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MSRA my cards > Obs/ gyne take home > Flashcards

Obs/ gyne take home Flashcards

1
Q

safe antihypertensives?

A

Pre-existing HTN: stop aRB/ ACEi. labetolol/ nifedipine (asthmatics) and hydralizine

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2
Q

Postnatal HTN management?

A

enalapril / nifedipine/ amlodipine (in black) then labetolol

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3
Q

Test to rule out pre-eclampsia in weeks 20-35?

A

Placental growth factor (blood test). low is likely to be eclampsia

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4
Q

Definition of gestational hypertension

A

<20weeks 140/90 or increased of 15/30 from booking date.
After 20W - pregnancy induced.

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5
Q

Definition of eclampsia?

A

20w+ with 140/90 HTN and feature of proteunura/ organ dysfunction or placental dysfunction.

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6
Q

Eclampsia prophylaxis?

A

75mg Aspirin from 12 weeks if 1x high RF (CKD/DM/HTN/autoimmune) or 2 x moderate RF (FH/ multip/ first pregnancy/ 40+, BMI 35+, 10yrs+last pregnancy)

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7
Q

HIV positive pregnant woman care?

A

No breast feeding
Vaginal delivery if < 50 viral load
Offer antiretrovirals to everyone
If C/S - give antiretroviral IV 4 hrs before

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8
Q

Induction of labour summary?
BISHOP score factors?

A

BISHOP - includes cervical dilation, effacement, consistency (softness), position, fetal station.
(PEDSS)
<5 - unlikely to progress naturally. 9+ natural.
40-41w - do sweep
6 or less - vaginal E2 or misoprostol
6 or more can do amniotomy/ IV oxytocin infusion

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9
Q

Drugs to avoid breast feeding? (Avoid feeding chickens soup and let ami drive ben’s car)

A

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

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10
Q

Down’s syndrome screening including nuchal scan (timeline)

A

Week 11-13+6

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11
Q

Early scan to confirm dates, exclude multiple pregnancy

A

Week 10-13+6

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12
Q

continuous abdominal pain
shock disproportionate to the amount of blood loss, uterus spasm firm or ‘woody’
the fetus hard to feel and auscultate

A

Plancental abruption

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13
Q

What situations to give anti D?

ectopic pregnancy managed medically?

A

Rh +ve infant delivered,
termiantion/miscarriage at 12 weeks+
ectopic pregnancy - surgical mx
ECV
antepartum haemorrhage
amniocentesis, CVS, fetal blood sampling
abdominal trauma

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14
Q

abdominal fullness, early satiety, 55+, increased urine urgency?
RF?
Protective?
Commone types?

A

Ovarian cancer sus - if CA125 35+, refer for USS.
RF: nulip, early menarche, late menses, BRCA1,2
protective: COCP, diagnostic lap,
Common: epithelial, serous cystadenoma

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15
Q

COCP protective against and RF for?

A

coc goes on cervix and breast
RF for breast ca and cervical ca
Protective against endometrial and ovarian

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16
Q

Post menopausal bleed, dad has a history of Colorectal cancer.
DX?
RF?
Protective?
Ix?

A

Endometrial cancer
RF: Nulip, early menarch, late menopause, PCOS, DM, obese, HNPCC
Protective: smoking, COCP, IUS (mirena), cyclic progesterones, Multip
IX: USS endometrial thickness 4+ - do hysteroscopy and biopsy. FIGO staging, surgery +- radiotherapy

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17
Q

Black woman presents to fertility clinic with menorrhagia, deep dysparenuria?

A

Uterine fibroids:
Need TV USS
SX tx: progesterone, COCP, mirena,
fertility protective: mymectomy

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18
Q

Pain 4 days before period is due at 30 YO, yrs after normal periods. cX?

A

Secondary dysmenorrhoea
endometriosis
adenomyosis -large, boggy uterus
pelvic inflammatory disease-fever cervix excitation, dysfunctional bleed
intrauterine devices*
fibroids-low fertility, deep pain

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19
Q

Ectopic pregnancy -when would you do medical management, what does it involve?

A

BHCG <1500, foetus <35mm, no heartbeat no risk of rupture, if no other intrauterine pregnancy. Give methotrexate and F/U.

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20
Q

when to manage ectopic pregnancy surgically?

A

35mm+, 5000+bHCG,

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21
Q

neural tube defects test?
USS
test is USS not enough?

A

anencephaly form 12 w/ spina bifida 16-20 weeks

amnioscentesis to take aFP at 16 weeks

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22
Q

Down’s syndrome screen?

A

combined at 12 weeks
anomaly at 18-20+6

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23
Q

first dose of anti D for Rhesus negative women?
2nd dose?

A

28 weeks and 34 weeks

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24
Q

Secondary amenohrea cx?

A

no sx of androgen excess: hyperprolactinaemia: metoclopramide/ phenothiazines/
premature ovarian failure (FSH 20+), post pill amen

androgen excess: pcos (LH >FSH), cushings syndrome, pituitary failure (TSH low, t4 low)

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25
Q

tender tense utuers, PV bleed 32 w, fetal distress

A

placental abruption (2nd half pregnancy)

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26
Q

hx of fibroids, previous c-section, painfless vaginal bleed at 28 weeks?

A

placental previa

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27
Q

post AROM, PV bleed, fetal distress

A

vasa previa

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28
Q

smoking baby risks?

A

preterm labour, light for dates, reduced reading ability up to 11 YO,2x miscarriage, abnormal sperm

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29
Q

fetal alcohol syndrom head size?

A

microcephaly

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30
Q

Most common vaginal discharge cx?

A

candida and then trichomonas vaginalis (tx metronidazole, strawberry cervix)

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31
Q

Vaginal infections
BV TX?
gonorrhoea tx?
TV tx?

A

BV - metronidazole
gonorrhoea - cetriaxone/ oral ciproflox
TV - metronidazole

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32
Q

haem changes in rpegnancy?

A

low platelts, dilutional low Hb (larger volumne),, raised wcc lower iron and albumin, higher TIBC
lower U=Es
raised ALP. clotting same
TSH low in 1st, normal in 2nd and then high in 3rd trim

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33
Q

3rd trimester back pain cuased by?

A

muscle relaxation and pelvic ligament

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34
Q

common vaginal infections in pregnancy?

A

candida, then BV, then TV

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35
Q

hypermelanosis in sun exposed areas in pregnancy?

A

chloasma

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36
Q

when would an OTC pregnancy test be positive?

A

9 days after intercourse until 20 weeks of pregnancy, 5 days after miscarriage and trophoblastic disease.
by 11 days, 98% detected

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37
Q

PCOS tx?

risks of pcos?

A

COC + medroxyprogesterone to induce periods every 3 months, orlistat, metformin
clomifene (fertility)

risks:endometrial cancer, GDM, t2DM

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38
Q

post D+C/ PROM amenohrrhea cx?

A

asherman’s syndrome (adhesions in uterus. dx hysteroscopy)e

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39
Q

sheehan’s syndrom sx?

A

failure of lactation, fatigue, failure to menstruate, loss of sexual hair, post pit - diabetes insipidus

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40
Q

prengant, central abdo pain 16 weeks, fever, guarding, leukocytes on blood, waied WCc?

A

appendicitis
pain: RLQ in 1st, central in 2nd, RUQ in 3rd trim

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41
Q

30 weeks gestation, RUQ pain after eating pizza, vomitting

A

acute cholecystitis - do USS

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42
Q

10 w pregnant, previous pelvic inflammatroy disease, abdo pain, hypotension, mass?

A

ectopic
RF: PID,endometriosis, previous tubual, adhesions etc

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43
Q

chronic lower abdo pain, increases after fall, USS showed fluid below tubes and ovaries

A

ruptured ovarian cyst (rare in pregnancy)

44
Q

congenital toxoplasmosis tx?

A

mother - spiramycin

45
Q

syphillis tx?

A

benzathine benpen
cause miscarriage, still birth

46
Q

Listeria cx and tx?

A

CX: meats, dairy, soil, transplacental transmission and vertical transmission

TX:amoxicillin, gentamycin

47
Q

how does COC work?

POP?

A

acts of hypothalamys-pit-ovarian axis. ibhibits ovulationby supressing LH and FSH

POP:increases viscosity cervical mucus, reduces cilia activity, endometrial changes, supress ovulation

48
Q

emergency contraception and how does it work?

A

IUD CU: toxic to embryoo implantation, ovum and sperm, cervical mucus changes
ullipristal:delays ovulation 5 days
levonogestrel:delays ovulation 5 days but not in follicular phase

49
Q

hyperemesis - ix?

A

TFTs in all as hyperthyroid is common
U+Es - low K, lowNA, rasied ALT, SBR, high haematocrit,

high BHCg associated with molar/ trophoblasric disease

1st tx promethazine

50
Q

TX for fibroid?

A

Naids, tranexamic acid, COC/ IUS (most), gnrh agonist, ryeqo, ulipristal acetate (AF liver failure)

51
Q

woman with fibroid treated, now derranged liver function. cause?

A

ullipristal acetate

52
Q

pre-eclampsia definition?
HELLP definition?

RF?

A

HTN 20weeks +,proteinuria (0.3g in 24 hrs)
eclampsia 0 convulsions
hellp: haemolysis, elevated LFTs,low platelets

RF:40+, nulip, 10yrs between pregnancy,FH, BMI 30+, HTN, renal disease, vasc rf, mutlip

53
Q

Rf endometrial cancer?

A

nullip, tamoxifen, late menopause, DM, PCOS, FH ovary, breast, colon cancer

54
Q

nulliparous, acute painful lump on labia?

A

bartholin;s cyst. unilateral mass hen’s egg

55
Q

2nd trim brief pain pulling sensation/ stretching?

A

round ligament pain

56
Q

3rd trimester, sudden pain after coughing/ trauma?

A

rectus abdominis haematoma

57
Q

POP brands and time for missed pill?

A

levonogestrel/norethisterone - 3 hrs
desogestrel - 12 hrs
drospirenone - 24 hrs

58
Q

Cervical cancer screening?
breast cancer screening?

A

25-49 3 yrly, 50-64 5 yrly
50-70 - 3 yrly mammogram

59
Q

colon cancer screening uk?

A

one off flex sigmoidoscopy at 55 Yrs, 60-74 YO - 2 yrly FIT test

60
Q

when to refer to infertility clinic?
When to consider early referral?
ix?

A

<35 refer at12 months) if not conceived. otherwise 36+ refer 6 months

earlier: amen, sti, abnromal exma, PID/surgery. men with varicocele and surgery/ exam abnormality

mid luteal proj (7 days before expected period), day 2-4 FSH, LH, chlamydia, prolactin TSH,
men: 3 day semen sample, consider repeat after 3 months - refer if 2x abnormal

61
Q

cx of tubule failor (infertility women), drug cx?

A

most common - infection/ ovulation failure
drugs: sulfazalazine, spironolactone, cox i, antiepileptics, recreational, neuroleptics,cytotoxic,

62
Q

most accurate way to detect ectopic / tubular pregnancy?

A

transvaginal USS

63
Q

hyperemesis gravidarum more common in?

A

mutliple pregnancies, <30YO, non smoking, obese, trophoblastic disease, female foetus.
raised haematocrit,

64
Q

which meds would mean extra precaution with cocp?

A

rifampicin, st john’s wort, anticonvulsants, antiretrovirals (inducers)

65
Q

sx to stop taking cocp asap?

A

chest pain, HTN, 120/95, immobile, VTE sx,severe stomach pain, hepaittis, jaundice,sob, haemoptsosi

66
Q

1 set of twins, 1 miscarriage 12 weeks, 1 daughter and currently pregnant. G+P?

A

total pregnancies including current - G4
P - 2+1 pregnancies after 24 w + Y losses before 24

67
Q

Values for starting Fe in pregnancy?

folic acid?

A

blood values <110 at booking, <105 at 28 weeks, MCV <84

400mcg until 12 weeks, 10mcg vit d OD

68
Q

HRT and cancer risk?

A

both O only and combined increase breast (more with combines) and ovarian
O only increases endometrial cancer (only given if hysterectomy already done)

69
Q

HRT SE?

A

Breast tenderness, depression, leg cramps, headache, N, migraines, mood swings, back pain, dyspepsia

70
Q

HRT regimens best?

peri/post menopausal?

urogenital sx?

A

post menopausal (1yr) - any, but continuous best to avoid withdrawal (IX any bleed 6 months after starting HRT)

perimenopausal - 3 monthly or monthly cycle, consider switching to continuous after menopaus/ 54YO

urogenital sx: low vaginal O, ospemifene

monitor 3 monthly, do BP and then yearly when stable. using <5 yrs is safe

71
Q

which HRT progesterone is better tolerates?
which progesterone better for fluid retention sx?

A

medroxyprogesterone and dydrogesterone

drospirenone

72
Q

HRT CI??

A

undiagnosed PV bleed, endometrial hyperplasia,breast cancer, vte (unless on tx), recent mi, acute liver disease, thrombophillic disorder

73
Q

hot flushes tx non HRT

A

SSRI

74
Q

SX of lymphogranuloma venereum? (complication of chlamydia?

A

tenesmus, anorectal discharge, diarrhoea, altered bowel habit

75
Q

commonest cx of bleeding during sex?

A

cervical ectropion

76
Q

Breast lump - painless, post trauma, red/ bruised/ dimpled in large breast?

A

fat necrosis

77
Q

Breast lump:30 YO discrete, firm, non tender, mobile mice

A

fibroadenoma

78
Q

breast lump that changes with menstrual cycle?

A

breast cyst

79
Q

chancroid/ painful genital ucler cx?

A

haemophilus ducreyi

80
Q

COCP regards to smoking/ breast feeding?

A

4 for breast feeding <6 weeks post partum, 6 months post is 1.
smoking 15+/ day (4)

81
Q

Hyperthyroid in pregnancy? tx?

A

1st trim - use propylthyrouracil, 2nd - carbimazole. mostly due to graves disease.

82
Q

leiomyoma?

A

fibroid or benign tumour growth from smooth muscle of uterus

83
Q

which tx of fibroid causes osteoporosis?

A

gnrh agonist

84
Q

primary amen but still gets cyclic pain?

A

imperforate hymen

85
Q

menorrhagia tx?

A

no concrapetion - tranexamic acid. if contra - mirene, then COCP, then dept

86
Q

ovarian cancer RF?
how do we measure prognosis?

A

More ovulations, nuliparity, late ,menopause, early menarche, brca 1, 2
Risk malignancy index (RMI) prognosis in ovarian cancer is based on US findings, menopausal status and CA125 levels

87
Q

ectopic pregnancy expectant mx?
medical mx?
surgical mx? - salpingectomy/otomy?

A

<35mm, no Heart beat, systemitically ok, hcg <1000,

medical mx? - <35mm, hcg <1500

surgical - 35mm+, hcg 1500+, heart beat
no rf infertility - salpingotomy, if RF for infertility - salpingectomy (eg tube damage)

88
Q

secondary amen, <40YO, FSH 30+, oestradiol <100?

A

premature ovarian failure- give hrt until 51 yo

89
Q

medication responsible for worsening stress incontinence?

A

doxazosin (relaxes bladder)

90
Q

Primary amenorrhoea, little or no axillary and pubic hair, elevated testosterone

A

androgen insensitivity. x linked. genetically male children with female phenotype

91
Q

miscarriage mx>

A

mifepristone then misoprostol (48 hrs after)

92
Q

WHICH hrt does not increase VTE risk?

A

transdermal

93
Q

painless, hard labial lump withLN?

A

vulval cancer (bartholin’s is painful, fluctuantr)

94
Q

RIF pain with positvie whorlpool sign after exercise?

A

ovarian torsion

95
Q

cervical screening for HIV positive patient?

A

annually (high risk) as soon as diagnosied

96
Q

pre-menstrual RIF pain 3 months, deep dysparenia, now bloating and urine frequency, no dysuria?
when to refer?

A

ovarian cyst (can put pressure)
if found in young woman <5mm, arrange repeat in 8 - 12 weeks and referral if sx persist
post menopausal - cysts unlikley, refer to gynae

97
Q

Post D+C, amenhorrhea?

A

asherman’s syndrome

98
Q

candida tx?
if prengant?

if recurrent candida?

A

po fluconazole 150mg

clotrimazole pessary 500mg

recurrent - consider lichen sclerosis, high swab, dm. trial induction-maintenance regime
induction: oral fluconazole every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 months

99
Q

boggy, enlarged uterus, chronic pain and ifnertility

A

adenomyosis same tx as endometriosis

100
Q

Woman on phenytoin and on tx for chlamydia. best contraception?

A

no COCP/ POP - interacts p450
chlamydia - no iud/ius
give injectable progesterone (longer reversibility) or implant

101
Q

most common symptoms of cervical cancer?

A

postcoital/ abdnormal PVB

102
Q

cervical discharge and organissms?
gram stain
NAAT
thayer-martin culture?

A

gram stain - BV, gold standard
NAAT - chlamydia, TV, gonorrhoea
thayer-martin - gonoccoal

103
Q

46 YO with menopausal sx, LMP 2 months ago?

A

diagnose perimenopause.
only investgiation Premature ovvarian in <45YO

104
Q

Breast cancer: when to refer before screening?

A

1st degree fh <40YO at dx/ b/L / male/ ovarian cancer/ jewish/ sarcoma in a relative <45YO, other childdhood cancers/ paternal hx of breast cancer

105
Q
A

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