Extra Flashcards
Describe the use of HIV PEP
Must be taken within 72 hrs
Taken for 28 days
When is tocolysis given?
If between 26 - 29+6 weeks in suspected preterm labour
What pain relief to use after birth?
Paracetamol, ibuprofen or dihydrocodeine
What is the acid base balance during pregnancy?
Respiratory alkalosis
Metabolic acidosis
What are the timeframes for retrieving forensic samples post sexual assault?
48hrs = VVS for digital penetration, oral penetration 72hrs = anal swabs 168hrs = VVS for vaginal penetration
What is lymphogranuloma venereum?
Chronic infection of lymphatic system due to chlamydia
Causes enlarged nodes, fever, muscle pain
HIV window testing times
The earliest you can be tested positive for HIV is 2 weeks post exposure, but 95% likely if tested at 4 weeks
What is HIV PREP?
Daily pill that can protect HIV negative people if taken every day
What types of retroverted uterus is normal + abnormal?
Retroverted + mobile = fine
Retroverted + fixed = adhesions/ PID
When can emergency contraception not be offered?
When zygote has implanted
If after 5 days of ovulation + 5 days after unprotected sex
When can you have unprotected sex after having the implant + injection?
7 days
What measurement increases in the fetus of DM mum?
AC
What is the quadruple test + when can it be done?
hcg, AFP, inhibit A, Ue3 (unconjugated estriol).
Used for 2nd trimester testing from 14+2 – 20 weeks
How many mothers get PND + psychosis, and how many dads?
1 in 10 mothers get PND
1 in 1000 get puerperal psychosis
1 in 25 fathers get PND
What is the cutoff % rise for ectopic pregnancy?
Rise <66% in 48hrs
What drug is misoprostol?
PGE1
What do NICE recommend for miscarriage?
2 weeks expectant
Salpingectomy vs salpingotomy
Salpingotomy is tube sparing but likely to be damaged + therefore ectopic again
When do you aim for delivery with pre-eclampsia + pregnancy induced HTN?
37 weeks
PIH = 40 weeks
What are the signs of pre-eclampsia + PCR ratio?
Hyperreflexia + clonus
Ratio >30
What liver enzyme is usually high during pregnancy?
ALP - secreted by placenta
What is the danger with vasa praevia + ARM?
Vasa praevia – fetal blood vessels run through membrane. Will cause fetal blood loss if ARM
What are the complications of placental abruption?
DIC
How thick an endometrium is worrying?
> 4mm
What are the causes of PMB?
Atrophic vaginitis
Endometrial cancer
Cervical pathology
Breakthrough bleed on HRT
What organisms cause endometritis?
Caused by group A strep, gram neg + anaerobes
Most common SE of progesterone only contraception?
Change in bleeding pattern
When is emergency contraception required?
EC needed any time in cycle, after day 21 postpartum, after day 5 of abortion or miscarriage
What are the CI of Ulipristal?
Cannot be used within 5 days of another hormonal contraception
What contraceptions are affected by enzyme inducers?
COCP, POP, implant, oral EC
What contraceptions are not affected by enzyme inducers?
depo, IUS, IUD
What are the Fraser guidelines?
Understands advice
Doctor could not persuade them to tell parents
Likely to begin or continue having sex
In best interests
Without contraception, health would suffer
What is the aim of HIV treatment?
Aims to reduce viral load to <50 copies + allow CD4 recovery
What is the treatment of PID?
Ceftriaxone, doxycycline + metronidazole
When do mothers begin to feel fetal movements?
Reduced fetal movements
What infection screens are done at booking?
HIV, Hep B + C, syphilis
What is the MAGPIE trial?
magnesium sulphate in Pre-E
What is the CLASP trial?
Low dose aspirin in next pregnancy if pre-eclampsia in this one
When can you do a FBS, and what readings indicate delivery + retesting?
only if >3cm dilated
<7.2 = deliver
7.2-7.25 repeat in 30 mins
When can you see a fetal pole + fetal heart activity on USS?
fetal pole at 6 weeks
fetal heart activity at 6-7 weeks
When will a TVUSS show a IUP?
hCG >1500
What is the management of endometrial cancer?
MRI, TAHBSO +- RT
What is the management of ovarian cancer?
tumour markers, CT, cytoreductive surgery + chemo
What is the management of cervical cancer?
cone biopsy, surgery, RT
When should you do a VE?
Only in labour
What reduces your risk of pre-eclampsia?
Smoking
When is the screening for GDM?
26 weeks
16 weeks if previous GDM
What are the restrictions if giving prophylactic + therapeutic LMWH before delivery?
12hrs must pass after last dose of prophylactic dose before epidural or spinal
24hrs must past after last dose of therapeutic dose before epidural or spinal
What are the components of the Bishops score?
Cervical dilation Cervical effacement Cervical consistency Cervical position Fetal station
Meaning of different Bishops scores - max score, cut off for favourable induction
Max score = 13
>8 = induction likely to be successful
<6 = induction likely to be unsuccessful
What are the types of forceps commonly used in delivery?
Simpson = used when baby’s head is cone shaped
Elliot = used when baby’s head is round
Kielland = used for rotation
Wrigleys = used to reduce risk of uterine rupture if baby is high
Neville Barnes = used when no rotation is needed
Most common type of ovarian cancer?
Serous
What is shouldering on a CTG?
Fetal heart rate rise before + after deceleration = coping well
What are the causes of fetal tachycardia on CTG?
Maternal pyrexia, hypoxia, prematurity, salbutamol use, fetal distress
When is B lynch suture used?
Atonic uterus
What are the normal blood result changes during pregnancy?
WCC high, ALP high
albumin low, Hb low, platelets low
First line management of fibroids?
Myomectomy
What is the difference between total + subtotal hysterectomy?
Total = cervix + uterus Subtotal = just uterus
