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1
Q

Desiring contraception and skin prone to outbreaks

Best option?

A

COCP: can treat acne too

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2
Q

2 HIV +ve people in sexual relationship. Contraception?

A

Still recommend condoms due to risk of transmission of variants of virus

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3
Q

Inevitable vs incomplete miscarriage

A

Cervix open in incomplete and can be open in inevitable, BUT in incomplete passage of POC has started

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4
Q

Pubic symphisis Rx

A 
Explain and reassure
Normally not helped by analgesics (even paracetamol)
But can offer co-codamol
In severe cases can consider:
Obstetric physio
TENS machine
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5
Q

Maternal anaemia is more common in multiple pregnancy. When to recheck FBC?

A

20-24/40

Recheck again at 28/40 as normal

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6
Q

Indications for aspirin in multiple pregnancy

A

Age >40
First pregnancy in >10 years
BMI >35
FHx pre-eclampsia

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7
Q

When to offer elective birth in multiple pregnancy?

A

Dichorionic: 37/40
Monochorionic: 36/40
Triplets: 35/40

Give steroids in build up to each

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8
Q

Monitoring in monochorionic twins

A

Fortnightly USS to assess twin-twin transfusion

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9
Q

Contraindications to POP

A

Active liver disease

Breast ca

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10
Q

Congenital rubella syndrome features:

A

CCC-SMITH

Cardiac anomaly
Cataracts
Cerebral calcification
Splenomegaly
Microcephaly
Icterus
Thrombocytopenia
Hepatomegaly
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11
Q

Criterion for referral for pre-eclampsia

A

Greater than 30/20 increase from Booking
BP >160/100
BP 140/90 + Sx/proteinuria
Features of IUGR

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12
Q

What is septic pelvic thrombophlebitis?

Px, Ix, Rx

A

Rare post-partum condition

Px: abdo pain and fever during postpartum
Continue to spike despite ABx

Ix: CT/MRI

Rx: IV Heparin - quickly resolves
(long term anticoagulation seldom needed)

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13
Q

What is the National Screening Programme for Downs Syndrome?

A

Nuchal translucency scan at 11-13/40

If risk >1/150, offer amniocentesis or chorionic villus sampling
counsel for risk of miscarriage

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14
Q

Rapidly enlarging central pelvic mass
+/- vag bleeding
+/- mass effect symptoms

A

Uterine leiomyosarcoma

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15
Q

Rx for breech baby

A

External cephalic version

if fail, elective C-section

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16
Q

Most common indication for induction

A

“post dates”

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17
Q

Modes of induction

A
  1. Membrane sweep

2. vaginal prostaglandins in pessary form (commonest medical IOL)

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18
Q

UK Perinatal Mortality Rate

A

Number of neonatal deaths from 24/40 to 7 days old + stillbirths, per 1000

(WHO includes late miscarriage from 22-24/40 but UK does not)

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19
Q

LH:FSH ratio in PCOS

A

2:1-3:1

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20
Q

RFs for uterine rupture

A

High parity
Macrosomia
Previous c-section
Birth within 18months of c-section (Scar still healing)

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21
Q

Commonest cause of maternal death in pregnancy in UK

A

PE/VTE

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22
Q

Amniotic fluid embolism Px + RFs

A

Px: similar to PE

RFs:
trauma
ruptured membranes
traumatic delivery
instrumental delivery
amniocentesis
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23
Q

Which HRT regimen produces withdrawal bleed?
Which HRT regimen is indicated in post-menopausal women as it stops menses?
Which HRT recommended in hysterectomy?

A
  1. Continuous Oes + cyclical Prog
  2. Continuous Oes + Prog
  3. Continuous Oes
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24
Q

Up to what gestation is medical abortion appropriate? What is the therapy?

A

9/40
Mifepristone followed by prostaglandin 48h later

NB. Can also be used 9-20/40 “late medical abortion”

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25
Post partum endometritis Px RFs Rx
2-10days post partum: fever, tachycardia, abdo pain ``` RFs: HIV PROM Retained POC Obesity DM Extremes of productive age Manual removal of placenta ``` Rx: IV ABx +/- septic 6
26
When can secondary PPH happen
24h to 12/52 postpartum
27
Ogilvie syndrome?
pseudoobstruction post surgery/acute medical illness eg. delivery
28
Ovarian cyst classification
o Physiological  Follicular cyst = most common cyst  Corpus luteum cyst o Benign germ cell tumours  Dermoid cyst/teratoma = most common benign ovarian tumour o Benign epithelial cell tumours  Serous cystadenoma = most common benign epithelial tumour  Mucinous cystadenoma ~pseudomyxoma peritonei if ruptures o (NB. Fibroma ~Meig’s syndrome)
29
Most common benign ovarian tumour
Dermoid cyst/teratoma
30
Most common benign epithelial tumour
Serous cystadenoma
31
Meig's syndrome associated with which ovarian cyst
Fibroma
32
Most common ovarian cyst
follicular
33
Cyst associated with pseudomyxoma peritonei
Mucinous cystadenoma (if ruptures)
34
Transient idopathic osteoporosis Px
Hip/Groin pain, unable to weight bear, raised ESR | in THIRD trimester
35
``` Endometrial cancer Px RFs Prognosis Rx ```
Px: postmenopausal bleeding in >55yo REFER TWR + TVUS RFs: oes exposure (COCP and smoking are protective) Prognosis: good Rx: TAHBSO +/- radiotherapy If frail: progestogen therapy
36
Postmenopausal woman with ovarian cyst. | Key Rx?
Urgent referral to gynaecologist for ALL
37
When is booking visit?
8-12/40
38
When is the downs/nuchal scan
11-13+6/40
39
When is the anomaly scan
18-20+6/40
40
In obstetrics, who gets vitamin D replacement?
ALL pregnant AND breastfeeding women
41
Malignant associations of COCP
Increased incidence of BREAST and CERVICAL Reduced incidence of ovarian and endometrial cancer
42
MoA of contraception
All inhibit ovulation EXCEPT: o POP (EXCEPT desogestrel): thickens cervical mucus o IUD toxic to sperm o IUS prevents endometrial proliferation
43
Cervical screening frequency and ages
25-49yo: every 3 years | 50-64yo: every 5 years
44
When to investigate for infertility
After 12 mo of regular intercourse OR After 6mo if >35yo female
45
Diagnostic features of hyperemesis gravidarum
Electrolyte imbalance Dehydration 5% w/l from pre-pregnancy weight
46
Scale for assessment of Postnatal depression
Edinburgh scale
47
Px of vulval cancer
elderly female with itchy, sore, ulcerated lesion on labia majora
48
Molar pregnancy: | Complete mole genetics
o 2 sperm fertilise empty ovum = 46chr all paternal o 2-3% of choriocarcinoma o May see hyperthyroidism
49
Molar pregnancy: | Partial mole genetics
Haploid egg fertilised by 2 sperm or 1 that duplicates = 69 XXX or 69 XXY
50
Hirsutism Ax
``` o PCOS – most common o Cushings o CAH o Primary adrenal tumour o Androgen-secreting ovarian tumour o Androgen therapy o Obesity o Drugs: phenytoin, steroids ```
51
Bacteria involved in BV
anaerobes that replace lactobacilli ie. isolate gram positives and gram negatives
52
Features of congenital VZV
``` MERLS: Microcephaly Eye defects Rudimentary digits Limb hypoplasia Skin scarring ```
53
Management of prem labour (early stages)
Tocolytics + steroids - tocolytics may stop labour - steroids in case of delivery to reduce risk of RDS
54
Vasomotor premenopausal Sx Hx of VTE ?option for Rx
Clonidine
55
COCP and surgery
Stop 4/52 prior | can switch to POP
56
Asymptomatic bacteriuria at booking for pregnancy, treat or not?
Treat
57
Contraceptive patch directions and missed changes
o Change patch every week for 3 weeks, then remove for a week for withdrawal bleed o If patch removal delayed by <48h, immediately change patch + no further precautions o If patch removal delayed be >48h, immediately change + 7/7 condoms + ?emergency contraception o If patch removal delayed at end of 3 weeks: remove and change on upcoming day as normal o If patch application delayed at end of 4 weeks, apply patch + use condoms 7/7
58
Puerperal pyrexia Ddx
Likely endometritis (needs IV ABX eg. Clinda) Other causes: UTI, wound infection, mastitis, VTE
59
Premature babies and vaccinations
Get them as normal, according to chronological age | If <28/40 born, should receive them in hospital
60
SDLD RFs: SDLD prophylaxis?
o DM mother o Male o C-section o 2nd born of prem twins prophylaxis: maternal steroids
61
Gestational DM Dx and Rx
Dx: Screen with OGTT @ booking + 24-28/40  FG >5.6; 2h G>7.8 Rx: FG <7: lifestyle -> add metformin if targets not met within 2 weeks • Add insulin if still not met FG>7: start insulin FG 6-6.9 + evidence of complications: start insulin If cannot tolerate metformin or decline insulin: glibenclamide
62
Post partum emergency contraception
o EC not required prior to 21/7 o After 21/7: Progesterone only EC (Levonelle, EllaOne) can be used o Do not insert Cu IUD prior to 28/7 o B-F 98% effective if fully BF, amenorrheic and <6mo
63
Contraception time until effective
o Instant = IUD o 2 days = POP o 7 days = all else
64
Contraceptive of choice in younger people
Nexplanon/Prog implant: - easier compliance - lasts 3 years!
65
Contraceptives unaffected by enzyme induction
IUD IUS Depoprovera
66
COCP if breastfeeding?
Breastfeeding <6/52 postpartum = UKMEC 4
67
Pharm emergency contraceptives, within what time frame can they be used?
* Levonelle ~72h * EllaOne ~120h, avoid in sev. Asthma Both can be used >1x/cycle
68
Nitrofurantoin + pregnancy
Can be used in early preg but avoid near term due to neonatal haemolysis risk Cefalexin or amox instead
69
C/Is to foetal blood sampling
Maternal HIV/Hep Foetal haemophilia Delivery <34/40
70
Medical abortion Rx
Mifepristone -> Misoprostol NB. Mifepristone sensitises myometrium to prostaglandin-induced contractions
71
Incomplete abortion Rx
Misoprostol
72
Precocious puberty definition
Puberty <8 in females; <9 in males
73
Mcune-Albright Syndrome Px
unilateral cafe au lait spots precocious puberty polyostotic fibrous dysplasia ~fractures
74
POF definition and RFs
= onset of premenopausal Sx + elevated FSH/LH at <40yo ``` RFs:  Chemo  Radio  AI  Idiopathic ```
75
RFs for hyperemesis gravidarum
- Hx eating disorder - molar pregnancy - multiple pregnancy - primp NB. Smoking not a RF (actually more common in non-smokers)
76
When should child with mother who has HIV be tested for ANTIBODY
18mo
77
Antihypetensives in pregnancy
Labetalol Methyldopa Hydralazine Nifedipine
78
RFs for retained placenta
``` Age >35 >5 births Prematurity Hx PPH INDUCED labour ```

Tomakesense 2 (18 decks)

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