Passmed OG Flashcards by Phoebe Kendal

First line treatment for urge incontinence?

Bladder retraining

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First line treatment for stress incontinence?

Pelvic floor muscle training

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What is used in medical management of a miscarriage?

Vaginal misoprostol

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What is used in the medical management of an ectopic pregnancy?

IM methotrexate

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Why would we give MGSO4 to pregnant ladies?

In eclampisa to prevent seizures

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Symptoms of PMS?

Anxiety, stress, fatigue, mood swings, bloating and breast pain

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Management of PMS?

Mild = regular small complex carbohydrates 
Moderate = new COCP
Severe = SSRI (sertraline)

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What are the stages of ovarian cancer?

1 = confined to ovaries
2 = local spread within the pelvis
3 = spread beyond the pelvis to the abdomen

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Presentation of ovarian cancer?

Abdominal distention and bloating 
Abdominal and pelvic pain 
Urinary symptoms 
Early satiety 
Diarrhoea

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Investigations for ovarian cancer?

CA125

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Bishop score is inversely correlated with…

Labour duration

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What does a bishop score of <6 suggest?

Cervical ripening is needed

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What is the most common cause of early-onset severe infection in the neonatal period?

Group B streptococcus

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Presentation of vulval carcinoma?

Lump or ulcer on labia majora, can be itching and irritation

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Presentation of vulval intraepithelial neoplasia?

White or plaques

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What does high beta hCG, low TSH and high thyroxine suggest?

Molar pregnancy

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What is a complete hydatidiform mole?

Benign tumour of trophoblastic material.

Empty egg is fertilised by a single sperm, then duplicates its own DNA. All 46 chromosomes are of paternal origin

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Presentation of molar pregnancy?

Bleeding in first or early second trimester
Exaggerated symptoms of pregnancy (hyperemesis)
Uterus large for dates
High hCG
Hypertension and hyperthyroidism

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What is a partial mole?

A normal haploid egg fertilised by either
- 2 sperm
- 1 sperm with duplication of paternal chromosomes
DNA is both maternal and paternal but is triploid

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When can expectant management be used in an ectopic pregnancy?

Unruptured embryo, <35mm, no heartbeat, asymptomatic, declining B-hCG

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Can you prescribe contraception to a 13 year old?

NO - even if competent

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What secretes hCG?

Syncytiotrophoblasts

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Function of hCG?

Maintains production of progesterone by corpus luteum in early pregnancy

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When can hCG be detected?

8 days after conception

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When do hCG levels peak?

8-10 weeks gestation

What is a simple cyst?

Unilocular - more likely to be physiological or benign

What is a complex cyst?

Multilocular - more likely to be malignant

Management of a cyst in a post-menopausal woman?

REFER to gynaecology

What is the McRobert's manoeuvre?

Patient supine with both hips fully flexed and abducted. | Used in shoulder dystocia

What methods of contraception are contraindicated in smokers?

all combined hormonal methods: | COCP, patch, vaginal ring

Risks for hyperemesis gravidarum?

``` Multiple pregnancies Trophoblastic disease Hyperthyroidism Nulliaparity Obesity ```

Is smoking associated with hyperemesis?

Smoking is associated with a DECREASED incidence of hyperemesis

1st line treatment for hyperemesis gravidarum?

Antihistamines

What is the primary mode of action of the contraceptive implant?

Inhibition of ovulation

What is the mode of action of the COCP?

Inhibits ovulation

What is the mode of action of the POP?

Thickens cervical mucous

What is the mode of action of the intrauterine contraceptive device?

Decreases sperm motility and survical

What is the mode of action of the intrauterine system?

Prevents endometrial proliferation

Name the 3 types of emergency contraception?

Levonorgestrel Ulipristal IUD

What is the first line treatment for pre-eclampsia?

Labetalol

What is the first line treatment for pre-eclampsia in a patient with asthma?

Nifedipine | labetalol is contraindicated in smokers

What is a 'white curdy discharge, pH <4.5' likely to suggest?

Candidiasis

Treatment for chlamydia?

Oral doxycycline

Name the causes of infertility?

Male factor, unexplained, ovulation failure, tubal damage

What would a '6-8 week amenorrhoea with lower abdominal pain and vaginal bleeding'?

Ectopic pregnancy

What is a threatened miscarriage?

Painless vaginal bleeding occurring < 24 weeks. Cervical os is closed

What is a missed/delayed miscarriage?

Gestational sac containing a dead foetus <20 weeks without symptoms of expulsion.

What is an inevitable miscarriage?

Cervical os is open. | Heavy bleeding, clots and pain

What is an incomplete miscarriage?

Not all products of conception have been expelled

What is placental abruption?

Separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space

Features of placental abruption?

Constant pain Tender, tense uterus Normal lie and presentation Foetal heart absent or distressed

What is the 1st line investigation for post-menopausal bleeding?

TVUS

Causes of postmenopausal bleeding?

``` Vaginal atrophy HRT Endometrial hyperplasia Endometrial cancer Cervical cancer Ovarian cancer Vaginal cancer ```

What is vaginal atrophy?

Thinning, drying and inflammation of the vagina due to a reduction in oestrogen following the menopause

At age 25-49 what is the timeframe for routine smears?

3 years

At >50 what is the timeframe for routine smears?

Every 5 years

What cardiovascular changes occur in pregnancy?

Increase SV, HR and CO | Diastolic BP reduced in early pregnancy, returns to normal at term

What respiratory changes occur in pregnancy?

Pulmonary ventilation, tidal volume increase. Fall in pCO2 BMR raised

What is an amniotic fluid embolism?

Foetal cells/amniotic fluid enter the mothers bloodstream

Presentation of amniotic fluid embolism?

During labour or post-partum | Chills, shivering, sweating, anxiety and coughing

Is it safe to breastfeed while on anti-epileptics?

Yes

Effect of sodium valporate during pregnancy?

Neural tube defects

What is the least teratogenic of the anti-epileptics?

Carbamezepine

Effect of phenytoin during pregnancy?

Cleft palate

Which form of LARC is current breast cancer a contra-indication for?

Injectable progesterone contraceptives

1st line investigation for endometriosis?

Laparoscopy

Presentation of endometriosis?

Chronic pelvic pain Dysmenorrhea Deep dyspareunia Urinary symptoms

If a woman presents with a 'heavy, dragging' sensation, what does this suggest?

Urogenital prolapse

What is placenta accreta?

Attachment of the placenta to the myometrium, due to a defective decidua basalis. As the placenta does not properly separate during labour there is a risk of post-partum haemorrhage

What are the risk factors for placenta accreta?

Previous C section | Placenta praevia

Can you use aspirin while breastfeeding?

NO. | It is associated with Reye's syndrome which can cause liver and brain damage

What drugs should be avoided in pregnancy?

``` Antibiotics (ciprofoxaxin, tetracycline, chloramphenicol, sulphonamides) Psyhciatric durgs (lithium, benzodiazepens) Aspirin Carbimazole Methotrexate Sulfonylureas Cytotoxic drugs Amiodorone Clozapine ```

What is the 1st step after chicken pox exposure in pregnancy?

Check varicella antibodies

What are the features of foetal varicella syndrome ?

Skin scarring, eye defects, limb hypoplasia, microcephaly and learning disablilities

What should you do if the pregnant woman <20 weeks is exposed to chickenpox and is not immune?

Give varicella-zoster immunoglobulin

What are the risk factors for endometrial cancer?

``` Obesity Nulliparity Early menarche Late menopause HRT Diabetes mellitus PCOS HNPCC ```

How does endometrial cancer present?

Postmenopausal bleeding If in premenopausal = change intermenstrual bleeding Possibly pain and discharge

1st line investigation in endometrial cancer?

TVUS | Hysteroscopy with endometrial biopsy

Treatment for endometrial cancer?

Total abdominal hysterectomy with bilateral salpingo-oophorectomy

Name the 2 protective factors for endometrial cancers?

COCP | Smoking

What is a cord prolapse?

Umbilical cord descending ahead of the presenting part of the foetus.

Management of cord prolapse?

Presenting part of foetus may be pushed back into the uterus to avoid compression. Tocolytics can be used. If the cord is past the level of the introitus it cannot be pushed back, and a C section is performed.

What blood markers are measured in Down Syndrome?

Beta-human chorionic gonadotrophin (beta-hCG) and pregnancy associated plasma protein A (PAPP-A)

What test results show down-syndrome?

Increased HCG, decreased PAPP-A and thickened nuchal translucency