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Joshua's OnG > Genral > Flashcards

Genral Flashcards

1
Q

What is the treatment used in medical abortion and what are the time frames for doing so?

A

Up to 9 weeks: 200mg mifepristone orally followed by 800mcg misoprostol vaginally/sublingually.

Over 9 up to 13+6: 200mg mifepristone orally followed by 800mcg misoprostol vaginally/sublingually, then 400mcg every 3 hours until abortion occurs.

Always offer analgesia

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2
Q

What surgical abortion methods are used. When are they used? What are the risks?

A

Vacuum aspiration with large bore cannulae or dilation and evacuation.

Used greater than 14 weeks.

Uterine rupture
Bleeding requiring transfusion
Cervical damage.
Future scarring and infertility.
Infection - UTI give you some antibiotics - doxycycline
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3
Q

Reasons for termination of pregnancy.

A

A - risk to mothers life.
B - prevent grave permanent injury to mothers physical or mental health.
C - prevent risk of injury to physical or mental health of mother (24wk)
D - prevent risk to existing child(ren) of the family.(24wk)
E - child born would suffer from handicap
F - emergency save mothers life.
G - emergency prevent grave danger

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4
Q

Recommended dose of aspirin for PIH

A

75mg OD low dose aspirin. FROM 12weeks. Until birth
Risk factors : t2DM, CKD, hypertensive disease in previous preg, autoimmune disorders.

Greater than 140 s or 90 d or increase above booking of 30 s or 15 d

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5
Q

3 anti emetics used in pregnancy

A

Cyclizine
Metoclopramide
Prochlorperazine

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6
Q

Safest anti- epileptics in pregnancy

A

Lamotrigene
Carbimazepine

Valproate is causes neural tube and craniofacial defects.

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7
Q

Hyperthyroidism treated with?

A

Propylthiouracil is preferred to carbimazole as less likely to cross placenta

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8
Q

Which antihypertensives should not be used in pregnancy? Why?

A

Ace inhibitors as causes renal dysgenesis and craniofacial abnormalities

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9
Q

When shouldn’t certain UTI antibiotics be used?

A

Don’t use trimethoprim in first trimester due to being a folic acid antagonist
Don’t use nitrofurantoin in third trimester due to neonatal haemolysis

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10
Q

what is the cut off for anaemia in pregnancy

A

1st T: 110
2nd/3rd T: 105
post: 100

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11
Q

When would you consider giving parenteral iron

A

when oral iron is not tolerated or there is no time before delivery.

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12
Q

Do you need bleeding to diagnose abruption

A

no - oly 80 percent of cases

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13
Q

What are the risk factors for abruption

A 
age(increasing)
smoking
cocaine or other drug use
maternal hypertension
trauma
previous abruption
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14
Q

How do you manage PID

A

Test for chlamydia and gonnorhoea
treat with antibiotics - empirically if severe and suspicions are high
remove intrauterine devices unless very mild.

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15
Q

what are the main complications with PID?

A 
10-20% after single episode.
chronic pelvic pain
ectopic
fitz hugh curtis syndrome
peritonitis
reactive arthiritis
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16
Q

What is the cutoff for antepartum haemorrhage?

A

after 24 weeks is classes as APH

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17
Q

when can you get placenta praevia

A

only in 3rd trimester?

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18
Q

What is the management of uterine fibroids

A

1st - IUS
2nd Tranexamic acid
3rd OCP
4th myomectomy/ hysteroscopic endometrial ablation

GnRh agonist may be used in the short term to shrink fibroids - typically before surgery

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19
Q

When in hyperemesis most common

A

8 - 12 weeks but may be upto 20 weeks

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20
Q

What are the associations of HG

A 
nulliparity
obesity
multip
trophoblastic disease
hyperthyroidism
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21
Q

What are the treatment options for HG

A

antihistamine - promethazine or cyclazine(also anticholinergic)
can advise p6 pressure point - but little evidence.
admission for IV hydration

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22
Q

What are the complications of HG

A 
Wernickes encephalopathy - hence giving pabrinex
Mallory weiss tear
central pontine myelinolysis
ATN
small for dates
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23
Q

What is the management in primary genital herpes infection within 6 weeks of delivery.

A

oral acyclovir should be given to any infection after 36 weeks and any primary infection within 6 weeks of delivery.

c section should be for anyone with primary infection over 28 weeks

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24
Q

what is the treatment for BV

A

oral metronidazole

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25
Q

trichomonas vaginalis treatment (TV)

A

Oral metronidazle

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26
Q

what do you see on BV histology

A

clue cells and stippled vaginal epithelial cells

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27
Q

TV symptoms

A 
green/yellow frothy discharge
vulvovaginitis
strawberry cervix (rare)
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28
Q

gonnorhoea treatment

A

IM ceftriaxone + oral azithromycin

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29
Q

What is the difference betweena complex and a simple ovarian cyst?

A

simple - unilocular - usually benign

complex - multilocular (

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30
Q

What are the 4 causes of PPH

A

Tone - atony 90%
Tissue - retained products
Trauma - tears
Thrombin - coagualtion

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31
Q

How much blood counts as PPh

A

> 500ml

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32
Q

What is the management of primary PPH

A

ABC
IV syntocinon 10 units or ergometrine 500micrograms
IM carboprost
stitchign and ligation

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33
Q

what is a rokitansky nodule

A

outgrowth of contents of a mature terratoma - dermoid cyst.

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34
Q

What is the natural course of a corpus luteal cyst in pregnancy

A

involute in second trimester

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35
Q

at how many weeks does the blood pressure trough during pregnancy

A

20-24

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36
Q

how long does it take PIH to resolve?

A

around 1 month

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37
Q

What are the high risk groups which require aspirin in pregnancy? what does should be given?

A 
75mg OD from 12 weeks
Diabetes
previous PIH or preecalmpspia
CKD
autoimmune disease such as SLE
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38
Q

At what age is menopausal symptoms with elevated gonadotrophins considered premature ovarian failure

A

before 40

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39
Q

Quantify the breast cancer risk with HRT

A

~1.25x @5 years
breast cancer higher if progestogen added
risk declines and return to normal after 5 years when stopped taking and is equal to someone who did not take HRT

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40
Q

test for chlamydia

A

first void urine sample for NAAT

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41
Q

What are the risk factors for placenta praevia

A

previous praevia
previous c section (implantation on lower segement scar
multiple pregnancy
multiparity

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42
Q

danazol usage

A

used to treat endometriosis
is an ethisterone derivative but will not prevent implantation.
can also be used in fibrocystic change of the breast

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43
Q

why wont the COCP help someone after UPSI

A

because it prevents ovulation rather than implantation

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44
Q

upto how many hours is leveonogestrel lisenced?

A

72 hours but work upto 120 unlicensed.

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45
Q

What is the pearl index?

A

The Pearl Index is the most common technique used to describe the efficacy of a method of contraception. The Pearl Index describes the number of pregnancies that would be seen if one hundred women were to use the contraceptive method in question for one year. Therefore in the question, assuming the Pearl Index is 0.2 and the medication is adhered to perfectly, we would expect to see 0.2 pregnancies for every hundred women using the pill for one year - or 2 for every thousand.

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46
Q

When should you give Magnesium sulphate

A

rarely required to stop current fit as usually resolve. howver if a decision has been made to deliver the foetus then it should be given with:

Loading dose: Magnesium Sulphate 4 grams
 8mls of MgSO4 (50%) diluted with 12mls Normal Saline (0.9%) = Total 20mls
 Give IV over 20 minutes using syringe driver rate of 60 mls/hour
Maintenance dose: Magnesium Sulphate 1 gram per hour
 20mls MgSO4 (10 gms) diluted with 30mls Normal Saline (0.9%) = Total
50mls
 Give IV using syringe driver at rate of 5mls/hour
Recurrent seizures whilst on Magnesium Sulphate
 Further bolus of 4mls MgSO4 (2 gms) diluted with 6mls Normal Saline
(0.9%) Give IV over 5 minutes
 If possible take blood for Magnesium levels before bolus
 Notify Obstetric and Anaesthetic Consultants

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47
Q

is trimethoprim safe in pregnancy

A

yes

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48
Q

What is the normal dose of folic acid

A

400mcg

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49
Q

What is the high risk dose of folic acid, when shoulkd it be taken until, and who needs to take it?

A 
5mg taken upto 12th week
risk factors:
them or partner or family history of NTD
have coeliac, diabetes, thalasaemia, 
taking antiepileptics
Obese - >30kg/m2
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50
Q

When should contraception be stopped in menopause

A

after 1 year of no periods with women over 50, and after 2 years in those under 50

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51
Q

Which contraceptives must be withdrawn at 50

A

oestrogen containing

depot provera

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52
Q

use of contraception with beginning HRT

A

POP cannot be relied upon to protect the uterus from cancer risk with HRT unless HRT contains a progestogen component too. The IUS however does provide this protection.

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53
Q

define a late deceleration

A

Deceleration of the heart rate which lags the onset of a contraction and does not returns to normal until after 30 seconds following the end of the contraction
Indicates fetal distress e.g. asphyxia or placental insufficiency

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54
Q

define variable decelleration

A

Independent of contractions

May indicate cord compression

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55
Q

What is the usual dose of levonogestrel for emergancy contraception

A

1.5mg. repeat dose if vomiting within 2 hours

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56
Q

what are the anatomical sections of the fallopian tube? which is most likely to be the site of an ectopic? same as fertilisation place

A

fimbriae 10%
infundibulum
ampulla 65%
isthmus 11%

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57
Q

most common POP complaint/side effect?

A

Women should be advised about the likelihood and types of bleeding patterns expected with POP use. As a general guide:
20% of women will be amenorrhoeic
40% will bleed regularly
40% will have erratic bleeding.

Between 10% and 25% of women using a POP will discontinue this method within 1 year as a result of these bleeding patterns.

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58
Q

What is the management of shoulder dystocia

A

mcroberts
episiotomy
manual manipulatin and manoevres including mood screw
syphisiotomy

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59
Q

What is an amniotic fluid embolism and how does it present:

A

amniotic fluid embolism usually occur during or within 30 minutes of labour.

Respiratory distress, hypoxia, and hypotension

is a diagnosis of exclusion - can be differentiated from intracranial haemorrhage by lack of headache.
it should be managed in ITU

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60
Q

Who should be traced in a chlamydial infection

A

partners in the last 6 months or most recent partner - they should be offered treatment beofer getting test results.

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61
Q

Causes of secondary post partum haemorrhage

A

endometritis
retained products of concenption

occurs 24hrs - 12 weeks (recent change from 6)

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62
Q

what are the causes of puerperal pyrexia

A 
endometritis
UTI
wound infection (tears or csection)
mastitis
VTE
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63
Q

what is the management of endometritis

A

Hospital for IVabx - clindamycin and Gent

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64
Q

Are steroids safe in breastfeeding

A

yes

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65
Q

How do yo umanage breech

A

upto 36 weeks nothing

then ECV offered to nulliparous at 36 weeks and multiparous at 37 weeks

most opt for c sectin if still breech

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66
Q

What should be done at birth of a baby to a rhesus negative mother

A 
Cord blood taken
FBC
Blood group
Coombs test
kleihauer test
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67
Q

What are the sensitising events of rhesus disease?

A

delivery of a Rh +ve infant, whether live or stillborn
any termination of pregnancy
miscarriage if gestation is > 12 weeks
ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required)
external cephalic version
antepartum haemorrhage
amniocentesis, chorionic villus sampling, fetal blood sampling

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68
Q

what percentage of mothers are rhesus negative

A

15%

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69
Q

when are normal doses of anti D given

A

either single at 28 or double at 28 and 34

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70
Q

What is the contraindication to IUD

A

suspected PID - those at high risk should be screened first for infection. The IUD may cause PID

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71
Q

what is ashermans syndrome

A

Adhesions and fibrosis of the endometrium - often a complication of ERPC or curretage

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72
Q

What are the causes of secondary amenhorrhoea

A 
Pregnancy
Hypothalamic - stress and exercise
Premature ovarian failure
thyroid dysfunction
sheehans
prolactinoma
PCOS
ashermans
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73
Q

What are the risk factors for POM (premature ovarian failure)

A

family history of POM
Chemo/radiation
autoimmune disease

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74
Q

Who gets fibroids

A

20% white and 50% black women after menopause

Rare before puberty as they are a response to oestrogen

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75
Q

what is microgynon 30

A

COCP

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76
Q

How long does it take for each contraceptive to become effective?

A

Instant: IUD
2Days: POP
7 Days: COCP, IUS, implant, injection.

Unless on first day of cycle.

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77
Q

When should you start the COCP

A

ideally in the first 5 days of the period and it will be effective instantly. if not then 7 days are required till it is effective.

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78
Q

which antibiotics can reduce the efficacy of COCP?

A

only enzyme inducing antibiotics

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79
Q

how should a UTI be treated the first trimester

A

NOT with trimethoprim. use nitrofurantoin (not in third trimester - neonatal haemolysis)

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80
Q

What is a missed miscarriage

A

gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion
mother may have light vaginal bleeding / discharge and the symptoms of pregnancy which disappear. Pain is not usually a feature
cervical os is closed
when the gestational sac is > 25 mm and no embryonic/fetal part can be seen it is sometimes described as a ‘blighted ovum’ or ‘anembryonic pregnancy’

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81
Q

what is the difference between in inevitable and incomplete miscarriage

A

idea that incomplete, the body is unable to expel the remaining content and will require erpc.

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82
Q

symptoms of a hydatiform mole

A

high hcg causing HG
thyrotoxicosis due to stimulation of TSH R
usually large for dates
bleeding in 1st or early 2nd trimester

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83
Q

what percentage of hydatiform moles go on to become choriocarcinoma

A

2-3%

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84
Q

what is the management of a hydatiform mole

A

referral to specialist centre for removal

contraception for 1 year - do not get preggerz

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85
Q

What percentage of CIN3 becomes cancer

A

31%

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86
Q

What is a nexplanon

A

implant

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87
Q

what are the common side effects of progestogens

A

headache
nausea
breast pain

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88
Q

Which UKMEC levels should you worry about

A

4 - DO NOT use
3 - not worth the risk
2 - small risk but usually safe

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89
Q

When is the implant contraindicated

A

ACTIVE BREAST CA
previous breast ca, liver cirrhosis, heart disease or stroke.
antiphospholipid antibodies

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90
Q

What place does MRI have in endometriosis

A

can help with diagnosis if bowel symptoms and rectal involvement

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91
Q

What do you measure to test a womans fertility

A

day 21 progesterone.

the corpus luteum should have produced a day 21 surge in progesterone. telling you that the patient has ovulated.

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92
Q

How should you NOT manage an ectopic

A

do not palpate for adnexal mass as increases risk of rupture

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93
Q

what are the absolute contraindications to VBAC

A

classical scar and previous uterine rupture.

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94
Q

How do you define recurrent miscarriages and what are the most common causes?

A

anyone with 3 spontaneous miscarriages

Antiphospholipid antibodies 15%
Poorly controlled endocrine disorders e.g DM, PCOS, thyroid
Uterine abnormality e.g septum
parental gene abnormality
smoking
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95
Q

what is antiphospholipid syndrome

A

causes increased clotting risk - antibodies to fat

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96
Q

What stage of disease do endometrial cancers usually present with?

A

stage 1 - treated with a hysterectomy and bilateral salpingo-oophorectomy. Radiotherapy is often used more than chemo. and routine removal of lymph nodes is not helpful

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97
Q

ovarian FIGO

A

Stage 1 Tumour confined to ovary
Stage 2 Tumour outside ovary but within pelvis
Stage 3 Tumour outside pelvic but within abdomen
Stage 4 Distant metastasis

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98
Q

what diabetic drugs are safe in pregnancy

A

metformin and insulin and then second line instead of metformin you can use glibenclamide.

you cannot use gliclazide or liraglutide.

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99
Q

Who needs to undergo peak monitoring of LMWH levels?

A

under 50kg and over 90kg women. Monitor anti Xa activity

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100
Q

VTE prophylaxis in pregnancy

A 
Age > 35
    Body mass index > 30
    Parity > 3
    Smoker
    Gross varicose veins
    Current pre-eclampsia
    Immobility
    Family history of unprovoked VTE
    Low risk thrombophilia
    Multiple pregnancy
    IVF pregnancy

Four or more risk factors warrants immediate treatment with low molecular weight heparin continued until six weeks postnatal. If a woman has three risk factors low molecular weight heparin should be initiated from 28 weeks and continued until six weeks postnatal.

Low molecular weight heparin is the treatment of choice for VTE prophylaxis in pregnancy.

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101
Q

What is klaxons syndrome

A

failure to produce GnRH - primary amenorrhoea

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102
Q

what is primary amenhorrhoea defined as

A

failure to start menses by age of 16 - HOWEVER you should start workup if there is no change by 13.

secondary must have had 6 months of periods before stopping to count

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103
Q

What are the symptoms of imperforate hymen

A

blue bulging membrane with cyclical pain and no bleeding

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104
Q

what is mullerian agenesis

A

absence of internal female organs. only external genitalia

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105
Q

When can you identify twin to twin transfusion syndrome

A

monochorionic twins
shared placenta means there is blood flow between the twins. can be fatal to one or both.

polyhydramnios and oligohydramnios

it is identified between 16 and 24 weeks. after this time you are scanning for IUGR

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106
Q

Management of PCOS in conception

A

weight loss
clomiphene
metformin
ovarian drilling then try above again

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107
Q

What is the difference between a complete and partial hydatidiform mole

A

Complete: 46 chromasomes all from the father

Partial: 69 chromasomes XXX or XXY

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108
Q

What is the treatment for urge incontinence

A

bladder retraining for atlas 6 weeks

medical management including antimuscarinics oxybutinin(avoid in older frail) or tolterodine

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109
Q

What is the surgery of stress incontinence

A

retropubic mid urethral tape procedures

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110
Q

what is the most common cause of postcoital bleeding

A

ectropian

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111
Q

how many antenatal visits should a woman have

A

10 if first and 7 if more (uncomplicated)

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112
Q

Which children are at risk of vitamin k deficient bleesing

A

BREASTFED. need vit k at birth.

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113
Q

How does chorioamnionitis present

A

brown fould smell9ing discharge with fever, tachy etc, may have raised fetal heart rate

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114
Q

when does red degeneration usually happen?

A

1st or second trimester and presents with fever pain and maybe vomiting

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115
Q

management of chorioamnionitis

A

IV abx and delivery

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116
Q

When are you in second stage of labour

A

when the cervix is fully dilated - this process will take about an hour and is associated with transient foetal bradycardia

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117
Q

what is lochia

A

Lochia may be defined as the vaginal discharge containing blood mucous and uterine tissue which may continue for 6 weeks after childbirth.
Lochia typically takes the course of fresh bleeding, which undergoes colour changes before finally stopping. The patient can be reassured and advice should be given to her regarding lochia. Specifically, she should be told that if this begins to smell badly, its volume increases or it doesn’t stop, she should seek medical help

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118
Q

which blood products need to be crossmatched

A

all except platelets

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119
Q

what is cryoprecipitate

A

essentially clotting factors

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120
Q

What is the management of DIC

A

Clotting studies and a platelet count should be urgently requested and advice from a haematologist sought. Up to 4 units of FFP and 10 units of cryoprecipitate may be given whilst awaiting the results of the coagulation studies.’

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121
Q

What is in SAG-M blood

A

When plasma taken out it is replaced by saline, mannitol, glucose and adenine. upto 4 units of this can be given before whole blood is preferable.

122
Q

What are the layers cut through to get to the uterus in a c section

A 
Superficial fascia
Deep fascia
Anterior rectus sheath
Rectus abdominis muscle
Transversalis fascia
Extraperitoneal connective tissue
Peritoneum
Uterus
123
Q

what are the risks of prematurity

A 
Risk of prematurity
increased mortality depends on gestation
respiratory distress syndrome
intraventricular haemorrhage
necrotizing enterocolitis
chronic lung disease, hypothermia, feeding problems, infection, jaundice
retinopathy of newborn, hearing problems
124
Q

what drugs should be used in peurperal depression and why?

A

paroxitine because it has low availibility in the breast milk
Fluoxetine should be avoided as it has a long half life

CBT is th first line treatment still as this disease is likely to peak at 3 months

125
Q

braxton higgs

A

occur in the last 4 weeks, irregular and may be spaced at 20 mins

126
Q

What are the risk factors for cord prolapse

A 
prematurity
multiparity
polyhydramnios
twin pregnancy
cephalopelvic disproportion
abnormal presentations e.g. Breech, transverse lie
placenta praevia
long umbilical cord
high fetal station
127
Q

How should a cord prolapse be managed

A

push presenting part back into the uterus
administer tocolytics
patient to get on all fours
c section
1 in 500 births but reduced as breech is usually c sectioned now.
can deliver a cord prolapse with forceps but requires skill

128
Q

When should you get a mec baby seen by a doc

A 
low threshold for abnormalities
respiratory rate above 60 per minute
the presence of grunting
heart rate below 100 or above 160 beats/minute
capillary refill time above 3 seconds
temperature of 38°C or above, or 37.5°C on 2 occasions 30 minutes apart
oxygen saturation below 95%
presence of central cyanosis
129
Q

what drugs can be used to help with smoking cessation

A

varenicline and bupropion (neither should be used in pregnancy - NRT)

130
Q

which hepatitis is screening for in pregnancy

A

hep b

131
Q

what is the target range for blood pressure in pre eclampsia or PIH

A

<150 systolic and 80-100 diastolic

132
Q

Ace inhibitors - okay in preganancy?

A

no fetotoxic

133
Q

contraindications to ergometrine

A

hypertension - use oxytocin

134
Q

What does a bishops score of 5 or less

A

labour is unlikely to progess without induction

135
Q

at how many weeks should an uncomplicated pregnancy be offered induction

A

41-42 weeks

136
Q

at how many weeks should diabetic mother be induced

A

38

137
Q

How should you manage a PPROM

A

admit for 48 hours, and give antibiotics and steroids
safety net with regular temperature reading s and signs of chorio. ABX = erythro for 10 days
at 34 weeks consider induction as likely that risk of infection outweighs risk of delivery

138
Q

What drug is used in the management of OC

A

ursodeoxycholic acid

139
Q

what are the risks of OC

A

IUD - induced at 37

prem babies

140
Q

What is one of the most severe risks of an instrumental delivery

A

Femoral nerve Weakness in knee extension, loss of the patella reflex, numbness of the thigh

Lumbosacral trunk Weakness in ankle dorsiflexion, numbness of the calf and foot

Sciatic nerve Weakness in knee flexion and foot movements, pain and numbness from gluteal region to ankle

Obturator nerve Weakness in hip adduction, numbness over the medial thigh

most recover within 6 week sbut some are permanent

141
Q

contraindications to epidural

A 
Coagulopathy:
APTT ratio or INR >1.4
Platelet count < 100
Low molecular weight heparin (e.g. Enoxaparin, Clexane) given within last 12 hours if on prophylactic dosing (20 or 40mg) or within last 24 hours if on therapeutic dosing (>40mg)
Clopidogrel given within the last 7 days

Local sepsis

142
Q

what vaccinations should be offered in pregnancy and when?

A

Influenza - to all pregnant in the flu season regardless of trimester (october to january)

pertussus - ideally given at 28-32 but can be given upto 38. it should be given in every pregancy

there is no individual pertussus vaccine so it is given with diptheria, polio and tetanus.

rubella should be offered if the individual is not immune. - it is not a live vaccine

143
Q

Late decellerations should be investigated how?

A

fetal blood sampling to measure a pH - >7.2

144
Q

What is placenta accreta? what are the risk factors?

A

Attachment of the placenta TO the myometrium due to a defective decidua basalis. (hence why the normal is called placenta decidua)

there is a risk of PPH due to improper detachment

previous c section or praevia?

145
Q

what are the other placental attachment abnormalities?

A

17% Increta - IN the myometrium

5% Percreta - PAST the myometrium into uterine serosa and can attach to other organs

146
Q

What measures ofSFH are there?

A

20 weeks at umbilicus

36 weeks at xiphisternum

147
Q

is nifedipine contraindicated in breastfeding

A

no

148
Q

epidural anaesthesia reduced blood pressure and therefore is helpful in pre eclampsia

A

same day delivery of pre eclampsia is an option from 34 weeks - just as with PPROM etc

149
Q

what is johnsons manoevre

A

used for inversion of the uterus - slow manual replacement of the uterus.
tocolytics can be used to help relax the uterus but this may aggrevate bledding

150
Q

how often do type 1 diabeteics need to measure blood sugard in pregnancy

A

daily fasting, pre meal, 1 hour post meal, and bed time

151
Q

different types of grade 3 tear

A

3a: less than 50% of EAS thickness torn
3b: more than 50% of EAS thickness torn
3c: IAS torn
fourth degree: injury to perineum involving the anal sphincter complex (EAS and
IAS) and rectal mucosa

152
Q

what is the presentation of chorioamnionitis in the absence of ruptured membranes? what organism causes it?

A

associated with the genital mycoplasma bacteria

foul smelling, maternal signs of infection

153
Q

First steps in managing postnatal depression

A

Edinburgh score

154
Q

IVF is a risk factor for what

A

most things

praevia

155
Q

which antibiotic should be used in UTI when breastfeeding

A

trimethoprim - nitro is bad - causes G6PD

156
Q

Guidelines for foetal monitoring in uncomplicated 1st stage

A

For foetal monitoring: carry out intermittent auscultation immediately after a contraction for at least 1 minute, at least every 15 minutes, and record it as a single rate.
Palpate the woman’s pulse every 15 minutes to differentiate between the two heart rates.
Contraction monitoring every 15 minutes. Strength; during a contraction, you shouldn’t be able to indent the uterus with your fingers. Duration; usually 3 or 4 per 10 mins, lasting <1 min each.

157
Q

What are the risks for a child and mother with shoulder dystocia?

A

Baby: Erbs palsy or other brachial plexus injuries, HIE

Mother:3rd degree tear is not episiotomy, PPH, risk recurrence

158
Q

what are the risk factors for a breech presentation?

A 
prematurity
Praevia
fibroids
previous breech
oligo/polyhydramnios
fetal anomalies
multiple pregnancy
159
Q

What are the benefits of VBAC

A

decreased risk of foetal respiratory difficulties and decreased maternal fever. can allow better chance of further vaginal deliveries.

160
Q

things which worsen chance of VBAC?

A

previous c section for shoulder dystocia. Baby >4kg, increasing maternal age and BMI, induction.

161
Q

What are the chances of succesful VBA in someone with 1 single c section? and then also one SVD

A

75%

85-90%

162
Q

what is the risk of uterine rupture? what are the oother risks?

A

1 in 200

increased risk of needing transfusion.

HIE 8 in 10,000

163
Q

absolute contraindications to VBAC

A

classical c section incision

164
Q

Relative contraindications to VBAC

A

myomectomy or hysterotomy

165
Q

What is the management of HG?

A 
USS for reassurance
Fluids - plasma-lyte/NACL with KCL20mmol
Anti emetics - cyclizine50mgTDS, metoclopramide10mgTDS, Ondansetron4-8mgTDS
Vitamins  - Pabrinex 1+2, folic acid
Stomach protection - ranitidine
VTE prophylaxis - enoxaparin 40unitsOD
166
Q

what are the indications for admission of HG?

A

2+ ketones
clinical evidence of dehydration
intolerance to food and fluid
weight loss?

167
Q

What are the complications of HG?

A

Psychological/ emotional - can effect bonding with baby and have mental health repercussions
Wernickes
Hyponataemia - seizures respiratory arrest, central pontine myelinolysis
mallory weiss tear
DVT

fetal - SGA, preterm

168
Q

What is the difference between exomphalos and gastroschisis

A

free loops in gastro and whole protrusion in exomphalos

169
Q

What does glucocorticoid reduce the risk of antenataly?

A

RDS IVH mortality

170
Q

What 3 markers are used in the triple test

A

oestroil bHCG AFP

171
Q

what markers are used in the combined test

A

Age NT b hcg PAPP-a

172
Q

what is the main difference between amnio and chorionic villous sampling

A

time at which is can be done. chorio at 13 vs amnio from 16. slightly greater risk of 1-2% miscarriage with chorio.

173
Q

what is the treatment for genitourinary prolapse.

A

Physio - pelvic floor exercises
Pessary lasts 6-12 months fir biggest that isnt uncomforatble - support or space occupying
surgery - sacrohysteropexy, sacrocolpopexy

174
Q

Why do spetic children often need FFP

A

to treat the DIC as is evidenced by their non blanching rash

175
Q

What contraception can be used in breast cancer

A

IUD. no hormonal contraception is allowed

176
Q

Upto what day do you not need emergancy contraception after child birth

A

21

you cannot insert the coil until after 28 days anyway due to perf risk

177
Q

What 3(of4) things are needed for diagnosis of BV

A 
AMSEL's criteria
clue cells
ph>4.5
possitive whiff test (additon of potassium hydroxide produced fish smell)
thin white homogenous discharge

mx oral met for 5-7 days and washing advice

relapse rates are high with >50% in 3 months

178
Q

how long after birth should a woman wait to have her cervical smear

A

atleast 12 weeks

179
Q

When should you do a smear test during pregnancy

A

if there has been a previous abnormal smear then can be done by a specialist as long as there is no praevia

180
Q

how do you diagnose a suspected praevia

A

abdominal uss

181
Q

What should be done if a pravia is found on the 16-2 week anomaly scan

A

rescan at 34 weeks until which time they do not need to limit activity unless they bleed

if at 34 there is still grade1/2 then recheck in 2 weeks

if there c section should be given for grades 3 and 4
grade 1 is Vaginal delivery

182
Q

Which HRT should be used in the perimenopause

A

CYCLICAL as this allows for withdrawal bleeds.

topical creams and pessaries are only useful to prevent vaginal symptoms

183
Q

What is the management in OHSS

A

fluid replacement and thromboprophylaxis

184
Q

What causes OHSS

A

hcg, gonadotrophin and clomiphene

185
Q

tranexamic acid and mefanamic acid are safe to use in women trying for children?

A

yes - they must be started on the first day of the period and are taken for 3-4 days

186
Q

What are the chances that a salpingotomy will become a salpingectomy

A

1 in 5

187
Q

How often can emergancy contraception be used?

A

once per cycle - can use different type to get around this

188
Q

What things increase the chance of ectropian

A

higher oestrogen levels:
pregnancy, COCP, ovulatory phase of cycle) they may result in features of increased discharge and post coital bleeding

can be managed with cold coagulation but only if really causing an issue

189
Q

What is the management of dysmenorrhoea

A

mefanamic acid

190
Q

What produced hcg

A

first by the embryo and then by the placental trophoblast

levels peak at around 8-10 weeks gestation

191
Q

What is the second line treatment for chlamydia

A

doxy 100mg BD 1/52

192
Q

What is the colour difference of blood in abruption and in praevia

A

bright red in praevia and dark red in abruption

193
Q

What is the difference between a simple and complex cyst

A

simple - fluid filled

complex - solid

194
Q

At what level of 21-day progesterone would you repeat the test and confirm ovulation?

A

upto 30 repeat, over means ovulation

if lower than 16 likely to need refferal

195
Q

What are the precipitants of thrush

A

recent antibiotic use
immunosuppression

it causes a non offensive discharge

196
Q

what is the management of thrush

A 
pessary of clotrimazole500mg
OR
oral fluconazole 150mg PO stat
OR
oral itracnazole 200mgbd 1day

Oral agents are not for use in pregnancy

consider a maintenance dose each week if the infection is chronic

197
Q

Whirlpool sign

A

volvulus and ovarian torsion

198
Q

What would dopplers show of a torted ovary

A

no venous flow with absent or reversed diastolic flow

199
Q

What is associated with a low and high AFP in pregancny

A 
Low = downs
High = NT defects
200
Q

Treatment for PMS

A

OCP and SSRI aswell as lifestyle factors such as sleep hygeine, healthy diet, weight and exercise, reduction of stress.

201
Q

What is wertheims hysterectomy

A

I think it is the same as a radical hysterectomy i.e everything including the upper third of the vagina
BUT with resection of pelvic nodes added on.

used for stage 2b

202
Q

What is the difference between a subtotal, total, and radical hyseterectomy

A

subtotal doesnt take the cervix.
total takes the cervix
Radical takes the surrounding tissue aswell. including parametrium and upper third of the vagina.
It hink this may include the ovaries and tubes too?

203
Q

what is the management for lichen sclerosus

A

Topical steroids and emollient and regular checkup due to increased risk of vulval cancer.
NOTE: a biopsy should only be taken if there is clinical uncertaintly or there is a poor response to treatment

204
Q

what are the coplications of a hysterectomy

A

vault prolapse and enterocele

may get urinary retention post op for a bit

205
Q

How does a degenerating fibroid present and what is the management?

A

low grade fever, pain and vomiting with reassuring signs of the foetus

offer analgesia and rest and it should resolve witin a week.

206
Q

What is the triad of symptoms seen in vasa praevia

A

rupture of membranes with continuous blood but no pain with foetal bradycardai.

no risk to the mother but HIGH to the child

207
Q

Which is worse for bleedign risk prolonged ventouse or a forceps?

A

ventouse

208
Q

What are the risk factors for a placenta praevia?

A

previous c sections and multiparity

209
Q

What is the management for hepatitis B in pregnancy?

A

They may have a vaginal birth as there is no evidence to duggest there is a reduction in vertical transmission with a c section.

The child should be given HBIg and a hep b vaccine within 12 hours of birth and then further vaccine at 1-2 months and 6 months.

210
Q

What are the normal changes heard on cardiovascular examination in pregnancy?

A

an ejection systolic murmur is heard in 96% of women and 84% have a third heart sound. Forceful apex beat is not a cause for concern provided it is still within 2cm of the mid-clavicular line

uterus may block blood return to the heart - i.e when lying supine

211
Q

What are the physiological changes in pregnancy affecting the lungs?

A

tidal volume increases 40%

o2 requirement goes up 20% along with BMR of 15%

212
Q

What are the physiological changes in pregnancy affecting the blood?

A

Factor 7,8 and 10 and fibrinogen rise.
blood volume up 30% - 20% red cell rise and 50% plasma rise

platelets fall
WCC and ESR rise

213
Q

What are the physiological changes in pregnancy affecting the urinary system?

A

blood flow increases by 30% and so GFR goes up 30-60%

retention of salt increases due to sex steroids and there is some increase in protein loss

214
Q

What are the physiological changes in pregnancy affecting the liver?

A

ALP rises by 50%
albumin levels fall
hepatic flow doesnt change

215
Q

What is the weight of the uterus?

A

100g up to 1100g

216
Q

What are the biochemical changes happening during pregnancy?

A

calcium requirement goes up and even more so once lactation begins. serum levels of calcium fall due to increased demand and active transport accross the placenta.
increases in 1-25 hydroxy vitamin D cause huge increases in gut absorption of calcium.

217
Q

What size of ectopic can be treated medically?

A

<35mm, it must have no heartbeat and they must have a hcg of less than 1500. stable without pain.

they must be willing to attend for follow up.

218
Q

what does a hydatidiform mole look like on USS?

A

On ultrasound, the mole appears as a solid collection of echoes with numerous small anechoic spaces which resembles a bunch of grapes (also known as ‘snow-storm’ appearanc

219
Q

what is the riskiest form of breech presentation?

A

footling due to high risk of cord prolapse

220
Q

When would you give abx for mastitis?

A

when you suspect the cause is infective:

no improvement with expression in 12-24 hours
there is an infected nipple fissure
there is a positive culture

221
Q

hyperechogenic bowel on USS

A

CF
downs
CMV infection

222
Q

Name the 5 tumour markers and what they indicate?

A

CA 125 Ovarian cancer
CA 19-9 Pancreatic cancer
CEA Bowel cancer
AFP Liver cancer and germ cell tumours (e.g. testicular)

223
Q

What are the long term complications of PCOS

A 
Subfertility
Diabetes mellitus
Stroke &amp; transient ischaemic attack
Coronary artery disease
Obstructive sleep apnoea
Endometrial cancer
224
Q

What are the causes of oligohydramnios

A 
premature rupture of membranes
fetal renal problems e.g. renal agenesis/pckd/urethral obstruction
intrauterine growth restriction
post-term gestation
pre-eclampsia
225
Q

What is an overactive bladder

A

due to an increase in detrussor activity

226
Q

What is mixed incontinence?

A

mixture of stress and urge

227
Q

What is overflow incontincenc

A

likely due to outflow obstruction

228
Q

from how many weeks gestation does gestaionally induced hypertension present?

A
  1. cannot develop before this.
229
Q

What is the treatment for group b strep colonisation?

A

intrapartum IV ben pen

230
Q

treatment of choice for stage 1 and 2 endometrial cancer?

A

total abdominal hysterectomy with bilateral salpingo-oophorectomy

231
Q

What is the major risk factor for cord prolapse

A

although not a risk factor per say artificial rupture of membranses is when the majority happen.
To manage it one should place the hand into the vagina to elevate the presenting part. use of tocolytics

232
Q

Management for uterine atony?

A 
5 units of syto
then ergo
then sytno infucion
carboprost
miso 1000 PR
233
Q

Is vaginal bleeding pre 12 weeks a sensitisation event?

A

no as long as bleeding is not really heavy or continupous or painful.

234
Q

What is oxybutinin

A

anti muscarinic for detrussor overactivity

235
Q

What might make you suspect vesicovaginal fistulae? what is the way to diagnose it?

A

continuous dribbling incontinence - dye studeies should be done to diagnose

236
Q

When should urodynamic studies be done?

A

when there is a degree of clinical uncertainty as to the cause of incontinence

237
Q

How big does a uterine fibroid need to be before one would opt for surgical intervention rather than medical?

A

3cm

238
Q

What is the treatment of twin to twin transfusion syndrome?

A

indomethacin - NSAID inhibits prostaglandin synthesis

239
Q

How often should HIV sufferers have smears?

A

annually

240
Q

What is miegs syndrome

A

benign ovarian ymour
ascites
pleural effusion

241
Q

What are the 3 things associated with an increased nuchal translucency?

A

downs
congenital heart defects
abnormalities of the abdominal wall

242
Q

What are alternatives to HRT

A

tibolone is a synthetic androgen

SSRI

clonadine and gabapentin are niche
progestogens such as norethisterone

243
Q

When does a kleihaur test need to be done?

A

in any sensitizing event after 20 weeks. (given with anti D)

244
Q

In whom should fgm be reported to the police

A

anyone under 18. it does not need to be reported if you can identify that another professional has made the report.

245
Q

What is the management for someone with FGM

A

if under 18 reported to the police and social cervices.

anyone must have fgm documented in notes, and their details submitted to a register owned by the HSCIS (health and social care information centre)

They should be given advice to make them aware that it is a criminal offence which can gain them upto 14 years in prison (7 for not stopping)

de - infibulation must be offered.

246
Q

What are the 4 types of FGM

A

1 - partial or total removal of the clitoris/and or the hood

2 plus minora (with or without majora excision)

3 - narrowing of the oriface i.e sewing up

4 - all others eg piercings and pricking scraping

247
Q

When should a mother be checked for anaemia and red cell alloantibodies?

A

8-12 and then 28

248
Q

why cant you do a smear in pregnanc

A

difficult to interpret results

249
Q

When should oxybutinin not be used?

A

frail elderly due to increased risk of falls.

solifenacin or tolteradine should be used instead

250
Q

What are the causes of polyhydramnios

A

Maternal DM

fetal abnormalities such as duodenal atresia or tracheooesophageal fistula.

251
Q

what grip must not be used in assesment of foetal lie if possible?

A

pawlicks grip

252
Q

treatment of candidiasiss in pregnancy?

A

imidazole PV

253
Q

What are wilsons criteria?

A

the condition should be an important health problem
the natural history of the condition should be understood
there should be a recognisable latent or early symptomatic stage
there should be a test that is easy to perform and interpret, acceptable, accurate, reliable, sensitive and specific
there should be an accepted treatment recognised for the disease
treatment should be more effective if started early
there should be a policy on who should be treated
diagnosis and treatment should be cost-effective
case-finding should be a continuous process

254
Q

Where are LH and FSH produced

A

anterior pituitary

255
Q

what is the role of LH

A

to form and maintain the corpus luteum as well as thinning og the graffian follicle membrane

256
Q

What does oestrogen do in the follicular phase

A

thins cervical mucous and thickens the endometrium

257
Q

When are you most fertile in the cycle?

A

5 days before and 2 days after ovulation. (sperm remains in for a long time

258
Q

What does progesterone do?

A

stimulates oestrogen production
initiates the secretory phase
increases basal body temperature
inhibits LH and FSH production

259
Q

What are the phases of the menstrual cycle?

A

menstrual
follicular
luteal

260
Q

How do you know if someone is about to ovulate?

A

thinning of cervical mucous due to oestrogen surge and rise in body temperature due to LH surge.

261
Q

How much of the endometrium is shed suring the menstural phase

A

basal layer remains intact and the rest is shed by contraction of the myometrium

262
Q

At how many weeks would you expect a woman to start kicking?

A

18-20 if not had a baby before

15-18 if they have

263
Q

How many weeks does the 3rd trimester start at?

A

29 weeks?

first one ends at 12

264
Q

when does the first stage of labour begin

A

when the effaced cervix is at 3cm dilation

265
Q

how do you estimate the due date

A

add 9months and 1 week to the first day of the LMP

266
Q

What are the potential complications of induction

A 
uterine hyper stimulation
uterine rupture
c section
prolapsed cord
prolonged labour if induced too early
267
Q

What is the MOA of tranexamic acid?

A

it is an antifibrinolytic and reduces losses by around 50%

268
Q

What should be done before endometrial ablation?

A

biopsy to check tissue as it will be burnt

269
Q

What should be done before endometrial ablation?

A

biopsy to check tissue as it will be burnt

270
Q

What causes pain during menstruation?

A

high prostaglandin levels often cause large contraction and uterine ischemia

271
Q

How do you define precocious puberty in a girl

A

secondary sex characteristics before 8 or menstruation before 10

272
Q

What is the treatment for MCune albright syndrome

A

cyproterone acetate

273
Q

What is thought to cause PMS

A

progetogens - PMS in luteal phase

274
Q

What is the management for PMS

A

SSRI in second half of cycle or contnuous
OCP
oestrogen HRT can be useful

275
Q

What are the main differences in the male and female pelvis

A

larger pelvic inlet

u shaped pubic arch rather than a ‘v’

276
Q

When should you give gnrh pretreatment for fibroid shrinking

A

when doing open. not lap.

injection of vasopressin reduces blood loss

277
Q

What are the symptoms of adenomyosis

A

painful, heavy irregular periods

278
Q

what is a haematomaetra

A

collection of blood in the uterus - rare - caused by wlling off of the cervix after endometrial resection

OR by an imperforate hymen

279
Q

What are uterine polyps

A

uaually arise from endometrial tissue and are mostly benign however can have potential for dysplasia.

commonly found in 40+

often found in women on tamoxifen

280
Q

what is a nabolthian follicle

A

overgrowth of squamous cells over the top of gladular

281
Q

CIN1 vs 3

A

cells only in lower 1/3 vs whole thickness(carcinoma in situ)

1/3 of women with CIN3 develop cancer in 10 years

282
Q

at what age does screening for cervical cancer become 5 yealy

A

49

283
Q

What are the complications of the LLETZ

A

haemorhage

premature birth

284
Q

When doe sa functional cyst become worrying?

A

over 5cm and been there for more than a couple of months

measure ca125 - cutoff is >35 for scan

285
Q

What markers should you measure in women under 40 if you suspect a malignancy?

A

AFP and hCG as germ cell tumours are more common in these age groups and produce these hormones

286
Q

Where does the lymph drainage go?

A

inguinal
femoral
external iliac

287
Q

What is the difference between plichen planus
simplex
sclerosus

A

planus - purple/red
simplex - majora mainly affected inflamed and thickened
sclerosus - pink white, loss of collagen thinning

288
Q

What is the function of the bartholian gland

A

to secrete lubricatng mucus for coitus

infection would rsult in large painful tender swollen nodules

insicion and rainage with marsupialsation

289
Q

What is the difference between small for gestational age and small for dates(or IUGR)

A

lower than the 10th centile for their weight is small for GE

wheras growth restriction or small for dates means the SFH is smaller than expected.

IUGR is when there is faltering growth and they are falling off the centiles

290
Q

What are the symetrical causes of IUGR?

A

congenital abnormality
infection
normal small
poor nutrition

291
Q

What are the asymetrical causes of IUGR?

A 
Placental insufficiency
Pre eclampsia (hypertension)
diabetes
smoking
placental factors such as abruption
maternal chronic disease
292
Q

What are the sequlae of IUGR?

A

Higher levels of morbidity and mortality overall with many long term dequelae. They may be:

Cerebral palsy
learning disability
short stature
IUD
prematurity - all sequalae of that.
NEC
293
Q

What does bakers hypothesis suggest?

A

can cause fetal programming which leads to increased risk of what we would consider diseases of the aged such as CHD, hypertension, diabetes dyslipidaemia.

294
Q

What is the management for a patient with IUGR.

A

immediate referral to obstetric team who will need to do:
close observation and monitoring
dopplers
scans
may indicate amniocentesis to test for congential abnormalities or infection
May need to consider early delivery if risks outweigh benefits
increased risk of emergancy c section
will need to have corticosteroids at some point to reduce risk of surfactant deficinecy and IVH.

295
Q

How long should follow up smear be in CIN2

A

6 moths

296
Q

What do you do if you find moderate dyskaryosis

A

refer for colposcopy REGARDLESS of hpv status

297
Q

How much crystalloid can you give before you need to give blood products

A

3.5l and so you can wait for blood products

298
Q

how do you confirm small for dates

A

uSS - no need for doppler

299
Q

how do POPs work?

A

thickens cervical mucous

300
Q

At what age is the OCP become ukmec2

A

40 and then should be stopped at 50

301
Q

At what age does injectable become UKMEC 2

A

45

302
Q

how do you manage delayed speach and language

A

hearing test and SALT

Joshua's OnG (3 decks)

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