Obstetrics

Question 1

RF of SGA

Answer 1

Major- >40, smoke >11, previous SGA or stillbirth, HTN - if so umbilical at 26-28

Minor 3x- uterine 20-24 then if abnormal

Question 2

What is needed to see for viable pregnancy

Answer 2

Yolk sac and gestational sac- if not PUL- Bhcg 48hrs

Question 3

Last fatal movement

Answer 3

24 weeks

Question 4

PEC diagnosis alternative

Answer 4

Headache, RUQ instead of proteinuria or organ dysfucntin

Question 5

Ectopic treatment

Answer 5

<1000 IU/L: expectant management
<1500 IU/L: patient’s choice between methotrextate and expectant management
1500-5000 IU/L: patient’s choice between methotrexate and surgery
>5000 IU/L: surgery
NB: The ectopic pregnancy must not be larger than 35mm, there must be no visible heartbeat, and no pain or haemodynamic instability, otherwise surgery is indicated

Question 6

Ectopic vs PID

Answer 6

Ectopic- bowel

Question 7

When to take 5mg folate

Answer 7

HIV on cotrimox, DM, Obese, previous NTD, epilepsy

Question 8

VTE prophylaxis

Answer 8

3RF- 28w until 10d
4RF- 12w until 10d
VTE/previous - 6w pp

RF- 35, 30 BMI, parity 3, smoker, PEC

Question 9

When can’t you give steroids before

Answer 9

24w

Question 10

When is AFP raised

Answer 10

Abdminal wall defect, pat, NTD

Question 11

Hypoechoic bowel

Answer 11

CF, DS, CMV

Question 12

Increased nuchal fold

Answer 12

DS, CHD, Abdo wall

Question 13

People who need OGTT

Answer 13

Obese, asian, FH, >4.5kg- 24-28w

Question 14

When can return to pre pregnancy insulin

Answer 14

As soon as eating

Question 15

How to treat epilepsy initially

Answer 15

As if eclampsia- MgSO4

Question 16

Molar follow up

Answer 16

In specialist centre- normal level of bhcg for 6m before next pregnancy
Methotrexate if rising

Question 17

Aspirin 75mg is given to

Answer 17

If 2 of fat, forty, FH, first

Chronic HTN, kidney, DM, PEC in previous

Question 18

Signs of MgSO4 OD and tx

Answer 18

Hyporelfexia and resp depression

Ca gluconate

Question 19

When to stop Mgso4

Answer 19

24hrs after last seizure or birth

Question 20

Mx of Hep B

Answer 20

Can do vaginally, IVIG and vaccine at birth

Vaccine at 1m and 6m

Question 21

Who require IP ABx

Answer 21

GBS swab, previous child with infection, pre term

Question 22

Signs of AFL

Answer 22

jaundice, epigastric pain, vomitting, hypoglycaemia, thirsty

Question 23

Measuring baby

Answer 23

CRL <14, FL, AC, HC after

Question 24

Birth of twins timing

Answer 24

MCMA: 32 to 33+6 weeks
MCDA: 36 to 36+6 weeks
DCDA: 37 to 37+6 weeks

Question 25

When to give emergency cerclage

Answer 25

16-28w dilated cervix, enraptured

Question 26

Diagnosing pre term LABOUR

Answer 26

>30w- TVUSS- <15mm

Question 27

Diagnosing PPROM

Answer 27

Speculum | IGFBP1

Question 28

PPH management

Answer 28

Bimanual, oxytocin, ergo (not if asthmatic/HTN), carboprost (not in asthmatic) Massage, oxytocin, Balloon tamponade

Question 29

Ix of recurrent Misccariage

Answer 29

Cytogenic analysis of POC, pelvic USS, APL ab, BV- cause not usually found

Question 30

Dose of anti D and kleinhauer

Answer 30

Kleinhauer test only >20w- give anti D within 72 hours of events <20 w 250, > 500U

Question 31

Rash Presents at umbilicus

Answer 31

Pemphigus gestinalis

Question 32

What to give with ECV and when can't do

Answer 32

Tocolytics- nifedipine B agonist- terbutaline Cant do ECV if ROM or multiple

Question 33

What type of speculum are there

Answer 33

Cusco- normal speculum | Sims- for prolapses ?

Question 34

When to use surgery for miscarriage

Answer 34

haemorrhage or infection surgery is better

Question 35

When sterilisation works for women

Answer 35

Laprascopic- contraception for next menstrual period, hysteroscopic- 3months

Question 36

Perineal tear grades and tx

Answer 36

1- vaginal muscoa, 2 perineal muscle, 3a external b >50% external c internal, 4 anal mucosa 1- no repair 2- midwife 3-4- clinician in theatre

Question 37

When to use prophylactic cerclage or vag progesterone

Answer 37

<25mm cervical and hx of miscarriage or PROM

Question 38

When don't you have to give anti D in rheas negative

Answer 38

Small bleed <12w

Question 39

When can you use forceps

Answer 39

``` Fully dilated OA- keiller for OP ROM Cephalic Engaged Pain releif Sphincter empty ```

Question 40

PP grades

Answer 40

1- away from os 2- on internal os 3- partial cover 4- full cover

Question 41

Purpuric foliccularis

Answer 41

Pruritic follicular eruption with papules and pustules mainly on the trunk Looks like acne Resolves within weeks of delivery

Question 42

Mx of dead foetus after abruption

Answer 42

Induce vaginally

Question 43

When to give Abx for mastitis

Answer 43

Infected nipple fissure Symptoms do not improve or are worsening after 12-24 hours despite effective milk removal Bacterial culture is positive.

Question 44

Mx of uterine hyperstimulisation

Answer 44

Stop Oxytocin Check CTG Maybe give tocolytics

Question 45

What condition can be caused by GDM

Answer 45

NTD, fetal respitaroy Syndrome

Question 46

When to screen thyroid at booking

Answer 46

DM, AI, first FHx, prev or current thyroid

Question 47

What condition can cause RDS

Answer 47

GDM

Question 48

Pregnant Wirth fibroid- fever and vomitting

Answer 48

red degeneration, resolves 5-7d

Question 49

When to stop lmwh

Answer 49

24hrs before delivery | Wait until 2hrs before giving epidural

Question 50

Headache and neurology post part- dx and tx

Answer 50

central venous sinus thrombus MRI IV UF heparin