Oral Exam Flashcards
(107 cards)
1
Q
Endometrioma on uss
A
Ground glass echogenicity
1-4 compartments
No papillary structures with detectable blood flow
2
Q
Cancers more common in women with endo
A
Non Hodgkin’s lymphoma
Ovarian cancer
However no increase in overall incidence of cancer in these women
3
Q
Danazol
A
Weak androgen and anabolic steroid and a functional anti estrogen
SE of Acne, excessive hair growth, voice deepening, breast atrophy, adverse lipid profiles
Monitor liver function
4
Q
Risks of glycine overload
A
Fluid overload
Hyponatremia
Hyperammonemia
5
Q
Vasa praevia types
A
1 = associated with velamentous cord insertion 2 = bilobed placenta or succenturiate lobe
6
Q
Risks of AMA
A
Mum = GDM, PET/PIH
Baby = miscarriage, chromosomal abnormalities/malformations, IUGR, IUD, PTB
7
Q
Uterine artery Doppler assessment
A
For screening for severe growth restriction or PET
If abnormal at 20 weeks repeat at 24/40
Notching after 24 weeks is abnormal
8
Q
When to perform MCA PI
A
SGA/FGR with abnormal UAPI at any gestation
>34/40 if normal UAPI
9
Q
Diagnosis of sGR in twins
A
EFW discordance of >25% or EFW one twin <10th centile
10
Q
Issues with ACEi in pregnancy
A
Risk of fetopathy - controversial but possible
T2/3 exposure - impaired renal function, oligohydramnios
Anuria and renal failure post partum
11
Q
Overall risk of complications dependent on birth type
A
Elective CS 7%
Emergency CS in labour 16.3%
Instrumental vaginal birth 12.9%
12
Q
Stillbirth numbers based on gestation
A
- 4/1000 after 39/40
4. 6/1000 at 41/40
13
Q
What is dolichocephaly
A
An elongated fetal head
14
Q
Three features that help dustinguish AFLP from HELLP syndrome
A
Profound hypoglycaemia
Marker hyperuricaemia
Coagulopathy in absence of thrombocytopenia
15
Q
Rationale for betamethasone
A
Decreases incidence and severity of RDS
Decreases mortality
Decreases ICH and NEC
16
Q
Antenatal corticosteroids maternal and fetal risks
A
Maternal = transient hyperglycaemia, 30% increase in total leukocyte count, may be an increase in uterine activity.
Fetal = may have a decrease in FHR variability, transient improvement in UAPI, neonatal hypoglycaemia
17
Q
Side effects and contraindications to nifedipine for tocolysis
A
SE = nausea, flushing, headache, dizziness, palpitations, increased heart rate. No fetal concerns.
CI = hypersensitivity to drug, hypotension, pre load dependent cardiac lesions, and caution if HF with reduced EF
18
Q
Terbutaline for tocolysis
A
Beta 2 agonist
Increase in maternal HR and SV observed (tremor, palpitations, SOB, chest discomfort)
SC 250mcg every 20-30 mins to max 4 doses until tocolysis achieved
19
Q
Metabolic effects of terbutaline
A
Hypokalaemia
Hyperglycaemia
Lipolysis
20
Q
Difference between Bell’s palsy and Ramsay hunt syndrome
A
Identifical unilateral facial palsy in both conditions.
In RHS there are herpetic vesicles in the external auditory meatus and occasionally the soft palate
21
Q
Define Bell’s palsy
A
Unilateral LMN weakness of the facial nerve
Due to herpes zoster, simples or can be related to pregnancy or pre eclampsia.
Short 2 week course of steroids can speed or increase chance of recovery if commenced within 24-72 hours of onset of symptoms.
22
Q
Which epileptic patients require vitamin K in the last 4 weeks of pregnancy
A
Women on phenytoin, carbamazepine, and phenobarbitone.
23
Q
Diagnosis of pemphigoid gestationis
A
Skin biopsy - direct immunoflourescence shows C3 deposition at BM zone
In most cases, indirect immunofluorescence on serum will show antibodies
24
Q
Fetal risks of pemphigoid gestationis
A
IUD
LBW
PTB
10% neonates will have a similar bullous skin eruption
25
Why is misoprostol preferred regime for IUFD IOL
Superior to oxytocin as shorter induction to birth interval, shorter duration of hospital stay, lower complication rates.
26
Lactation suppression
Dostinex 1mg within 24 hours of birth
Superior to bromocriptine
Dizziness, headache, nausea the main side effects
Avoid in women with PET/postpartum HTN
Offered with a fetal loss from 20/40 or medical conditions that are not compatible with breastfeeding
27
Ebsteins anomaly
Malformation of tricuspid valve and right ventricle.
Apical displacement of the septal leaflet of the TV and displaced anterior leaflet.
1/1000 risk if on lithium (1/20,000 population)
28
Features of warfarin embyropathy
```
Chrondrodysplasia punctate
Midface hypoplasia
Short proximal limbs
Short phalanges
Scoliosis
```
29
Reversal agents for warfarin and LMWH
Warfarin - vitamin K and FFP
| LMWH - protamine sulphate
30
Concern with paroxetine and tamoxifen
Shouldn’t be prescribed together as paroxetine may inhibit tamoxifen metabolism
31
Non pharmacological management of VMS
Black cohosh - reduces hot flushes but reports of liver damage
Vitamin E - marginal efficacy. 800-1000IU/day
CBT - some benefit
32
Classic triad rubella
Deafness
Cardiac disease
Cataracts
33
Differential diagnosis of discordant nuchal translucency in twins
Aneuploidy
Early TTTS
Structural abnormality - especially heart
34
Risks of fetoscopic laser therapy
```
PPROM
Fetal death
Infection
Abruption
80% chance survival of one twin with 80% chance of being neurologically intact
```
35
Indications and risks of ovarian drilling
Second line therapy for women with PCOS who are clomiphene resistant with anovulatory infertility.
Risk of reduced ovarian reserve and loss of ovarian function and adhesion formation
36
IVF ovulation triggers
Done when 2 or more follicles of 18 or more mm are identified and estradiol > 200
Options include
- urinary and recombinant hcg
- recombinant LH or GnRH agonist (if In an antagonist cycle)
37
Investigations for hydrops
Tertiary anatomy scan, MCA PSV and fetal ECHO
Maternal FBC, group and antibody screen, Hb electrophoresis
Kleihauer
Infectious serology - torch, parvovirus, varicella, syphillis
Amniocentesis for karyotyoe
38
Consequences of congenital CMV infection
```
SNHL
Chorioretinitis
Hepatitis
Pneumonia
Thrombocytopenia
Jaundice
Intellectual impairment
Death
```
39
Monitoring in a kell positive pregnancy
First confirm Fetus susceptible - partner genotype, if positive then fetal testing
Fortnightly MCA PSV from 18/40
IUT if anaemic
MFM
40
Kell kills why?
Suppresses erythropoiesis and causes hemolysis
41
Investigations for thrombocytopenia at booking
APL antibodies
ANA, dsDNA for lupus
Liver and renal function tests
Anti-platelet antibodies
If very low, re check to confirm not an error
Viral serology - rubella, mumps, varicella, parvovirus, hepatitis C, EBV
42
Differential diagnosis for early neonatal death
```
Prematurity
Congenital infection
Sepsis
Thrombosis
Tumour
NAIT
Perinatal asphyxia
```
43
Investigations for NAIT
Maternal HPA genotype
| Paternal HPA genotype
44
Antenatal Management of pregnancies at risk of NAIT
Referral to MFM
Tertiary imaging to exclude fetal ICH
Offer IVIG from 16-18/40
Serial ultrasounds every 2-4 weeks for growth and fetal brain review
Elective Caesarean section at 37 weeks preferred MOD. Can consider IOL in multips around 38/40 with avoidance of ventouse, forceps, FBS/FSE
45
Postnatal management of NAIT
```
Cord blood for platelet count
Platelet transfusion if <30
Vitamin K
USS head to assess for ICH
FBC daily until platelets stable at >100
```
46
What does APGAR encompass?
```
Breathing
Colour
Tone
HR
Reflex irritability
```
47
Management of latent syphillis
IM benzathine penicillin weekly for three weeks. Needs 4 weekly RPR titres to monitor response.
Monthly growth scans
Risks to baby of syphilis = IUGR, IUD, hydrops, PTB, congenital infection and anomalies
48
How does acetic acid work?
Dehydrates cells so that squamous cells with large or dense nuclei reflect light and appear white
Blood vessels and columnar cells not affected
49
How does lugols iodine work?
Glycogen containing cells take up iodine and become dark brown.
Non glycogenated cells such as normal columnar or glandular cells, high grade lesions and many low grade lesions do not take up iodine and remain light yellow.
50
Indications for UH instead of LMWH for PE management
Significant renal impairment
Higher risk of bleeding
Massive PE with CV compromise
Rapid reversal required
51
Short term side effects of radiation
```
Fatigue
Nausea
Skin changes
Anaemia/leukopenia
Radiation cystitis, proctitis, vaginitis
```
52
Causes of ambiguous genitalia
```
CAH
5 alpha reductase deficiency
Tumours
Maternal hormones in pregnancy
Androgen insensitivity syndrome
```
53
Chromosome abnormalities not detected by microarray
Balanced chromosome rearrangement
Triploidy
Mosaicism
54
What is a Copy number variant of unknown significance?
Alteration of a segment of DNA where there is limited information/evidence regarding its prognosis
55
Indications for intervention with a fetal Brady arrhythmia
FHR <55
Hydrops
Evidence of deterioration in cardiac function
56
Investigations for RPL
```
Karyotype
Antiphospholipid antibodies
TSH, T4, thyroid antibodies
HbA1c
Pelvis USS
Thrombophilia screen
Cytogenetics on POC if available
```
57
Women who benefit from aspirin prophylaxis in pregnancy
```
Previous preg with PET
Diabetes
Chronic hypertension
Multi fetal gestation
Kidney disease
Autoimmune disease eg SLE, APLS
```
58
Complications of an incarcerated uterus
```
Urinary retention
Bladder rupture
PTL
PPROM
IUD
Uterine rupture
```
59
Investigations for POI
```
Karyotype
Pelvic USS
FMR1 mutation
Hcg
Prolactin
TSH and thyroid antibodies
AMH and estradiol
Anti adrenal antibodies
DEXA
```
60
Abnormal testicular size
<15mls volume or length <3.6cm is abnormal
61
Azoospermia investigations
```
FSH, LH, testosterone
Karyotype
Y chromosome microdeletion
CFTR gene mutations
Scrotal ultrasound
Anti sperm antibodies
```
62
How does clomiphene work
SERM modulator
At hypothalamus it blocks the negative feedback due to estrogen
At pituitary it increases the response to GnRH
In the ovary in a low estrogen environment it acts as an agonist and enhances FSH stimulation of LH receptors on granulosa cells.
63
Lithium and BPAD and pregnancy
PTB, LBW, cardiac anomalies
Used for refractory cases. Safer options are respiradone, lamotrigine or Quetiapine
64
Circumstances to exercise caution with vaginal mesh
Patients younger than 50
Primary prolapse repair
Posterior prolapse without significant apical descent
Patients where Ovestin use is contraindicated as this is the primary management of mesh erosion
Chronic pelvic pain
Lesser grades of prolapse
65
When may the ilioinguinal and iliohypogastric nerves get injured?
During transverse suprapubic incision (avoid extending beyond lateral borders of rectus muscle)
Lateral trocar insertion (place higher than ASIS)
Injury leads to numbness of suprapubic region, or labia majora and medial thigh
66
Injury to the genitofemoral nerves
Compression with retractor blade or excessive flexion of hip in Lithotomy
Damage causes numbness of medial thigh and lateral labia
67
Obturator nerve injury
During pelvic lymphadenectomies or pelvic support procedures
Leads to weakened thigh adduction and numbness of inner thigh
68
Pudendal nerve damage
During sacrospinous fixation or uterosacral ligament suspension
Perineal and vulva pain
69
Posterior branches of internal iliac
Iliolumbar
Lateral sacral
Superior gluteal
70
Anterior branches of internal iliac artery
```
Pudendal
Inferior gluteal
Middle rectal
Vesical/vaginal, interior vesical
Obturator
Umbilical
Uterine
```
71
Principles of bladder repair
Identification
Referral to urogynae or urologist if not within scope
Completion of other dissection
One or two layer closure with 2.0 or 3.0 vicryl, continuous or interrupted
Confirmation with methylene blue
IDC 10 days
Cystogram prior to removal
72
Uterine inversion recurrence rate
33%
73
Dose of ergometrine
0.25mg slow IV or IM
| Q5 minutes to a max of 4 doses (1mg)
74
Major finding of the term breech trial
Perinatal mortality and serious morbidity was significantly lower in planned caesarean group With a RR of 0.33
75
Stages of selective IUGR in monochorionic pregnancies
Stage 1 = positive diastolic velocities in both twins
2 = AREDV in one or both
3 = cyclical waveforms in umbilical a
76
Management for pregnancies post fetoscopic laser coagulation in TTTS
Initially weekly USS of fetal brain, heart, limbs, Doppler’s
If normal after two weeks can return to standard fortnightly intervals
77
TTTS timing of delivery
34-36+6 weeks
| Caesarean section generally
78
Risks of lithium in pregnancy
Lbw
PTB
Polyhydramnios
Cardiac
Therefore serial growth, counsel PTB, and tertiary anatomy scan + consideration of echo
PN risks of lithium toxicity - poor feeding, lethargy, hypotonia
79
Which conditions require lactation suppression
HIV
Lithium use by mum
IUFD
80
CMV sequelae in utero and neonatal
T1 = SGA, microcephalic, intracranial clarifications
After 20/40 more likely to have visceral disease eg pneumonia, hepatitis, petechiae, jaundice
Neonate = SNHL, seizures, developmental delay, chorioretinitis
81
Treatment of primary HSV in pregnancy
Valaciclovir 1g po bd for 7/7
Lignocaine gel
Analgesia
Return advice on passing urine
82
Indication for tenofovir use in pregnancy
If high viral load of HBV DNA > 200,000 then offer 200mg/day tenofovir from 30/32 weeks and continue until 6/52 postpartum
83
Side effects of HAART in pregnancy
Safe
Hyperglycaemia therefore OGTT
Anaemia
Hepatototoxicity
Require viral load, LFTS, and CD4 count 1-2 monthly and at 36/40
84
Syphillis in utero findings
Hepatomegaly
Hydrops
Placental thickening
85
Treatment of varicella zoster in pregnancy
Aciclovir 800mg po five times daily for 7/7, supportive cares, written info
Refer MFM
Amnio >5/52 post infection
86
In utero findings of toxoplasmosis
Hydrocephalus
Brain and hepatitic calcifications
Ascites
Hepatosplenomegaly
87
Pregnancy risks in women with turners syndrome
```
PET
Coarctation of the aorta
Turners in offspring if own eggs
C/S
CPD
```
88
Issues related to turners syndrome
```
Growth
Hormonal/puberty
Fertility
Cardiac
Skeletal
Renal
Autoimmune
```
89
Mirena counselling
LARC
52mg levonorgestrel
Releases 20 micrograms per day
97% women will have significant reduction in blood loss by one year
Up to 50% become amenorrhoeic
Protects endometrial hyperplasia/carcinoma
90
Medical management of endometriosis
Hormonal contraceptives
Progestogens - MPA oral or depo, mirena, NE
Anti- progestogens - gestation on
GnRH - eg goserelin/zoladex with add back estrogen
Aromatase inhibitors for refractory cases in use with other hormonal treatmnet
91
Adhesions prevention in endometriosis
Only evidence specific to endometriosis is surgicel (oxidised regenerated cellulose).
It is also bactericidal to a range of gram negative and positive anaerobes and aerobes
92
E+P breast cancer risk
1/1000 more cases
| Unlikely significant however with <5 years of use
93
Criteria for fertility sparing treatment in cervical cancer
Ib1 or lower
Tumour <2cm maximal diameter
Confined to cervix
Negative lymph nodes
If 1a1 or 2 then cone or simple trachelectomy
If 1b1 then radical trachelectomy
94
Indication for pelvic lymph node dissection in cervical cancer
Fertility sparing desired
Ia2 or higher disease where there is no evidence of enlarged/suspicious nodes on imaging and primary surgery is being performed
95
Difference between Lloyd Davis and Lithotomy
Lloyd Davis = 30 degree trendelenburg with hip flexion at 15 degrees
Lithotomy = no trendelenburg, variable hip flexion and external rotation
96
Borders of pelvic lymph node dissection for cervical cancer
Deep circumflex iliac vein causally to common iliac artery cephalid.
Any suspicious nodes sent for frozen section of fertility sparing
97
1A vs 1B disease of the vulva
a = tumour = 2cm and stromal invasion =1mm
B = greater than A but no extension to urethra/vagina/anus. Needs LN assessment as 8% positive nodes
98
VWD types
Type 1 = quantitative defect. Improves in pregnancy as factor 8 and VWF increases
Type 2 = qualitative defect and thrombocytopenia worsens
Type 3 = severe quantitative deficiency and VWF does not increase with gestation
99
Treatments to increase platelet count in ITP
Steroids
IVIG
Azathiopine
Platelet transfusion
100
Treatment of a thyroid storm
Beta blockers
Thionamide - eg PTU
Supportive cares - IVF
Glucocorticoids (reduces conversion of T4 to T3)
101
Fetal risks of pemphigoid gestationis
PTB
IUGR
IUD
Bullous eruption in 10%
102
Fetal investigations in red cell alloimmunisation
Hb
Bilirubin
Direct anti globin test
Paed review
103
Blood analyses in an MSS2
AFP
Ue3
Bhcg
Inhibin
104
Risks of SSRI in pregnancy
Small increase in neonatal convulsions
| Neonatal adaptation syndrome and NICU admission
105
What is neonatal adaptation syndrome?
```
Respiratory distress
Feeding difficulty
Jitteriness
Irritability
Temperature instability
```
106
Routine pregnancy surveillance of anti-Ro or anti-La positive
Auscultation of FHR from 16/40 weekly to screen for complete heart block
If suspected then fetal echo
ECG and likely ECHO at birth
107
Risk of fetal infection with parvovirus
8-20% maternal infection if exposure and susceptible
50% risk of fetal infection
10% excess fetal loss
3% risk of hydrops
