrine

Answer 331

Threatened- Painless vaginal bleeding occurring before 24 weeks, but typically occurs at 6 - 9 weeks The bleeding is often less than menstruation Cervical os is closed Missed- A gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion Mother may have light vaginal bleeding / discharge and the symptoms of pregnancy which disappear. Pain is not usually a feature Cervical os is closed When the gestational sac is > 25 mm and no embryonic/fetal part can be seen it is sometimes described as a 'blighted ovum' or 'anembryonic pregnancy' Inevitable- Heavy bleeding with clots and pain Cervical os is open Incomplete- Not all products of conception have been expelled Pain and vaginal bleeding Cervical os is open

Answer 332

Around 5 weeks of age

Answer 333

7 days before next period as that is when it is highest

Answer 334

Fetal distress- immediate caesarean No fetal distress- observe closely, SteroidS, no tocolysis, threshold to deliver depends on gestation

Answer 335

Maternal antiretroviral therapy Mode of delivery (caesarean section) Neonatal antiretroviral therapy Infant feeding (bottle feeding) Offer HIV screening to everyone

Answer 336

Yes everyone with HIV

Answer 337

Vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended A zidovudine infusion should be started four hours before beginning the caesarean section

Answer 338

Zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml. Otherwise triple ART should be used. Therapy should be continued for 4-6 weeks Breast feeding not reccomended in UK

Answer 339

Cervical intraepithelial neoplasia 6 months for test of cure

Answer 340

Vaginal atrophy (Can occur in women taking HRT) (Can occur in endometrial hyperplasia?

Answer 341

Anyone with risk factors: BMI of > 30 kg/m² Previous macrosomic baby weighing 4.5 kg or above Previous gestational diabetes First-degree relative with diabetes Family origin with a high prevalence of diabetes (South Asian, black Caribbean and Middle Eastern)

Answer 342

Gastroschisis Vaginal can be attempted - without a peritoneal covering. - lateral to the umbilical Mx - surgical correction ASAP - cover with sling-film(since no peritoneal covering) Omphalocele Caesarean indicated - with peritoneal covering - umbilical site Mx - no need csling film BUT surgical treatment usually in staged (may take months) to allow lung adaptation

Answer 343

If 7 days missed consecutively- start again as new user

Answer 344

Sheehan syndrome describes hypopituitarism caused by ischemic necrosis due to blood loss and hypovolaemic shock Amenorrhoea and symptoms of hypothyroidism (Big cause is PPH)

Answer 345

May occur after dilitation and cutterage Can prevent endometrium responding to oestrogen- could cause amenorrhoea

Answer 346

Primary: defined as the failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics (such as breast development), or by 13 years of age in girls with no secondary sexual characteristics Secondary: cessation of menstruation for 3-6 months in women with previously normal and regular menses, or 6-12 months in women with previous oligomenorrhoea

Answer 347

Hypothalamic amenorrhoea (e.g. secondary stress, excessive exercise) Polycystic ovarian syndrome (PCOS) Hyperprolactinaemia Premature ovarian failure Thyrotoxicosis* Sheehan's syndrome Asherman's syndrome (intrauterine adhesions)

Answer 348

Presents in women who have recently stopped breast feeding Should be painless

Answer 349

Within the first or second trimester

Answer 350

RF is premature membrane rupture Deliver foetus and IV antibiotics Fever, tachycardia, neutrophilia, uterine tenderness and foul smelling discharge

Answer 351

Acronym for Haemolysis, Elevated Liver enzymes and Low Platelet count Can develop in the late stages of pregnancy Got a cross over with severe pre eclampsia

Answer 352

Nausea & vomiting Right upper quadrant pain Lethargy Investigations: haemolysis, elevated liver enzymes, low platelets Treatment: Delivery

Answer 353

Ursodeoxycholic acid is used for symptomatic relief Weekly liver function tests Women are typically induced at 37 weeks

Answer 354

Raised LH:FSH ratio Testosterone may be normal or mildly elevated Sex hormone binding globulin (SHBG) is normal to low

Answer 355

All relatively deficient and breastmilk poor source- reduces the risk of haemorrhagic disease of the newborn Either IM or orally

Answer 356

Emotional and physical symptoms women may experience before the luteal phase Doesn't occur pre puberty, in pregnancy or post menopause

Answer 357

Emotional symptoms include: anxiety stress fatigue mood swings Physical symptoms: bloating breast pain

Answer 358

Mild symptoms- lifestyle advice- sleep, exercise, smoking, alcohol, small regular meals Moderate symptoms- COCP Severe symptoms- SSRIs

Answer 359

Hypothalamic hypogonadism

Answer 360

Temperature of > 38ºC in the first 14 days following deliver Endometritis: most common cause Urinary tract infection Wound infections (perineal tears + caesarean section) Mastitis Venous thromboembolism Management: If endometritis is suspected the patient should be referred to hospital for intravenous antibiotics (clindamycin and gentamicin until afebrile for greater than 24 hours)

Answer 361

Sacrocolpoplexy

Answer 362

Cystocele/cystourethrocele: anterior colporrhaphy, colposuspension Uterine prolapse: hysterectomy, sacrohysteropexy Rectocele: posterior colporrhaphy

Answer 363

Abnormal proliferation of the endometrium- abnormal intermentrual bleeding- higher risk for endometrial cancer Simple or atypical Simple- high dose progestogens, levornogestrel system Atypia- hysterectomy

Answer 364

Babies born to mothers who are chronically infected with hepatitis B or to mothers who've had acute hepatitis B during pregnancy should receive a complete course of vaccination + hepatitis B immunoglobulin Hep B cannot be transmitted through breast feeding but HIV can

Answer 365

36 weeks in nulliparous 37 in multiparous

Answer 366

Onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40

Answer 367

Idiopathic Bilateral oophorectomy Radiotherapy Chemotherapy Infection Autoimmune disorders

Answer 368

Similar to normal climacteric Climacteric symptoms- hot flushes, night sweats Infertility Secondary amenorrhoea Raised FSH, LH levels (elevated FSH from two samples taken 4-6 weeks apart) Low oestradiol

Answer 369

HRT or COCP until average age of menopause (51)

Answer 370

The isthmus- most at risk of rupture Most common in the ampulla

Answer 371

Expectant management of an ectopic pregnancy can only be performed for 1) An unruptured embryo 2) <35mm in size 3) Have no heartbeat 4) Be asymptomatic 5) Have a B-hCG level of <1,000IU/L and declining

Answer 372

A for Abruption previously; B for Blood pressure (i.e. hypertension or pre-eclampsia); R for Ruptured membranes, either premature or prolonged; U for Uterine injury (i.e. trauma to the abdomen); P for Polyhydramnios; T for Twins or multiple gestation; I for Infection in the uterus, especially chorioamnionitis; O for Older age (i.e. aged over 35 years old); N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)

Answer 373

Goserelin Triptorelin

Answer 374

For the first 3 weeks, the patch is worn everyday and needs to be changed each week. During the 4th week, the patch is not worn and during this time there will be a withdrawal bleed

Answer 375

If the patch change is delayed at the end of week 1 or week 2: If the delay in changing the patch is less than 48 hours, it should be changed immediately and no further precautions are needed. If the delay is greater than 48 hours, the patch should be changed immediately and a barrier method of contraception used for the next 7 days. If the woman has had sexual intercourse during this extended patch-free interval or if unprotected sexual intercourse has occurred in the last 5 days, then emergency contraception needs to be considered. If the patch removal is delayed at the end of week 3: The patch should be removed as soon as possible and the new patch applied on the usual cycle start day for the next cycle, even if withdrawal bleeding is occurring. No additional contraception is needed. If patch application is delayed at the end of a patch-free week, additional barrier contraception should be used for 7 days following any delay at the start of a new patch cycle.

Answer 376

FBC Ultrasound scan

Answer 377

Requires contraception: Mirena coil- intrauterine system COCP Long-acting progestogens Does not require contraception: Mefenamic acid (helps with dysmenorrhoea)or tranexamic acid

Answer 378

HIV, syphillis, Hep B Sickle cell, thalassemia

Answer 379

Rupture of the membranes followed by painless vaginal bleeding and foetal bradycardia

Answer 380

Respiratory rate and reflexes (urine output, oxygen sats)

Answer 381

Increased risk of breast cancer- by addition of progestogen Increased risk of endometrial cancer- oestrogen by itself not given to women with a womb Increased risk of VTE- due to addition of progestogen- not the case for transdermal Increased risk of stroke Increased risk of ischaemic heart disease if taken 10 years after menopause

Answer 382

Both have bleeding Vaginal atrophy- most common and assocaited with dryness and dyspareunia, post coital bleeding Endometrial hyperplasia- associated with obesity, no pain or post coital bleeding

Answer 383

A sterile speculum examination should be performed (to look for pooling of amniotic fluid in the posterior vaginal vault) but digital examination should be avoided due to the risk of infection if pooling of fluid is not observed NICE recommend testing the fluid for placental alpha microglobulin-1 protein (PAMG-1) (e.g. AmniSure®) or insulin-like growth factor binding protein‑1 Ultrasound may also be useful to show oligohydramnios

Answer 384

Admission Regular observations to ensure chorioamnionitis is not developing Oral erythromycin should be given for 10 days Antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome Delivery should be considered at 34 weeks of gestation - there is a trade-off between an increased risk of maternal chorioamnionitis with a decreased risk of respiratory distress syndrome as the pregnancy progresses

Answer 385

bHCG- High TSH- Low Thyroxine- High bHCG can stimulate the thyroid gland to produce thyroxine, negative feedback so TSH low

Answer 386

Mild symptoms- lifestyle advice- exercise, smoking, alcohol Moderate symptoms- new-generation COCP (contains drospirenone) Severe symptoms- SSRI

Answer 387

Women with previous GBS offered intrapartum antibiotic prophlaxis or testing late in pregnancy and then antibiotics If woman has GBS requires intrapartum benzylpenicillin

Answer 388

Depo provera Also delay in fertility returning of up to 1 year, increased risk osteoporosis and irregular bleeding

Answer 389

Amenorrhoea, climateric symptoms (hot flushes, night sweats), lost oestradiol, raised gonadotrophins

Answer 390

Flucloxacillin Continue breastfeeding

Answer 391

- BNF says to weigh up benefits and risk when deciding whether to use in pregnancy. - Use during the first trimester gives a small increased risk of congenital heart defects - Use during the third trimester can result in persistent pulmonary hypertension of the newborn - Paroxetine has an increased risk of congenital malformations, particularly in the first trimester

Answer 392

In the case of pregnancy of unknown location, serum bHCG levels >1,500 points toward a diagnosis of an ectopic pregnancy

Answer 393

Combined oral contraceptive pill increased risk of breast and cervical cancer protective against ovarian and endometrial cancer

Answer 394

Caesarean sections

Answer 395

Yes for up to 4 years The patient can then just take oestradiol

Answer 396

Regular and painful uterine contractions A show (shedding of mucous plug) Rupture of the membranes (not always) Shortening and dilation of the cervix

Answer 397

Labour may be divided in to three stages stage 1: from the onset of true labour to when the cervix is fully dilated stage 2: from full dilation to delivery of the fetus stage 3: from delivery of fetus to when the placenta and membranes have been completely delivered

Answer 398

Monitoring in Labour FHR monitored every 15min (or continuously via CTG) Contractions assessed every 30min Maternal pulse rate assessed every 60min Maternal BP and temp should be checked every 4 hours VE should be offered every 4 hours to check progression of labour Maternal urine should be checked for ketones and protein every 4 hours

Answer 399

Stage 1 - from the onset of true labour to when the cervix is fully dilated. In a primigravida lasts typical 10-16 hours latent phase = 0-3 cm dilation, normally takes 6 hours active phase = 3-10 cm dilation, normally 1cm/hr Also Latent- 0-3cm Active- 3-7cm Transition- 7-10cm

Answer 400

Stage 2 - from full dilation to delivery of the fetus 'passive second stage' refers to the 2nd stage but in the absence of pushing (normal) active second stage' refers to the active process of maternal pushing less painful than 1st (pushing masks pain) lasts approximately 1 hours if longer than 1 hour (can be left longer if epidural) consider Ventouse extraction, forceps delivery or caesarean section episiotomy may be necessary following crowning associated with transient fetal bradycardia

Answer 401

must be inserted within 5 days of UPSI, or if a woman presents after more than 5 days then an IUD may be fitted up to 5 days after the likely ovulation date Likely ovulation date is normal length of period (take the shortest one) and subtract 14

Answer 402

William's syndrome

Answer 403

Previous uterine rupture or classical caesarean scar

Answer 404

Paroxetine

Answer 405

Reduced urea, reduced creatinine, increased urinary protein loss

Answer 406

Refer to speacialist midwife led clinic

Answer 407

Intramuscular ceftriaxone + oral doxycycline + oral metronidazole Remove copper IUD

Answer 408

Mild- Lifestyle advice Moderate- new generation COCP Severe- SSRI

Answer 409

Endometrial

Answer 410

IgG- got antibodies IgM- met someome with virus, immediate infection

Answer 411

4 weeks Pregnancy test taken 2 weeks after

Answer 412

Over 4.5 kg

Answer 413

3 or more Causes: Antiphospholipid syndrome Endocrine disorders: poorly controlled diabetes mellitus/thyroid disorders. Polycystic ovarian syndrome Uterine abnormality: e.g. uterine septum Parental chromosomal abnormalities Smoking

Answer 414

PCOS women Abdominal pain/bloating N+V Oliguria Ascites Thromboembolism Acute respiratory distress syndrome

Answer 415

Increased Increased AFP Neural tube defects (meningocele, myelomeningocele and anencephaly) Abdominal wall defects (omphalocele and gastroschisis) Multiple pregnancy Decreased Down's syndrome Trisomy 18 Maternal diabetes mellitus

Answer 416

15 if secondary sexual characteristics 13 with no secondary sexual characteristics

Answer 417

PElvic ultrasound FSH, LH, TSH, testosterone, sex hormone-binding globulin (SHBG) LH:FSH ratio raised Prolactin normal or elevated Testosterone normal or elevated SHBG normal to low Rotterdam criteria: Infrequent/no ovulation Clinical/biochemical hyperandrogenism Polycystic ovaries on USS

Answer 418

Refferal using suspected cancer pathway First-line investigation is trans-vaginal ultrasound - a normal endometrial thickness (< 4 mm) has a high negative predictive value Hysteroscopy with endometrial biopsy

Answer 419

Admit for obersvation and give steroids

Answer 420

Streptococcus agalacticae In chains

Answer 421

Vit A may be teratogenic- so avoid liver Take folic acid and vit D No drinking No smoking

Answer 422

For stage IA Most likely to preserve fertility- cone biopsy Recommended for women who don't want children- hysterectomy with lymph node clearance- gold standard Later sage- radiotherapy and chemotherapy

Answer 423

The woman who gave birth, not the genetic parents

Answer 424

Croup- Autumn Bronchiolitis- Winter

Answer 425

Neonatal resuscitation guidelines Birth: Dry the baby, remove any wet towels and cover and start the clock or note the time. Within 30 seconds: Assess tone, breathing and heart rate. Within 60 seconds: If gasping or not breathing - open the airway and give 5 inflation breaths Re-assess: If no increase in heart rate look for chest movement If chest not moving: Recheck head position, consider 2-person airway control and other airway manoeuvres, repeat inflation breaths and look for a response. If no increase in heart rate look for chest movement When the chest is moving: If heart rate is not detectable or slow (< 60 min-1) - start chest compressions with 3 compressions to each breath. Reassess heart rate every 30 seconds. If heart rate is not detectable or slow (<60 beats per minute) consider venous access and drugs

Answer 426

Usually mid cycle pain. Often sharp onset. Little systemic disturbance. May have recurrent episodes. Usually settles over 24-48 hours.

Answer 427

Fitz-Hugh-Curtis (PID complication) it is characterised by right upper quadrant pain and may be confused with cholecystitis

Answer 428

PID or suspected STI

Answer 429

4 weeks before

Answer 430

Depo provera

Answer 431

Multiparous women towards the end of their reproductive years dysmenorrhoea menorrhagia enlarged, boggy uterus NICE recommend transvaginal ultrasound as the first-line investigation MRI is an alternative symptomatic treatment tranexamic acid to manage menorrhagia GnRH agonists uterine artery embolisation hysterectomy considered the 'definitive' treatment

Answer 432

Maternal pyrexia Maternal tachycardia Foetal tacycardia More likely in pre-term PROM

Answer 433

Oral contraceptives due to lack of efficacy

Answer 434

In 3 months Should be performed after minimum of 3 days and max of 5 days of abstinence Deliver to lab within an hour

Answer 435

Increased risk of haemorrhage she is in the late first trimester if she has coagulopathies or is unable to have a blood transfusion Previous adverse and/or traumatic experience associated with pregnancy (for example, stillbirth, miscarriage or antepartum haemorrhage) Evidence of infection

Answer 436

Vacuum aspiration

Answer 437

Fibroid degeneration Grow in pregnancy due to oestrogen Enlarged uterus

Answer 438

Three stages: 1.Thyrotoxicosis 2. Hypothyroidism 3. Normal thyroid function

Answer 439

First the embryo Then the placental trophoblast Main role is to prevent the disintergration of the corpus luteum

Answer 440

When you measure for ovulation 7 days before end of cycle

Answer 441

First trimester < 110 g/L Second/third trimester < 105 g/L Postpartum < 100 g/L Treat with oral ferrous sulphate

Answer 442

Myomectomy

Answer 443

Breast cancer

Answer 444

ABRUPTION: A for Abruption previously; B for Blood pressure (i.e. hypertension or pre-eclampsia); R for Ruptured membranes, either premature or prolonged; U for Uterine injury (i.e. trauma to the abdomen- C-section); P for Polyhydramnios; T for Twins or multiple gestation/multiparity; I for Infection in the uterus, especially chorioamnionitis; O for Older age (i.e. aged over 35 years old); N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)

Answer 445

Immediately After 4 weeks if breast feeding

Answer 446

Yes, if before it is pre existing hypertension

Answer 447

A micturating cystourethrogram

Answer 448

None it works straight away

Answer 449

Previous gestational diabetes- at booking and 24-28 weeks Other risk factors- just 24-28 weeks

Answer 450

Causes: Premature rupture of membranes Potter sequence bilateral renal agenesis + pulmonary hypoplasia Intrauterine growth restriction Post-term gestation Pre-eclampsia

Answer 451

Stage 1 (1 word) = ovary Stage 2 (2 words) = ovary + pelvis Stage 3 (3 words) = ovary + pelvis + abdomen Stage 4 = distant metastasis Stage 1 Tumour confined to ovary Stage 2 Tumour outside ovary but within pelvis Stage 3 Tumour outside pelvic but within abdomen Stage 4 Distant metastasis

Answer 452

Erb's palsy occurs due to damage to the upper brachial plexus most commonly from shoulder dystocia. Damage to these nerve roots results in a characteristic pattern: adduction and internal rotation of the arm, with pronation of the forearm. This classic physical position is commonly called the 'waiter's tip' Klumpke's palsy occurs due to damage of the lower brachial plexus and commonly affects the nerves innervating the muscles of the hand

Answer 453

Aspirin from 12 weeks to all pregnant women who are at moderate or high risk of pre-eclampsia

Answer 454

2/3 on the Rotterdam scale: oligomenorrhoea clinical and/or biochemical signs of hyperandrogenism polycystic ovaries on ultrasound

Answer 455

Management Simple endometrial hyperplasia without atypia: high dose progestogens with repeat sampling in 3-4 months. The levonorgestrel intra-uterine system may be used Atypia: hysterectomy is usually advised

Answer 456

High level related to early labour Give steroids incase go into labour, monitor BMs if diabetic as can mess them up

Answer 457

Fluoxetine

Answer 458

Potentially sensitising events in pregnancy: - Ectopic pregnancy - Evacuation of retained products of conception and molar pregnancy - Vaginal bleeding < 12 weeks, only if painful, heavy or persistent - Vaginal bleeding > 12 weeks - Chorionic villus sampling and amniocentesis - Antepartum haemorrhage - Abdominal trauma - External cephalic version - Intra-uterine death - Post-delivery (if baby is RhD-positive)

Answer 459

Every year Women who are HIV positive are at an increased risk of cervical intra-epithelial neoplasia (CIN) and cervical cancer due to a decreased immune response and decreased clearance of the human papilloma virus

Answer 460

Until 24 hours after EITHER last seizure or delivery

Answer 461

Secondary amenorrhoea due to uterine adhesions following surgery or trauma from birth

Answer 462

The three features of Meig's syndrome are: a benign ovarian tumour ascites pleural effusion

Answer 463

Types cystocele, cystourethrocele rectocele uterine prolapse less common: urethrocele, enterocele (herniation of the pouch of Douglas, including small intestine, into the vagina) Surgical options cystocele/cystourethrocele: anterior colporrhaphy, colposuspension uterine prolapse: hysterectomy, sacrohysteropexy rectocele: posterior colporrhaphy

Answer 464

VEAL CHOP Variable decelerations --> Cord compression Early decelerations --> Head compression Accelerations --> Okay! Late decelerations --> Placental Insufficiency

Answer 465

Only if amniotic sac not ruptured

Answer 466

Higher risk of screening cancers- cervical and breast Lower risk of old age cancers- ovarian and endometrial

Answer 467

1st trimester- CHD 3rd trimester- persistant pulmonary hypertension of the newborn

Answer 468

Pelvic ultrasound

Answer 469

Up to 6 weeks

Answer 470

ABRUPTION: A for Abruption previously; B for Blood pressure (i.e. hypertension or pre-eclampsia); R for Ruptured membranes, either premature or prolonged; U for Uterine injury (i.e. trauma to the abdomen); P for Polyhydramnios; T for Twins or multiple gestation; I for Infection in the uterus, especially chorioamnionitis; O for Older age (i.e. aged over 35 years old); N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)

Answer 471

Cause of oligohydraminos- renal agenesis and pulmonary hypoplasia

Answer 472

Yes, phenytoin reduces folate

Answer 473

Vesicovaginal fistula

Answer 474

Prolonged rupture of the membranes >24 hours

Answer 475

Same On quadruple/combined similar to Down's but hCG lower

Answer 476

Can breastfeed as doesn't go into the milk Babies born to mothers who are chronically infected with hepatitis B or to mothers who've had acute hepatitis B during pregnancy should receive a complete course of vaccination + hepatitis B immunoglobulin Vaccine+HBIG within 12 hours of birth Hep B vaccine 1-2 months then 6 months

Answer 477

FSH/LH- anterior pituitary Oestrogen- ovaries Proesterone- corpus luteum of ovary

Answer 478

Menstration Follicular phase Ovulatory phase Luteal phase- last 14 days FSH causes maturation of an egg Oestrogen causes lining of uterus to grow LH causes ovulation Progesterone maintains the uterus lining, inhibits both LH and FSH

Answer 479

Clue cells

Answer 480

Trimethoprim tetarogenic 1st- nitrofurantoin (avoid near term) 2nd- amoxicillin MEN- 7 days treatment Women- 3 days

Answer 481

Calluses on knuckles or back of hand in bulimia

Answer 482

Face seizures at night Centrotemporal spikes

Answer 483

Referral to gynae

Answer 484

NSAIDs/Paracetamol COCP or progestogens GnRH analogues Surgery- ablation, laparoscopic excision

Obs/ Gynae Flashcards

(524 cards)