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Oishi's 5th year flashcards > Hard to recall O&G > Flashcards

Hard to recall O&G Flashcards

1
Q

What syndrome do anti-epileptics during pregnancy cause?

A 
Fetal Hydantoin Syndrome:
IUGR
Microcephaly
Cleft palate
Mental retardation
Hypoplastic fingernail defects
Distal limb deformities
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2
Q

Causes of omphalocele?

A

Trisomy 13
Trisomy 18
Exomphalos-macroglossia-gigantism syndrome

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3
Q

Most likely cause for DIC in a pregnant woman?

A

Placental abruption

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4
Q

4 features of isoimmunisation in a fetus?

A
  1. Erythroblastosis fetalis with haemolytic anaemia and erythroblasts on blood film
  2. Jaundice and hepatosplenomegaly
  3. Kernicterus
  4. Hydrops fetalis
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5
Q

What structures are at risk of damage following sacrospinous fixation for Tx of vaginal vault prolapse?

A

Sciatic nerves

Pudendal vessels

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6
Q

What nerve can be damaged by the lithotomy position and in abdomino-pelvic surgery?

A

Femoral nerve

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7
Q

When is pregnancy does breast enlargement and darkening occur?

A

12 weeks

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8
Q

Fetal indications for IOL?

A 
Post-due date
Fetal growth restriction
Certain diabetic pregnancies
Deteriorating haemolytic disease
Deteriorating fetal abnormalities
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9
Q

Maternal indications for IOL?

A

Pre-eclampsia
Deteriorating medical conditions
If Tx for malignancy needed

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10
Q

Why does shoulder tip pain occur?

A

Free intraperitoneal fluid irritating diaphragm

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11
Q

What kind of incontinence can alpha-adrenergic blockers cause?

A

Stress incontinence

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12
Q

Symptoms of PMS?

A
  1. Psychological: depression, anxiety, mood swings
  2. Behavioural: aggression
  3. Physical: breast tenderness, abdo bloating
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13
Q

Causes of hypogonadotrophic hypogonadism?

A

Kallman syndrome

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14
Q

Clinical features of Kallman syndrome

A 
Absent/delayed puberty
Hyposmia/anosmia
Colour blind
Unilateral kidney agenesis
Cleft lip
Bimanual synkinesia
Primary amenorrhoea
Cryptorchidism
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15
Q

Hormone profile in Kallman syndrome?

A

Low GnRH
Low FSH
Low LH
Low oestradiol

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16
Q

Causes of primary hypogonadism?

A

Klinefelter’s

Turner’s syndrome

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17
Q

Hormone profile in primary hypogonadism?

A

High GnRH
High FSH
High LH
Low oestradiol

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18
Q

Hormone profile in secondary hypogonadism?

A

High GnRH
Low FSH
Low LH
Low oestradiol

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19
Q

What does incomplete fusion of the paramesonephric ducts result in?

A

Bicornuate or septate uterus

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20
Q

When should HIV+ve women not on ART start meds while pregnant?

A

Start combined ART by 24 weeks and continue life long

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21
Q

First line Mx of severe allergic rhinitis in pregnancy?

A

Oral loratadine

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22
Q

During pregnancy what happens to tidal volume and minute ventilation?

A

They both increase

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23
Q

Features on congenital rubella syndrome?

A 
Sensorineural deafness
Congenital heart defects - paten ductus arteriosus
Congenital glaucoma
Cataracts
Microcephaly
Hepatosplenomegaly and jaundice
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24
Q

Definition of polyhydramnios?

A

AFI >95th centile (2-3L or 25cm of amniotic fluid)

Deepest vertical pool >8cm

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25
Q

What type of cysts do molar pregnancies cause?

A

Bilateral theca lutein cysts

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26
Q

Pathogenesis of ovarian stromal hyperthecosis?

A

Hyperplasia of ovarian stroma with clusters of luteinising cells within

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27
Q

Features of ovarian stromal hyperthecosis?

A

Increased androstenedione and testosterone = virilism and hirsutism
Conversion of androgen to oestrogen in peripheries = endometrial hyperplasia and AUB

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28
Q

Tx for ovarian stromal hyperthecosis?

A

Pre-menopausal: COCP + lifestyle measures

Post-menopausal: bilateral oophorectomy

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29
Q

What is the histological appearance of fibroids?

A

Smooth muscle bundles in a whorled appearance

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30
Q

Define true intersex

A

Individual who carries both male and female gonads

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31
Q

Define pseudointersex

A

Individual has phenotype and secondary sexual characteristics different to what is defined by their karyotype and gonads. Can be male or female intersex

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32
Q

Explain male intersex, it’s most common cause and how it would present

A

46XY and testes
Phenotypically female
Presents with primary amenorrhoea
Most common cause is complete androgen insensitivity

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33
Q

Explain female intersex, it’s most common cause and how it would present

A

46XX and ovaries
Phenotypically male
Most common cause is congenital adrenal hyperplasia

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34
Q

Features of fragile X syndrome

A 
Narrow face
Large ears
Large testicles
Mental retardation
Developmental delay
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35
Q

Inheritance of fragile X syndrome?

A

X-linked dominant

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36
Q

What syndrome does warfarin use in 1st trimester cause?

A

Conradi-Hunermann syndrome

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37
Q

Clinical features of Conradi syndrome (warfarin in 1st trimester)?

A 
Saddle nose
Frontal bossing
Short stature
Epiphyseal stippling
Optic atrophy
Cataracts
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38
Q

Which trimester is warfarin safe in?

A

2nd

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39
Q

What does warfarin increase risk of in 3rd trimester?

A

fetal or neonatal haemorrhage

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40
Q

Monitoring for diabetes in PCOS

A

If OGTT shows impaired glucose tolerance: Annual OGTT

If OGTT normal: Annual random fasting glucose

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41
Q

Another name for leydig cell tumour?

A

Hilus cell tumour

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42
Q

Features of leydig cell tumours?

A

Virilisation

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43
Q

Features of McCune-Albright syndrome?

A

Bone and ovarian cysts
Cafe au lait spots
Precocious puberty

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44
Q

Tx for McCune-Albright syndrome?

A

Cyproterone acetate (anti-androgenic progestogen)

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45
Q

What enzyme is deficient in congenital adrenal hyperplasia?

A

21-hydroxylase

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46
Q

Explain 46XY gonadal dysgenesis and how it might present

A

Phenotypically female
Mullerian structures present but gonad may remain a streak
Delayed puberty as gonads do not function

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47
Q

Explain 5-alpha reductase deficiency

A 
XY
Mutation in SDR5A2 gene
Testes but cannot virilise
Fetus has ambiguous genitalia
Infertile
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48
Q

What karyotype is Turner’s syndrome?

A

46XO

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49
Q

Clinical features of Turner’s syndrome?

A
  • Poor growth
  • Short stature
  • Webbing of the neck
  • Wide carrying angle due to in-turned elbows
  • Short fourth metacarpals or metatarsals
  • Delayed/absent pubertal development
  • Primary amenorrhoea
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50
Q

What medical conditions are associated with Turner’s syndrome?

A 
o	Coarctation of the aorta
o	Inflammatory bowel disease
o	Sensorineural and conduction deafness
o	Renal anomalies
o	Endocrine dysfunction e.g. thyroid disease
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51
Q

What effect does 21-hydroxylase deficiency on the hormone pathway?

A

No cortisol and aldosterone

Increased adrenal androgens

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52
Q

Tx of nipple thrush?

A

2% miconazole cream for 14 days

Can put in infants mouth if >4 months old

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53
Q

Examination findings of tongue tie?

A

Limited tongue movements - not past lips or up and down
A heart-shaped notch forms when you try to lift tongue
In posterior tongue tie the frenulum is not visible

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54
Q

UTI Tx in pregnancy?

A

Nitrofurantoin 100mg modified release BD for 7 days (avoid at term - neonatal haemolysis)
Alternative amoxicillin or cephalexin

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55
Q

When to offer ELCS to women with HIV? Indications?

A

38 weeks
HIV co-infection with Hep C
Zidovudine monotherapy
Women on HAART with viral load >50copies/ml

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56
Q

Why is aspirin contra-indicated in breast-feeding?

A

Risk of Reye’s disease in newborn

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57
Q

What does the progesterone challenge test involve and show?

A

Medroxyprogesterone acetate 5mg TDS for 5/7

Positive = vaginal bleeding –> functioning endometrium and outflow tract

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58
Q

Oral tx for acne and hirsuitism in PCOS?

Topical tx for hirsutism?

A

PO Cyproterone acetate

Topical eflornithine cream

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59
Q

What percentage of complete molar pregnancies go on to become invasive?

A

15%

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60
Q

How long does vulvodynia need to have lasted for by definition?

A

3 months

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61
Q

Which subset of menopausal women is fluoxetine contra-indicated in?

A

Breast cancer CURRENTLY receiving tamoxifen

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62
Q

Molar pregnancies are strongly associated with dysfunction of which gland?

A

Thyroid

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63
Q

Describe the path of the pudendal nerve

A
  1. Leaves pelvis through greater sciatic foramen between piriformis and coccygeus
  2. Crosses ischial spine
  3. Re-enters pelvis via lesser sciatic foramen
  4. Enters Alcock’s canal on lateral wall of ischiorectal fossa with internal pudendal vessels
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64
Q

How to locate the pudendal nerve trunk?

A

1cm below and medial to ischial spine

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65
Q

How long can you wait for the placenta to deliver?

A

1 hour

Give adjuncts of IM syntocinon and breastfeeding to stimulate its expulsion

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66
Q

WHO breastfeeding recommendations?

A

Initiate in first hour of infant’s life (in babies born to mothers with DM should be within 30 mins)
Exclusive breastfeeding for 6 months
Combination of foods and breastfeeding up to 2 years and beyond

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67
Q

What is used to induce multiple ovulatory events in an IVF cycle?

A

Human menopausal gonadotrophin + clomiphene citrate

Adjunct: FSH

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68
Q

Thyroxine recommendations in pregnant women with hypothyroidism?

A

Increase levothyroxine by 25mcg asap even if euthyroid

Check TFTs in 2 weeks

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69
Q

Histology of condylomata?

A

HPV 6 and 11
Basilar hyperplasia
Binucleated and multinucleated cells

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70
Q

The most common type of incontinence in women?

A

Stress

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71
Q

When do women who have had Tx in colposcopy need to be reassessed?

A

Test of cure in 6 months

If normal - recalled in 3 years regardless of age

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72
Q

In complete androgen insensitivity syndrome why do the uterine structures not develop?

A

The undescended testes produce anti-Mullerian hormone

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73
Q

Karyotype of Klinefelter’s?

A

47,XXY

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74
Q

Features of Klinefelter’s?

A 
Tall stature
Hypogonadism - infertility
Gynaecomastia
Sparse facial/axillary/pubic hair
Delayed motor and language development
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75
Q

What do Klinefelter’s phenotypically present with genitalia wise?

A

Normal male external genitalia

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76
Q

What is the role of 5-alpha reductase?

A

Converts testosterone to more potent dihydrotestosterone which drives sexual development

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77
Q

What Tx should babies born to mothers with HIV receive?

A

First dose of ART within 4 hours of birth

Continue until 4-6 weeks

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78
Q

When should babies born to mothers with HIV have blood PCR tests?

A 
Within 2 days of birth
At discharge
6 weeks
12 weeks
18 months
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79
Q

What is the most common cause of neonatal metabolic disorder?

A

Hypoglycaemia

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80
Q

When should BMs be checked in infants born to mothers with diabetes?

A

2-4 hours after birth

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81
Q

Where does each invasive cancer first metastasise to?

  1. Cervical
  2. Ovarian
  3. Vulval
  4. Endometrial
A
  1. Pelvic lymph nodes along the iliac arteries
  2. Para-aortic lymph nodes
  3. Superficial inguinal lymph nodes
  4. Iliac artery lymph nodes
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82
Q

What test is diagnostic of antiphospholipid syndrome?

A

Lupus anticoagulant +/- anti-cardiolipin antibody

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83
Q

Features of antiphospholipid syndrome?

A 
Recurrent or atypical venous thrombosis
Arterial thrombosis
Recurrent miscarriage/late fetal loss
Pre-eclampsia
IUGR
Thrombocytopenia
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84
Q

Anticoagulation during pregnancy with antiphospholipid syndrome?

A

Low dose aspirin + LMWH

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85
Q

Define unprovoked vulvodynia

A

Chronic vulvovaginal pain lasting at least 3 months

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86
Q

1st line Tx of unprovoked vulvodynia?

A

Amitryptyline

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87
Q

Define uterine hyperstimulation syndrome

A

> 6 contractions every 10 mins

<60s between contractions

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88
Q

Where do the gonads descend from during embryological life?

A

T10 vertebral level

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89
Q

Where does pain from ovaries or testes get referred to?

A

T10 - umbilicus

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90
Q

How does Addison’s disease cause premature menopause?

A

Steroid cell auto-antibodies cross-react with theca interna/granulosa layers of ovarian follicles

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91
Q

Number of miscarriages and % chance or successful subsequent pregnancy

A

1: 85%
2: 75%
3: 60%

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92
Q

How does lichen planus present?

A

Purple/red plaques usually on labia with central erosion

Overlying lacy, white, striated patch

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93
Q

What is a krukenburg tumour?

A

Gastric carcinoma which has metastasised to ovary

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94
Q

Histology of krukenburg tumour?

A

Signet ring cells

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95
Q

Most common ovarian tumour in over 50 year olds?

In 20-50 year olds?

A

Serous adenocarcinoma

Mucinous cystadenoma

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96
Q

When do Hep B vaccinations for infants born to mothers with hep B occur?

A

Birth
4 weeks
8 weeks
1 year

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97
Q

Indications for ELCS?

A 
HIV
Primary genital herpes in 3rd trimester
Placenta praevia major
Twin pregnancy where first baby is breech
Singleton breech at term after ECV fails
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98
Q

What is normal baseline fetal heart rate?

A

110-160bpm

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99
Q

Causes of fetal tachycardia?

A 
Hypoxia
Anaemia (fetal)
Fetal distress
Maternal pyrexia
Chorioamnionitis
Exogenous beta-agonist use
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100
Q

Cause of baseline fetal bradycardia?

A 
Severe fetal distress - secondary to abruption or rupture
Hypotension
Maternal sedation
Post-dates
OP or transverse position
Hypoxia
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101
Q

What is normal variability?

A

5-25bpm

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102
Q

How many accelerations would you expect to see normally antenatally?

A

At least 2 accelerations every 15 mins

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103
Q

Define an acceleration

A

Increase in fetal HR by 15bpm for at least 15sec

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104
Q

What do variable decelerations suggest?

A

Cord compression

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105
Q

What do late decelerations suggest?

Causes?

A 
Fetal distress - asphyxia, hypoxia, placental insufficiency
Causes:
- maternal hypotension
- pre-eclampsia
- uterine hyperstimulation
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106
Q

Describe a sinusoidal trace and what it indicates

A

10mins of smooth wave baseline with no variability

Suggests fetal anaemia/hypoxia

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107
Q

How can you tell if a fetus is OP?

A

Anterior - diamond shaped fontanelle

Posterior - Y shaped fontanelle

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108
Q

In which anatomical location does fertilisation occur?

A

Ampulla of fallopian tube

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109
Q

What is the max dose of prostaglandin for IOL?

A

6mg/day

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110
Q

Complications of IOL + augmentation of labour?

A 
Failure of induction
Uterine hyperstimulation
Nausea, vomiting and diarrhoea
Water intoxication
Uterine rupture
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111
Q

Which measurement is most reliable indicator of gestational age in first trimester? When should you switch to head circumference?

A

Crown-rump length

Once it is above 84mm

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112
Q

Which measurement is used to calculate gestational age after 14 weeks

A

Bi-parietal diameter or head circumference

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113
Q

Cytologically describe features of dyskaryotic cells in CIN

A

Anaplasia
Increased nuclear:cytoplasmic ratio
Hyperchromatism
Multinucleation

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114
Q

Symptoms of listeria infection in pregnancy?

A 
Fever
Headache
Malaise 
Back ache
Abdo pain
Pharyngitis
Conjunctivitis
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115
Q

Sequelae of listeria infection in pregnancy?

A

Miscarriage
Still birth
Preterm delivery
Neonatal listeriosis (50% mortality)

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116
Q

Tx of listeria infection?

A

High dose penicillin

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117
Q

Risk of parvovirus in 2nd trimester?

A

Hydrops fetalis

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118
Q

Define engagement

A

When less than 2/5ths of the head can be palpated abdominally

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119
Q

What is the maximum number of contractions associated with traction that should be used in instrumental delivery before EMCS

A

3

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120
Q

Which forceps can be used if fetus is OP

A

Kielland’s forceps

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121
Q

when can chorionic villus sampling take place?

A

11-14 weeks

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122
Q

What are the most common type of twins?

A

Dizygotic dichorionic diamniotic

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123
Q

What is the most common type of monozygotic twin?

A

Monozygotic monochorionic diamniotic

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124
Q

Requirements for twin-to-twin transfusion syndrome?

A

Must be monochorionic

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125
Q

When does twin-to-twin transfusion syndrome most commonly occur?

A

Monozygotic monochorionic diamniotic

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126
Q

What is the main hormone produced by the corpus luteum?

A

Progesterone

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127
Q

Infectious causes of miscarriage? (TORCH)

A 
Toxoplasmosis
Other infection
Rubella
CMV
HIV
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128
Q

Main causative pathogens of chorioamnionitis?

A

E coli
Streptococcus
Enterococcus faecalis

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129
Q

Which term describes transition from left occipitotransverse position to OA position as head passes through pelvis?

A

Internal rotation

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130
Q

Define gravida

A

Number of times woman has been pregnant regardless of gestation at delivery

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131
Q

Define parity

A

Number of deliveries including all live births (even <24 weeks) and stillbirths after 24 weeks
1st number: any birth after 24 weeks
2nd number: all pregnancies up to 24 weeks which did not result in live birth

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132
Q

What is the gold standard test for tubal patency?

A

Diagnostic laparoscopy and dye test

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133
Q

What does a fundal placenta increase risk of?

A

Uterine inversion

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134
Q

What is the by-product of female gametogenesis?

A

polar body

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135
Q

What does T sign indicate?

A

Monochorionic twins

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136
Q

What does lambda sign indicate?

A

Dichorionic twins

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137
Q

Explain Naegele’s rule

A

LMP + 7days + 9 months

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138
Q

Components of APGAR score?

A 
Appearance
Pulse
Grimace
Activity
Respiration
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139
Q

What does obstetric cholestasis increase risk of?

A

Preterm birth
Respiratory distress syndrome - meconium aspiration
Fetal death

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140
Q

Define the 4 categories of C-section

A
  1. Immediate threat to life of woman or fetus (30 mins)
  2. Maternal/fetal compromise but not immediately life threatening (30-75 mins)
  3. No maternal/fetal compromise but requires early delivery
  4. At a time to suit woman and health care services
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141
Q

What does being able to ballot the fundus and a heartbeat above the umbilicus suggest?

A

Breech position

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142
Q

Which movement occurs during crowning of the head?

A

Extension

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143
Q

Down’s syndrome screening - what is considered a positive result?

A

risk above 1:250

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144
Q

List 2 frequent risks of C-section

A
  1. Persistent wound and abdo discomfort

2. Increased risk of c-section in later pregnancies

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145
Q

How long does spermatogenesis take?

A

64 days

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146
Q

Explain the 5 steps of spermatogenesis.

A
  1. Primordial germ cells into spermatagonia
  2. Spermatagonia into primary spermatocytes (46 chromosomes)
  3. Primary spermatocytes into secondary spermatocytes (23 double stranded chromosomes)
  4. Secondary spermatocytes into spermatids (23 single chromosomes)
  5. Spermatids into spermatozoa (mature)
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147
Q

Define asthenospermia

A

Poorly motile sperm

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148
Q

Define azoospermia

A

Complete absence of sperm

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149
Q

Define oligospermia

A

Low sperm count

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150
Q

Define teratospermia

A

Morphologically defective

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151
Q

Define leucospermia

A

Infection in sperm

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152
Q

What does VBAC increase risk of?

A

Uterine rupture (risk increases if oxytocin used)

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153
Q

Most common cause of secondary PPH? Time frame for secondary PPH?

A

Infection followed by retained products

24 hours - 12 weeks

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154
Q

Which hormone promotes proliferation of glandular and stromal elements of the endometrium?

A

Oestradiol

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155
Q

Where is oestradiol secreted?

A

Ovary

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156
Q

Which type of ovarian tumours cause pseudomyxoma perotonei?

A

Mucinous

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157
Q

When should labour be induced in each of:
MCMA
MCDA
DCDA?

A

MCMA: 32 - 33+6 weeks
MCDA: 36 - 36+6 weeks
DCDA: 37 - 37+6 weeks

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158
Q

Which vaccinations are offered in pregnancy?

A

Whooping cough

Seasonal flu/influenza

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159
Q

How many cycles of IVF should women <40 be offered under NICE guidelines?

A

3

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160
Q

Criteria for IVF <40 under NICE guidelines?

A
  1. Unable to get pregnant through regular unprotected sex for 2 years
  2. Unable to get pregnant after 12 cycles of artificial insemination
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161
Q

How many cycles of IVF should women aged 40-42 be offered under NICE guidelines?

A

1

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162
Q

Criteria for IVF aged 40-42 under NICE guidelines?

A
  1. Unable to get pregnant through regular unprotected sex for 2 years
  2. Unable to get pregnant after 12 cycles of artificial insemination
  3. Never had IVF before
  4. No evidence of low ovarian reserve
  5. They’ve been informed of the additional implications of IVF and pregnancy at this age
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163
Q

Is it safe to breastfeed with Hep B?

A

Yes

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164
Q

Causes of oligohydramnios?

A 
premature rupture of membranes
fetal renal problems e.g. renal agenesis
intrauterine growth restriction
post-term gestation
pre-eclampsia
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165
Q

What does the combined test for Downs involve?

A

Nuchal translucency (>6mm)
PAPPA A
beta hcg

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166
Q

What does the quadruple test involve? When is it applicable?

A 
Unconjugated oestradiol
hCG
AFP
Inhibin A
15-20 weeks
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167
Q

What are obese women recommended to take?

A

5mg folic acid

10mg Vit D

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168
Q

Routine antenatal screening for which 3 diseases?

A

Hep B
Syphilis
HIV

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169
Q

How much does stroke volume increase by in pregnancy?

A

30%

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170
Q

In HIV pregnant women what should be avoided?

A

Forceps
Amniocentesis
Fetal blood sampling

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171
Q

With herpes infection of genitalia - how many weeks are required between infection to clear and vaginal delivery to be possible rather than caesarean?

A

6 weeks

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172
Q

Absolute contraindications to ECV?

A

Multiple pregnancy
APH
Major uterine abnormality
Ruptured membranes

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173
Q

What does SLE in pregnancy increase risk of?

A 
Spontaneous miscarriage
Fetal death
Pre-eclampsia
Preterm delivery
Fetal growth restriction
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174
Q

Features of Pruritic urticarial papules and plaques of pregnancy (PUPPP)? AKA polymorphic eruption of pregnancy

A

Itchy rash which appears on stretch marks late in pregnancy
Spares umbilicus
Can extend to buttocks and limbs and lesions often become confluent

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175
Q

Features of Pemphigoid gestationis?

A

blistering condition that starts in the umbilicus and spreads

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176
Q

Features of Prurigo gestationis?

A

excoriated papulitic rash of the trunk and extensor surfaces of upper limbs and shoulders with abdominal sparing.

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177
Q

Features of Impetigo herpetiformis?

A

blistering condition that always presents with a febrile illness and if not treated early can lead to maternal and fetal death

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178
Q

In pregnancy what are the blood glucose targets before and after eating in a diabetic?

A

before every meal the blood sugar should
be less than 5.5μmol/L
1 hour after a meal less than 7.8μmol/L.

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179
Q

What is another term for a blighted ovum and what would you see on USS?

A

Anembryonic pregnancy
USS:
gestational sac with no developing embryonic pole or yolk sac development

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180
Q

By 6 weeks what should you see on USS?

A

Fetal pole and fetal heart

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181
Q

If at 6 weeks you see a yolk sac what does it suggest and what is the next step?

A

Pregnancy of unknown viability

Repeat TVUS in 10-14 days

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182
Q

What does a pseudosac represent and what dx is it suggestive of?

A

decidualized reactive tissue

Suggests ectopic pregnancy

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183
Q

What is the risk of bladder injury in c section?

A

1 in 1000

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184
Q

What type of cancer are patients with pcos at higher risk of?

A

Endometrial

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185
Q

When is risk of VTE highest in people on HRT?

A

In first year

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186
Q

Chance of ovarian cancer with RMI <50?

A

3% –> watchful waiting advised

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187
Q

What is triptorelin?

A

a gonadotrapin-releasing hormone agonist that creates a temporary artificial menopause by reducing the FSH and LH levels.

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188
Q

When is it useful to use triptorelin and how long for

A

Before laparoscopy for 6 months in patients with severe endometriosis

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189
Q

What is the main function of progesterone?

A

enhance endometrial receptivity

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190
Q

Tx for severe PMS?

A 
SSRIs
Vit B6
Improved diet and exercise
CBT
Combined OCP
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191
Q

Tissues cut through during episiotomy?

A

Vaginal membrane
Perineal membrane
Bulbospongiosus
Superficial transverse perineii (STP)

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192
Q

CTG sensitivity and specificity

A

high sensitivity

low specificity

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193
Q

Absolute contraindications to epidural?

A 
Uncontrolled hypotension
Allergies to anaesthetics
Systemic infection
Skin infection over epidural site
Coagulopathy
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194
Q

Branches of the pudendal nerve?

A 
inferior anal nerve
inferior haemorrhoidal nerve
perineal nerve
dorsal nerve of clitoris
posterior labial nerve
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195
Q

Findings in DIC?

A 
increased PT
increased APTT
decreased platelets
increased bleeding time
active haemorrhage
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196
Q

Complications of toxoplasmosis in pregnancy for neonate?

A

Classic triad: intracranial calcifications, chorioretinitis, hydrocephaly

macro- or microcephal
convulsions
long-term neurodevelopmental delay

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197
Q

Which procedure carries the greatest risk of haemorrhage in the newborn?

A

Prolonged ventouse delivery

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198
Q

What is looked at in semen analysis and what are the normal ranges?

A
  1. Volume 1.5 - 6mL
  2. pH 7.2 - 8
  3. Morphology normal >4%
  4. Motility normal >50%
  5. Count >15 million/mL
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199
Q

Markers of pelvic outlet?

A

inferior margin of the pubic symphysis (pubic arch)
ischial tuberosities (left and right, sometimes
called the ischial spines)
tip of coccyx

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200
Q

What nerve supplies the labia majora?

A

Posterior labial artery from internal pudendal artery

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201
Q

How to calculate RMI?

A

USS x menopause x CA125
USS (1 point out of 5 for each concerning feature)
post-menopause x3

202
Q

What drug is used to reverse magnesium sulphate induced respiratory depression?

A

Calcium gluconate

203
Q

Factors increasing risk of miscarriage?

A 
Increased maternal age
Smoking in pregnancy
Consuming alcohol
Recreational drug use
High caffeine intake
Obesity
Infections and food poisoning
Health conditions, e.g. thyroid problems, severe hypertension, uncontrolled diabetes
Medicines, such as ibuprofen, methotrexate and retinoids
Unusual shape or structure of womb
Cervical incompetence
204
Q

When should LMWH Tx for DVT in pregnancy be monitored and using which test?

A

Women at extremes of body weight
Co-morbidities e.g. renal impairment
Test used: Anti-Xa activity

205
Q

When should prophylactic VTE therapy be recommended?

A

4+ risk factors = immediate prophylaxis

3 risk factors = from 28 weeks

206
Q

List some of the risk factors for VTE prophylaxis

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
207
Q

When is a Kleihauer test required?

A

Any sensitisation event after 20 weeks

208
Q

Swift’s mnemonics to remember Down’s, Edward’s and Patau’s?

A

Down’s is “HIgh” (↑hCG ↑inhibin)
Edwards - “HE is low” (↓hCG ↓estriol)
Patau is high (↑AFP)

209
Q

Causes of increased AFP?

A

Patau
Neural tube defects (meningocele, myelomeningocele and anencephaly)
Abdominal wall defects (omphalocele and gastroschisis)
Multiple pregnancy

210
Q

Causes of decreased AFP?

A

Down’s syndrome
Trisomy 18
Maternal diabetes mellitus

211
Q

Suspected endometritis Tx and what to do?

A

Admit

IV clindamycin and gentamicin until afebrile for >24hours

212
Q

What are the glucose targets for self-monitoring pregnant women with gestational or pre-existing diabetes?

A

Fasting: 5.3mmol/L
1 hour after meal: 7.8mmol/L
2 hours after meal: 6.4mmol/L

213
Q

What are some symptoms of TTTS a mother should look out for and why might they occur?

A

Any sudden increases in the size of their abdomen and/or any breathlessness, which may be the result of polyhydramnios affecting the recipient twin

214
Q

Causes of increased nuchal translucency?

A

Down’s
Congenital heart defects
Abdominal wall defects

215
Q

long term complications of hysterectomy with anterior posterior repair?

A

enterocele

vaginal vault prolapse

216
Q

When is continuous CTG monitoring in labour warranted?

A

Suspected chorioamnionitis/sepsis or temp of 38+
Severe HTN 160/110+
Oxytocin use
Presence of significant meconium
Fresh vaginal bleeding that develops during labour

217
Q

Which scan allows you to determine gender of a baby?

A

Fetal anomaly scan

218
Q

Indications for fetal echocardiography in second trimester?

A

Mother with congenital heart disease
Mother with T1DM
Mother with epilepsy on certain meds
Previous child with congenital heart defect that required surgical correction
Inadequate/abnormal view of heart on routine second trimester scan
High-risk NT result

219
Q

What feature is seen on CTG during fetal sleep?

A

Reduced variability

220
Q

In fetal blood sampling what pH is considered normal and can allow labour to continue?

A

pH >7.25

221
Q

What is a borderline result in fetal blood sampling and what does it mean in terms of management?

A

pH 7.2 - 7.25

Repeat pH needed in 30-60mins

222
Q

What is an abnormal result in fetal blood sampling and what does it mean in terms of management?

A

pH <7.2 confirms fetal compromise

Immediate delivery

223
Q

Use of what drug in preterm labour is associated with necrotising enterocolitis?

A

Co-amoxiclav

224
Q

What happens to RR during pregnancy?

A

Stays the same

225
Q

What happens to renal blood flow during pregnancy?

A

Increases

226
Q

What happens to albumin during pregnancy?

A

Decreases

227
Q

What must the bishop score be minimum to consider ARM?

A

5

228
Q

Features of fetal varicella syndrome?

A

Skin scarring
Neuro defects
Eye defects
Limb hypoplasia

229
Q

What is the venous drainage of the right ovary?

A

IVC

230
Q

What are the 3 parts of the broad ligament?

A

Uterus: mesometrium
Uterine tube: mesosalpinx
Ovary: mesovarium

231
Q

Which morning after pill does not interact with the progesterone only pill?

A

Levonorgestrel (Levonelle)

232
Q

During labour, what is required for easy passage into mid-cavity of the pelvis?

A

Flexion

233
Q

What stage of labour is when the levator ani muscles help the head move into the OP position?

A

Internal rotation

234
Q

What term describes when the head moves into alignment with the shoulders before they are delivered?

A

External rotation (restitution)

235
Q

How does cancer of the fallopian tube present?

A

Intermittent abdo pain relieved by sudden watery discharge

236
Q

What does a posterior chin on delivery mean?

A

Emergency C section - can’t deliver vaginally due to large occiput

237
Q

What drug is preferred in tx of hyperthyroidism when breastfeeding?

A

Propylthiouracil

238
Q

What hormone is produced in peripheral adipose tissue?

A

Oestrone

239
Q

If division of the embryo occurs at <3 days after fertilisation what type of twins are produced?

A

Monozygotic dichorionic diamniotic

240
Q

If division of the embryo occurs at 4-8 days after fertilisation what type of twins are produced?
What type are produced after 8 days?

A

Monozygotic monochorionic diamniotic

Monochorionic monoamniotic

241
Q

What measurement can provide info regarding fetal neurological status and tone?

A

Biophysical profile

242
Q

RFs for vulval cancer?

A

Lichen sclerosus
HPV (16)
Smoking
Immunosuppression

243
Q

Most common type of vulval cancer and what is it associated with?

A

Squamous cell carcinoma - lichen sclerosus

244
Q

RF for vaginal cancer?

A

DES (diethyltilbestrol use in maternal pregnancy)

245
Q

What kind of vaginal cancer do teenagers get and why?

A

Clear cell adenocarcinoma due to DES

246
Q

What kind of vaginal cancer do older women get?

A

Squamous cell carcinoma

247
Q

Which syndromes is PAPP-A low in?

A

Down’s
Edward’s
Patau’s

248
Q

Which type of contraception is least affected by enzyme inducers?

A

Depo-provera

249
Q

What are we specifically looking for in PET bloods?

A

FBC - low platelets
LFTs - high ALT
U&Es - high creatinine

250
Q

What % of shoulder dystocia is corrected with McRobert’s?

A

90%

251
Q

NICE cut offs for oral iron supplementation in pregnancy?

A

Booking visit <11g/dL

28 weeks <10.5g/dL

252
Q

Who is intracytoplasmic sperm injection suitable for?

A

Low sperm count (oligospermia)

Problems maintaining erection/ejaculation

253
Q

Who is intrauterine insemination suitable for?

A

Azoospermia (no sperm)
If a partner has an infectious disease e.g. HIV
If there is high risk of transmitting a genetic disorder
Same sex couples

254
Q

If a woman develops chicken pox during pregnancy when should she be referred to fetal medicine?

A

5 weeks after infection

255
Q

Which emergency contraception requires a doubling of dose in patients >70kg or BMI >26?

A

Levonorgestrel

256
Q

When to offer ECV?

A

At 36 weeks for nulliparous women

At 37 weeks for multips

257
Q

When does red degeneration typically present?

A

Mid second trimester

258
Q

Risk factors for vasa praevia?

A

Multiple pregnancy

IVF

259
Q

1st line tx for endometrial hyperplasia without atypia?

A

LNG-IUS

260
Q

If a patient with an IUD requires tx for PID when should they be reviewed?

A

After 72 hours - if symptoms have not improved consider removing IUD

261
Q

If previous GDM when to have ogtt?

A

OGTT asap after booking visit

If no GDM at booking then another OGTT at 24-28 weeks

262
Q

Ix for women with pre-existing T1 or T2DM in pregnancy?

A

HbA1c at booking

Renal and retinal assessment

263
Q

Features of listeria infection in pregnancy?

A

Spontaneous abortion
Premature
Pustular skin lesions
Neonatal meningitis and sepsis

264
Q

When is rubella most likely to undergo vertical transmission?

A

8-10 weeks (90%)

265
Q

Features of rubella infection in a pregnant woman?

A

Rash
Fever
Lymphadenopathy

266
Q

Features of congenital CMV?

A 
IUGR
Chorioretinitis
Periventricular calcifications
Sensorineural deafness
Microcephaly
267
Q

Time frame for vacuum aspiration?

A

10-14 weeks

268
Q

Time frame for dilatation and evacuation?

A

After 14 weeks

269
Q

Risks of NSAIDs in pregnancy?

A

PPHN
Premature ductus arteriosus closure
Oligohydramnios

270
Q

Which USS findings contribute to RMI?

A 
Multiloculated cysts
Solid areas
Bilateral lesions
Ascites
Intra-abdominal mets
271
Q

Next step for patients with a high RMI?

A

CT or MRI for staging

272
Q

Steps in managing major PPH?

A
  1. IV/IM syntocinon
  2. IM carboprost
  3. Balloon tamponade
  4. B-lynch suture
  5. Hysterectomy
273
Q

Features of congenital syphilis?

A

Skeletal abnormalities
Hepatosplenomegaly
Rhinitis

274
Q

Tx of syphilis in pregnancy?

A

IM benzathine penicillin

275
Q

Indications for tx for lactational mastitis and how long/what is tx for?

A

Persistent symptoms after 12-24hrs of effective milk removal
Nipple fissures
Systemically unwell
10-14 days of flucloxacillin

276
Q

What are Call-Exner bodies and what are they pathognomonic of?

A

Eosinophilic fluid filled spaces between granulosa cells

Granulosa cell tumours

277
Q

Who do granulosa cell tumours usually present in and symptoms?

A

Pre-pubertal girls - precocious puberty

Post-menopausal women - PMB

278
Q

Most common type of malignant germ cell tumour and features?

A

Dysgerminoma
Young girls
Associated with hypercalcaemia and excess beta-hCG

279
Q

Alternative to metformin in GDM if not tolerated?

A

Glibenclamide

280
Q

Risks of polyhydramnios?

A

Preterm delivery
Cord prolapse
Placental abruption
Malpresentation

281
Q

Definition of oligohydramnios?

A

AFI <5cm

282
Q

Risks of oligohydramnios?

A

Stillbirth
Limb contractures
Incomplete lung maturation

283
Q

Indications for planned C-section?

A 
Breech at term
Multiple pregnancy
Placenta praevia
Suspected morbidly adherent placenta
Women with HIV not on ART or viral load >400copies/mL
Women with HIV and Hep C
Women with primary HSV in 3rd trimester
284
Q

What is a severe obstetric cholestasis classed as? When should they be delivered?

A

Bile acids >40micromol/L

36 weeks

285
Q

RFs for endometritis?

A

Prolonged rupture of membranes
Prolonged labour
C section
PPH

286
Q

Surgical mx for urge incontinence?

A

Botox injections
Percutaneous tibial nerve stimulation
Sacral nerve stimulation
Augmentation cystoplasty

287
Q

Define prolonged second stage of labour

A

Active second stage of more than 1 hour in multips and more than 2 hours in nullips

288
Q

Requirements for delivery with neville barnes forceps? (FORCEPS)

A 
Fully dilated
OA position
Ruptured membranes
Cephalic presentation
Engaged presenting part
Pain relief adequate
Sphincter (empty bladder)
289
Q

Which instruments can be used to rotate a baby in OP position? Which is most successful?

A

Ventouse

Kielland forceps - most successful

290
Q

How low does gestational thrombocytopenia platelet count usually go? And when does it usually occur?

A

70x10(9)/L

3rd trimester

291
Q

When does ITP usually occur in pregnancy? What is the risk? Tx?

A

1st trimester
Risk = neonatal thrombocytopenia - intracranial haemorrhage
Tx = steroids or IVIG

292
Q

Minimum platelet count for epidural?

Minimal platelet count for safe delivery?

A

Epidural = 70x10(9)/L

Safe delivery = 50x10(9)/L

293
Q

After what beta-hCG level are intrauterine pregnancies usually visible? How many weeks is this?

A

1000 - 1500IU/L

294
Q

What BMI during pregnancy warrants referral to obstetric anaesthetist?

A

> 40kg/m(2)

295
Q

How often should women with monochorionic twin pregnancy have USS scans?

A

USS every 2 weeks from 16 weeks onwards

296
Q

How often should women with dichorionic twin pregnancy have USS scans?

A

USS every 4 weeks from 20 weeks onwards

297
Q

How can TTTS before 26 weeks be treated?

A

Fetoscopic laser ablation of communicating vessels

298
Q

What problem occurs only in monochorionic twins?

A

TTTS

Selective growth restriction

299
Q

When should GBS swabs be done if indicated?

A

35-37 weeks or 3-5 weeks before elective delivery

300
Q

What is the bladder neck anchored to in colposuspension?

A

Cooper’s ligament

301
Q

Triad in amniotic fluid embolism?

A

Acute hypoxia
Hypotension
Coagulopathy

302
Q

RFs for amniotic fluid embolism?

A

C section
Advanced maternal age
Multiple pregnancy
APH

303
Q

Dosing regimen for antenatal steroids?

A

2 doses of 12mg IM betamethasone 24 hours apart

304
Q

Features of magnesium sulphate toxicity?

A

Decreased RR
Arrhythmia
Loss of deep tendon reflexes

305
Q

Stages of endometrial cancer?

A
  1. In uterus only
  2. Connective tissue of cervix but not outside uterus
  3. Beyond uterus and cervix but not beyond pelvis
  4. Beyond pelvis
306
Q

In primary genital herpes during pregnancy what is the tx?

A

1st/2nd trimester: PO aciclovir from 36 weeks and expectant vaginal delivery
3rd trimester: PO aciclovir from 36 weeks and c section
Within 6 weeks of due date: Start PO aciclovir immediately

307
Q

RFs for prolapse?

A 
Childbirth
Old age
Obesity
Long term constipation
Heavy lifting
308
Q

Clauses of abortion act?

A

A: Risk to mother’s life
B: Termination will prevent serious injury to physical/mental health of mother
C: <24 weeks and continuing is risk to physical/mental health of mother
D: <24 weeks and risk to existing children/family
E: Child would be handicapped
F: Save mother’s life

309
Q

What is BV in pregnancy associated with?

A

Preterm labour

Chorioamnionitis

310
Q

Appearance of endometrioma on TVUSS?

CA125?

A

Echogenic “ground glass” appearance

Often raised

311
Q

Advice for women on whether they are experiencing reduced fetal movements?

A

Lie on left side
Count movements for 2 hours
If <10 then contact maternity unit asap

312
Q

When is planned vaginal delivery possible in HIV patients?

A

Viral load <50 copies/mL at 36 weeks

313
Q

Where should medical termination be done at 12+ weeks gestation?

A

Clinical setting

314
Q

MOA of misoprostol?

A

Cervical ripening

Uterine contractions

315
Q

MOA of mifepristone?

A

Breakdown of endometrium

316
Q

CIN1 where are the dysplastic cells?

A

Within lower 1/3rd of epithelium

317
Q

When should LLETZ be offered?

A

Patients with CIN2, CIN3 and CGIN

318
Q

Why are GnRH agonists e.g. goserelin acetate limited to 3 months of use?

A

They cause a significant reduction in bone mineral density

319
Q

Alternative to GnRH agonist but what is the main side effect?

A 
Ulipristal acetate (progesterone antagonist)
Liver damage
320
Q

Major RFs for pre-eclampsia?

A 
CKD
HTN in previous pregnancy
Autoimmune disease - SLE, APS
DM
Chronic HTN
321
Q

Moderate RFs for pre-eclampsia?

A 
Primip
Multip
MAternal age >40
Pregnancy interval >10 years
BMI >35
FH of pre-eclampsia
322
Q

How is dx of premature ovarian insufficiency diagnosed?

A

2x FSH >30IU/L taken 4-6 weeks apart

323
Q

PCOS hormone findings?

A

Elevated LH and FSH
LH:FSH ratio >1
Elevated testosterone
Reduced SHBG

324
Q

4 parameters used to calculate estimated fetal weight?

A

Abdo circumference
Head circumference
Femur length
Biparietal diameter

325
Q

Tx for molar pregnancy?

A

Suction curettage followed by serial beta-hCG measurements

326
Q

Thyroxine requirements in first trimester/planning to get pregnant people on replacement?

A

Increase levothyroxine by 25mcg per day

327
Q

Tx for ovarian cyst accident/rupture?

A

Admit for observation and analgesia
Pain should settle in 4-6 hours
Repeat TVUSS if ongoing bleeding

328
Q

Twins gravidity and parity?

A

Counts as 1 gravidity (single pregnancy even if 2 fetuses)

Counts as 2 parity (2 babies are born)

329
Q

How do RFs for VTE influence prophylaxis?

A 
4+ = immediate LMWH until 6 weeks post partum
3 = LMWH from 28 weeks until 6 weeks post partum
330
Q

Main counselling point for women taking progestogens as part of HRT?

A

Increased risk of breast cancer and VTE

331
Q

Main SE of Nexplanon? (Implant)

A

Irregular menstrual bleeding

332
Q

What is the most effective form of contraception?

A

Nexplanon

333
Q

What is a beads on string sign on USS suggestive of?

A

chronic salpingitis, with mural nodules appearing as ‘beads’ and the relatively-thin wall appearing as ‘string’

334
Q

Components of Bishop score?

A 
Cervical position
Cervical consistency
Cervical effacement
Cervical dilation
Fetal station
335
Q

Describe the normal stage 1 of labour (2 parts)

A

latent phase = 0-3 cm dilation, normally takes 6 hours

active phase = 3-10 cm dilation, normally 1cm/hr

336
Q

Complications of hyperemesis?

A 
Wernicke's encephalopathy
Mallory-Weiss tear
central pontine myelinolysis
acute tubular necrosis
fetal: small for gestational age, pre-term birth
337
Q

Effect of smoking on hyperemesis?

A

Associated with decreased incidence

338
Q

Life threatening complications of OHSS?

A

Hypovolaemic shock
Acute renal failure
Venous or arterial thromboembolism

339
Q

Presentation of OHSS?

A

ascites
vomiting and diarrhoea
high haematocrit

340
Q

Which fertility medication is most associated with OHSS?

A

GnRH agonists

341
Q

SEs of clomiphene?

A 
hot flushes (30%)
abdominal distention and pain (5%)
nausea and vomiting (2%)
342
Q

Definition and Tx for recurrent vaginal candidiasis?

A

4+ episodes in a year
induction-maintenance regime of oral fluconazole
induction: oral fluconazole every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 months

343
Q

How should bleeding with no pain a woman who is <6 weeks pregnant be managed?

A

Expectantly
These women should be advised:
to return if bleeding continues or pain develops
to repeat a urine pregnancy test after 7–10 days and to return if it is positive
a negative pregnancy test means that the pregnancy has miscarried

344
Q

Time periods for colposcopy referral?

A

When abnormal cytology is high-grade dyskaryosis (moderate or severe), women should be offered colposcopy within 2 weeks
If inadequate results, borderline results, or low-grade dyskaryosis (mild), they should receive an appointment within 6 weeks

345
Q

When should Negative hrHPV not return to normal recall?

A

the test of cure for individuals who treated for CIN1, CIN2, or CIN3 (6 months)
Untreated CIN1
follow-up for incompletely excised CGIN/stratified mucin producing intraepithelial lesion (SMILE) or cervical cancer
follow-up for borderline changes in endocervical cells

346
Q

Tx for ovarian cancers which are stage 2-4?

A

Primary: Surgical excision
Secondary: Chemo

347
Q

Positive pregnancy test after TOP - when to refer?

A

4 weeks after TOP indicates incomplete abortion or persistent trophoblast

348
Q

Safer alternative to oxybutynin in elderly women at risk of falls?

A

solifenacin
tolterodine
mirabegron

349
Q

How long is the mirena licensed for in use as contraception in HRT?

A

4 years

350
Q

What is placenta praevia associated with?

A

high presenting part or abnormal lie as a direct consequence of the low lying placenta

351
Q

Ovarian cancer ix? Exception?

A
  1. CA125
  2. If raised - urgent USS
  3. Referral to gynae
    Exception = abdo mass palpable - refer to gynae urgently
352
Q

Normal additional HS in pregnancy?

A

3rd HS
Ejection systolic murmur
Forceful apex

353
Q

Criteria for diagnosing a miscarriage on TVUSS?

A

crown-rump length greater than 7mm with no cardiac activity

354
Q

Recurrence rate of postnatal psychosis?

A

25-50%

355
Q

RFs 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
ARM - MOST COMMON
356
Q

Tx for gonorrhoea?

A

IM ceftriaxone

If sensitivity known give PO ciprofloxacin 500mg

357
Q

Tx for chlamydia?

A

PO doxycycline 100mg bd

358
Q

Fundal height growth normal range?

A

<24 weeks = 2cm a week

>24 weeks = 1cm a week

359
Q

Antidepressant of choice if breastfeeding?

A

Sertraline or paroxetine

360
Q

Indications for fetal blood sampling?

A

pathological CTG in labour (cervix dilated >3 cm)

suspected acidosis in labour (cervix dilated >3 cm)

361
Q

Contraindications to fetal blood sampling?

A

Maternal infection (HIV, hepatitis, HSV)
Fetal bleeding disorders (haemophilia)
Prematurity (<34 weeks of gestation)
Acute fetal compromise (prolonged fetal bradycardia of >3 minutes)
Acute event (cord prolapse/abruption/uterine rupture)
Clinical picture suggests birth should be expedited

362
Q

Interpretation of fetal blood sampling results?

A

pH:

  • ≥7.25: Normal FBS result. Repeat after 1 hour if CTG remains the same
  • 7.21–7.24: Borderline FBS result. Repeat after 30 minutes
  • ≤7.20: Abnormal FBS result. Consider delivery

Lactate:

  • normal: <4.1mmol/L
  • borderline: 4.2-4.8mmol/L
  • abnormal: >4.9mmol/L
363
Q

Which stages of cervical cancer can you offer radical hysterectomy and removal of pelvic lymph nodes?

A

Stage IB to IIA

Technically for earlier stages too

364
Q

first-line non-hormonal treatment for menorrhagia?

A

Tranexamic acid

365
Q

Most common benign ovarian tumour in women under the age of 25 years?

A

Dermoid cyst

366
Q

Post partum thyroiditis mx?

A

Beta blockers not anti thyroid drugs

367
Q

Time frame for primary PPH?

A

<24 hours

368
Q

What structures would you see week by week on TVUSS to confirm a pregnancy/determine PUL?

A 
4 weeks - gestational sac
5 weeks - gestational sac + yolk sac
6 weeks - fetal pole with heart beat
7 weeks - amniotic membrane
8 weeks - brain structure, limb buds
369
Q

What tests should be done for all pre-menopausal women with complex ovarian cysts?

A

serum CA-125, LDH, αFP and βHCG

370
Q

Measurements in routine 2nd trimester fetal biometry?

A

BPD
head circumference (HC)
AC
femur length (FL)

371
Q

When is the Fetal biophysical profile score assessed and what are the components? Number the abnormal findings

A

Fetal breathing:

  1. absent
  2. no breathing for ≥20 seconds within 30 mins

Fetal tone:

  1. slow extension with return to partial flexion
  2. absent fetal movement

Fetal movement:
1. <2 episodes of body/limb movements within 30 mins

Amniotic fluid volume:
1. abnormal if the largest pocket is <2x2 cm

CTG:

  1. <2 accelerations
  2. acceleration <15bpm in 20 mins
372
Q

What is an abnormal Fetal biophysical profile score?

A

4/10
6/10 is borderline and must be repeated to exclude fetus being asleep as the cause
8-10 is normal

373
Q

List women who should take 5mg dose of folic acid

A 
Previous child with NTD
Diabetes mellitus
Women on antiepileptic
Obese (body mass index >30kg/m²)
HIV +ve taking co-trimoxazole
Sickle cell
374
Q

What to do if 1 COCP missed at any point in cycle

A

take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
no additional contraceptive protection needed

375
Q

What to do if 2 COCP missed in week 1 (day 1-7)

A

Take last pill (even if 2 on one day)

Emergency contraception if sex in pill free interval or week 1

376
Q

What to do if 2 COCP missed in week 2 (day 8-14)

A

Take last pill (even if 2 on one day)

Don’t need emergency contraception

377
Q

What to do if 2 COCP missed in week 3 (day 15-21)

A

Take last pill (even if 2 on one day)
Finish pills in current pack
Omit pill free break and start new pack next day

378
Q

Definition of PPH? What constitutes major PPH?

A

The loss of 500 ml or more of blood from the genital tract within 24 hours of the birth of a baby
Major = >1000ml blood loss

379
Q

Layers cut through in a c section?

A 
Superficial fascia
Deep fascia
Anterior rectus sheath
Rectus abdominis muscle (not cut, rather pushed laterally following incision of the linea alba)
Transversalis fascia
Extraperitoneal connective tissue
Peritoneum
Uterus
380
Q

Which cells secrete bHCG? What is its role?

A

syncytiotrophoblasts

acts to maintain the production of progesterone by the corpus luteum in early pregnancy

381
Q

when do women experience an earlier urge to push - in OP or OA?

A

OP

382
Q

When to follow up ovarian cysts?

A

Simple ovarian cyst 50-70mm in diameter - yearly USS

Larger simple cyst - MRI or surgery

383
Q

Define primary amenorrhoea

A

No periods by 15yrs with normal secondary sexual characteristics
No periods by 13yrs with no secondary sexual characteristics

384
Q

Window for taking desogestrel?

A

12 hours

385
Q

Interpretation of serum progestogen in fertility testing?

A

<16nmol/l: Repeat, if consistently low refer to specialist
16-30nmol/l: Repeat
>30nmol/l: Indicates ovulation

386
Q

When to consider early referral to fertility services?

A

Female:

  • Age >35
  • Amenorrhoea
  • Previous pelvic surgery
  • Previous STI
  • Abnormal genital examination

Male:

  • Previous genital surgery
  • Previous STI
  • Varicocele
  • Significant illness
  • Abnormal genital examination
387
Q

What tx can you not give trans patients on testosterone therapy?

A

Oestrogen

388
Q

Which patients should receive a special cardiac scan and when does it happen?

A 
18-23 weeks
FH of congenital abnormalities
Maternal DM or connective tissue disease
Antiepileptics/antidepressants
Increased nuchal translucency
Multiple pregnancy
389
Q

What are the 4 purposes of the fetal anomaly scan?

A

Reproductive choice (TOP)
Prepare parents (disability/non-viability)
Manage birth in specialist centre
Intrauterine therapy

390
Q

SCD screening in high risk vs low risk areas?

A

High risk: blood test

Low risk: family origin questionnaire

391
Q

Thalassaemia screening?

A

All pregnant women

392
Q

When are fathers offered screening of SCD/thalassaemia?

A

If pregnant woman is a carrier

393
Q

What can be offered before fetal blood sampling if pathological CTG?

A

Fetal scalp stimulation - should see accelerations in response

394
Q

When to measure fetal HR in labour?

A

Low risk: Immediately after a contraction for 1 minute every 15 mins

395
Q

Rule of 3 for fetal brady on CTG?

A
  • 3 minutes: call for help
  • 6 minutes: move to theatre
  • 9 minutes: prepare for assisted delivery
  • 12 minutes: aim to deliver baby
396
Q

Causes of prolonged brady on CTG?

A 
cord compression
cord prolapse
epidural and spinal anaesthesia
maternal seizure
rapid fetal descent
397
Q

What is the most useful predictor of fetal wellbeing in SGA foetuses ?

A

Fetal heart rate variation

398
Q

Monitoring with epidural?

A

Continuous CTG for 30 mins after establishment/bolus
BP every 5 mins for 15 mins after establishment/bolus
Assess sensory block hourly

399
Q

Max time after full dilation a woman with an epidural can be in labour for before giving birth?

A

4 hours

400
Q

How long should pushing be delayed for with an epidural?

A

1 hour

401
Q

What does active mx of 3rd stage of labour mean?

A

routine use of uterotonic drugs - 10IU oxytocin
deferred clamping and cutting of the cord (1-5mins)
controlled cord traction after signs of separation of the placenta

402
Q

When to advise change from physiological to active mx of 3rd stage?

A

haemorrhage

the placenta is not delivered within 1 hour of the birth of the baby

403
Q

Complications of IUGR?

A

still birth
PTL
intrapartum foetal distress - birth asphyxia, meconium aspiration
post-natal hypoglycaemia
neurodevelopmental delay
risk type 2 diabetes and HTN in adult life

404
Q

Major RFs for IUGR?

A 
Maternal age >40
Smoker >11cigs/day
Cocaine
Daily vigorous exercise
Previous SGA baby
Chronic HTN
DM
Renal impairment
Antiphospholipid syndrome
Low PAPPA
405
Q

Which contraceptives can be given to women on enzyme inducers?

A

Depot medroxyprogesterone acetate
LNG-IUS
Copper IUD

406
Q

Lamotrigine and COCP interaction?

A

May reduce seizure control

407
Q

RFs for breech presentation?

A 
Uterine malformation
Placenta praevia
Polyhydramnios/oligohydramnios
Fetal abnormality (chromosomal/CNS malformation)
Prematurity
408
Q

What abx are given intraoperatively during a TAH?

A

IV Co-amoxiclav

409
Q

When do women first feel fetal movements?

A

Primip 20 weeks

Multip 16-18 weeks

410
Q

Most common cause of excess clear non-itchy discharge?

A

Ectropion

411
Q

How is progress in labour after ARM assessed?

A

Vaginal exam 2 hours later

412
Q

Thresholds for considering early birth in pre-eclampsia?

A

inability to control maternal BP despite using 3 or more classes of antiHTNs

maternal pulse oximetry <90%

progressive deterioration in liver function, renal function, haemolysis, or platelet count

ongoing neurological features, such as severe intractable headache, repeated visual scotomata, or eclampsia
placental abruption

reversed end-diastolic flow in the umbilical artery doppler velocimetry, a non-reassuring cardiotocograph, or stillbirth

413
Q

Mild, moderate and severe pre-eclampsia classifications?

A

Mild: 140-149/90-99mmHg
Moderate: 150-159/100-109mmHg
Severe: >160/>110

414
Q

When should mothers with diabetes deliver?

A

37-38+6 weeks

415
Q

Retinal scans in mothers with diabetes - when?

A

Booking
Normal: Repeat at 28 weeks
Abnormal: Repeat at 16-20 weeks

416
Q

Extra scans for serial growth measurement and amniotic fluid measurement in diabetes?

A 
28 weeks
32 weeks
36 weeks
If don't deliver between 37 and 38+6 weeks:
38 weeks
39 weeks
417
Q

How can you differentiate between PCOS and CAH since both have ovarian cysts?

A

CAH has high serum 17-hydroxyprogesterone

418
Q

What is a luteoma of pregnancy and how does it present?

A

Benign solid ovarian tumour
Arises only in pregnancy & disappears after delivery
Virilisation

419
Q

When is surgical mx of TOP first line?

A

After 14 weeks
If preferred by the woman
Medical TOP failed

420
Q

When should BP be checked again if a woman in antenatal clinic is found to have a high bp?

A

In 20 mins
If elevated - 2 further readings 4hrs apart
If still high admit for monitoring

421
Q

What gestation can amniocentesis take place from?

A

15 weeks

422
Q

Risk of miscarriage amniocentesis vs CVS?

A

Amniocentesis: 1%
CVS: 1.5-2%

423
Q

ECTOPIC mnemonic for RFs for ectopic?

A 
Endometriosis/previous ectopic
Contraception - IUD/POP/implant
Tubal surgery
Other abdo surgery
PID
Infertility Tx
Can't find cause (50%)
424
Q

When should women with GDM have their glucose checked after pregnancy?

A

6-13 weeks fasting blood glucose

425
Q

What is haematometra?

A

retention of blood in the uterus

426
Q

Lichen sclerosis tx?

A

Emollients
High potency steroid ointments (clobetasol propionate)
Topical Calcineurin inhibitors (Tacrolimus)

427
Q

Which increases risk of vulval cancer - lichen sclerosis or planus? When would you biopsy?

A

Lichen sclerosis

If not responding to tx

428
Q

Lichen planus tx?

A

Topical steroids (clobetasol)
Oral steroids
Consider ciclosporin

429
Q

Most likely cause of azoospermia?

A

Varicocoele

430
Q

Normal dose of folic acid in pregnancy?

A

400mcg

431
Q

Indications for intrauterine fetal transfusion?

A

Severe fetal anaemia usually due to red cell immunisation and parvovirus B19 infection in pregnancy

432
Q

When can the ureters be damaged during gynae surgery/Csection?

A

When the uterine pedicle is being tied off

433
Q

How much does IUI increase chances of pregnancy?

A

10 to 20 percent chance of getting pregnant with each IUI cycle

434
Q

First investigations for hyperprolactinaemia?

A

First:
TFTs for hypothyroidism
Chronic renal failure
Pregnancy

Second: MRI for pituitary adenoma

435
Q

Which hormone increases the most in pregnancy?

A

Oestriol

436
Q

What is a common side effect of laparoscopy that women should be warned about?

A

Shoulder tip pain due to CO2 inflation

437
Q

RCOG classification of OHSS?

A

Mild: abdo pain + bloating
Moderate: + N&V + ascites on USS
Severe: + clinical ascites + oliguria + Hct>45% + hypoproteinaemia
Severe: + VTE + ARDS + anuria + tense ascites

438
Q

Normal and abnormal apgar score?

A

5-minute Apgar score:
7–10 = reassuring
4–6 = moderately abnormal
0–3 = low

439
Q

Which organs are involved in fetal blood production?

A

<20 weeks: liver

>20 weeks: bone

440
Q

Rotterdam criteria for PCOS?

A
  1. Oligo/amenorrhoea
  2. Clinical/biochemical signs of hyperandrogenism
  3. PCOS on USS: at least 12 follicles in 1 ovary measuring 2-9mm in diameter/ovarian volume >10ml
441
Q

Trichomoniasis Ix findings?

A

High vaginal pH

Ovoid mobile parasites on wet saline mount

442
Q

3 CTG categories?

A

Reassuring: all features normal
Suspicious: 1 non-reassuring feature
Pathological: 2+ non-reassuring/1+ abnormal

443
Q

4Ts of PPH?

A
  1. Tissue (retained products)
  2. Tone (uterine atony)
  3. Trauma (episiotomy/perineal tears)
  4. Thrombin (DIC)
444
Q

Which patients should get baseline TFTs in pregnancy?

A 
Current thyroid disease
Previous thyroid disease
FH of first degree relative with thyroid disease
Autoimmune - coeliac
T1DM and T2DM
445
Q

POPQ stages for urogenital prolapse?

A

Stage 1: cervix prolapses >1cm above hymen (within vagina)
Stage 2: cervix prolapses between 1cm above and below hymen (to introitus)
Stage 3: prolapse >1cm below hymen but no further than 2cm less than total vagina length
Stage 4: complete eversion of vagina outside introitus
Procidentia: Uterus and cervix protrude from introitus and ulceration!

446
Q

Causes of secondary dysmenorrhea?

A 
o	endometriosis
o	adenomyosis
o	PID
o	intrauterine devices
o	fibroids
447
Q

Contra-indications to expectant management of miscarriage?

A
  • Increased Haemorrhage risk - late in 1st trimester
  • Adverse trauma with previous pregnancy
  • Coagulopathy
  • Infection
448
Q

When to scan during expectant mx of miscarriage?

A

If after 7-14 days there is no bleeding or continued bleeding
If after 3 weeks pregnancy test still positive

449
Q

1st and 2nd line analgesia in pregnancy?

A

1st line = paracetamol

2nd line = codeine phosphate

450
Q

1st and 2nd line Tx of prolactinoma?

A

1st line = dopamine agonist (cabergoline/bromocriptine)

2nd line = trans-sphenoidal surgery

451
Q

Tx of Women with Hb <100g/l in the postpartum period?

A

100–200mg elemental iron for 3 months

452
Q

Tx of anaemia in pregnancy?

A

Trial oral iron supplements for 2 weeks
Once Hb is in the normal range supplementation should continue for 3 months and at least until 6 weeks postpartum to replenish iron stores

453
Q

What ferritin level in pregnancy indicates oral iron supplementation?

A

<30μg/l

454
Q

Tx for UTI in pregnancy?

A

1st line = nitrofurantoin
2nd line = amoxicillin/cefalexin
Can use these all for asymptomatic bacteriuria

455
Q

Tx for pyelonephritis in pregnancy?

A

1st line oral = PO cefalexin

1st line IV = cefuroxime

456
Q

Indications for magnesium sulphate tx?

A

Consider the need for magnesium sulfate treatment, if 1 or more of the following features of severe pre-eclampsia is present:
ongoing or recurring severe headaches
visual scotomata
nausea or vomiting
epigastric pain
oliguria and severe hypertension
progressive deterioration in laboratory blood tests (such as rising creatinine or liver transaminases, or falling platelet count).

457
Q

Surgical mx of stress incontinence?

A

Colposuspension (open or laparoscopic)
Autologous rectus fascial sling
Retro-pubic mid-urethral mesh sling (don’t offer first line)
Intramural bulking agents

458
Q

What does a bagel sign suggest?

A

Ectopic pregnancy

459
Q

FSH in PCOS?

A

Normal

460
Q

Define a prolonged second stage of labour in a nullip with an epidural

A

3 hours

461
Q

Types of breech?

A

Frank – the legs are extended up to head, the buttocks are the presenting part
Complete – the hips and knees are flexed, buttocks are the presenting part
Incomplete – one or both hips are extended, knee or foot is the presenting part
Footling (single/double) – one or both legs are fully extended, foot/feet is the presenting part

462
Q

What do NICE recommend in the event with unstable bipolar on lithium becomes pregnant?

A

Switch meds gradually to an atypical antipsychotic

463
Q

When to offer an ogtt in pregnancy?

A 
BMI >30
Previous macrosomic baby
Previous GDM
First degree relative with DM
Ethnic origin with high DM risk
464
Q

What is clear fluid followed immediate vaginal bleeding suggestive of?

A

Vasa praevia

465
Q

RFs for pre-term labour?

A

overstretching of the uterus: Multiple pregnancy, polyhydramnios
Conditions where foetus is at risk: Pre-eclampsia, IUGR, placental abruption
Problems with the uterus or cervix: Fibroids, congenital uterine malformation, short or weak cervix, previous uterine or cervical surgery
Infection: chorioamnionitis, maternal or neonatal sepsis, bacterial vaginosis, trichomoniasis, Group B Streptococcus, STIs and recurrent urinary tract infections
Maternal co-morbidity (for example: Hypertension, diabetes, renal failure, thyroid disease etc.)

466
Q

When can you give an epidural?

A

Once a woman is in the active first stage of labour

467
Q

Opiate analgesia in labour?

A

PO codeine phosphate

IM/IV diamorphine

468
Q

What to give neonate if mother is Hep B positive just before labour?

A

HBV IgG
HBV vaccine
Both within 24 hours of birth

469
Q

IM anti-emetic in hyperemesis?

A

IM prochlorperazine

470
Q

Mx of FGM type III in labour?

A

anterior episiotomy during the second stage of labour under local anaesthetic or regional block

471
Q

Why is CVS performed between 11-14 weeks?

A

Risk of fetal limb abnormalities if performed before

472
Q

What are the Bishop’s score modifiers?

A

1 point is added to the score for each of the following:
Presence of pre-eclampsia
Each previous vaginal delivery

1 point is subtracted for each of the following:
Post-dates pregnancy
No previous vaginal deliveries
Premature pre-term rupture of membranes

473
Q

Complete vs partial mole

A

Complete mole: 1 sperm and an empty egg with no genetic material - no fetal tissue
Partial mole: 2 sperm + 1 egg - fetal tissue

474
Q

What is Potter’s syndrome?

A 
Constellation of signs due to oligohydramnios
Pulmonary hypoplasia
Clubbed feet
Facial deformity 
Congenital hip dysplasia
475
Q

Contraindications to tocolysis?

A

Greater than 34 weeks gestation
Non-reassuring CTG, fatal foetal anomaly or intrauterine death
IUGR or placental insufficiency
Cervical dilation >4cm
Chorioamnionitis
Maternal factors: pre-eclampsia, APH, haemodynamic instability

476
Q

Classifiaction of 3rd degree tears?

A

3a: less than 50% of the thickness of the external anal sphincter is torn
3b: more than 50% of the thickness of the external anal sphincter is torn, but the internal anal sphincter is intact
3c: external and internal anal sphincters are torn, but anal mucosa is intact

477
Q

3 criteria for lactational amenorrhoea to be effective?

A
  1. Complete amenorrhoea
  2. > 85% of feeds are breast
  3. <6 months since birth of baby
478
Q

Which cancer is smoking thought to reduce the risk of?

A

Endometiral (reduces oestrogen levels)

479
Q

How long does spinal anaesthesia last? Who do we therefore give it to?

A

1-2 hours

Multips (primips need epidural for longer pain relief)

480
Q

Highest risk of ABO incompatibility?

A

If mother is O negative

481
Q

Cause of neonatal hydrocephalus?

A

Maternal rubella infection

Causes aqueductal stenosis

482
Q

What is non-invasive prenatal testing for Down’s?

A

Maternal blood test looking at cell free foetal DNA
Being rolled out in the NHS now (fully by June 2021) as a screening tool for Down’s, Edward’s and Patau’s and some can also tell the baby’s sex (you can pay for it privately)
MORE accurate than combined test

483
Q

Normal ECG changes in pregnancy?

A

Flat or inverted T Wave in leads III, V1 and V2

Q Waves in leads III and aVF

484
Q

Risk of needing emergency c section if trialling vaginal breech delivery? Absolute contraindication to this?

A

40% risk of needing an emergency C-section

Footling breech

485
Q

Steps in vaginal breech delivery?

A
  1. Delivery of buttocks - if handling needed put thumbs on the sacrum and fingers on ASIS of baby
  2. Delivery of legs and lower body - if extended use Pinard’s manoeuvre
  3. Delivery of shoulders - Lovset’s manoeuvre
  4. Delivery of head - Mauriceau- Smellie-Veit Manoeuvre
486
Q

What is the least common malpresentation? How do you deliver them?

A

Brow

C section

487
Q

When is planned C section done for breech babies?

A

39 weeks

488
Q

Mx of uterine inversion?

A

summon help, discontinue uterotonic drugs, administer crystalloid aggressively and blood products (as needed), and attempt to manually reposition the uterus by pushing the fundus cephalad along the long axis of the vagina.

489
Q

1st line Tx of PMS?

A

Exercise
CBT
Vit B6
Combined new generation pill (cyclical or continuous)
Continuous or low dose luteal phase low dose SSRIs

490
Q

Tx for chlamydia in pregnancy?

A

Azithromycin 1g PO for one day and then 500mg OD for 2 days

491
Q

UKMEC 4 to cocp?

A 
<6 weeks post-partum and breastfeeding
Age >35 and smoking >15/day
Poorly controlled HTN
Vascular disease
Current or past history of IDH or stroke/TIA
History of VTE
Immobilisation due to surgery
Known thrombogenic coagulopathy or positive for antiphospholipid antibodies
Certain cardiac disease
Migraine with aura
Active breast Ca
Severe liver disease or liver Ca
492
Q

UKMEC 3 to cocp?

A 
Age <35 and smoking <15/day
BMI>35
Multiple RF’s for CVD
Well-controlled HTN
FH of VTE
Immobilisation not due to surgery
Migraine without aura 
Known carrier or gene mutations associated with breast CA
Undiagnosed breast mass
Past Breast Ca
Diabetes with vascular disease
Current gallbladder disease
493
Q

UKMEC 4 to coils?

A

Post-partum or post-abortion sepsis
Endometrial or cervical cancer, gestational trophoblastic disease
Undiagnosed vaginal bleeding
Active PID or active chlamydia or gonorrhoea
Pregnancy
Active breast Ca (for IUS only)

494
Q

UKMEC 3 to coils?

A

Between 48 hrs and 4weeks post-partum
Previous ectopic pregnancy
Uterine fibroids with distortion of uterine cavity
HIV with low CD4

495
Q

Which method of emergency of contraception makes the POP less effective for 5 days?

A

Levonelle

496
Q

Causes of oligo/azoospermia?

A

Idiopathic
Drug exposure
Varicocele
Anti-sperm antibodies – may occur after vasectomy reversal
Infection
Anatomical – congenital absence of vas deferens
Cystic fibrosis – causes obstruction
Hypothalamic hypogonadism
Kallmann’s syndrome – hypogonadotrophic hypogonadism
Hyperprolactinaemia

497
Q

How is IVF carried out?

A
  1. Ovulation and Egg collection
    - Single injection of LH or hCG given 34-38 hours before eggs collected
  2. Fertilisation and culture
    - Eggs and sperm incubated and transferred to growth medium
    - Grown for 6 days before transfer to uterus
    - Leftover embryos can be frozen
  3. Embryo transfer
    - Single or double embryo transfer
    - Can give luteal phase support with progesterone of hCG until 4-8 weeks
498
Q

Risk of miscarriage in threatened miscarriage?

A

25%

499
Q

Chance of successful VBAC? How does that change if previous successful VBAC?

A

75%

Increases to 85-80%

500
Q

Largest diameter of fetal skull?

A

Occipito-frontal – 11cm
Suboccipito-bregmatic – 9.5cm
Submento-bregmatic – 9.5cm
Vertomental – 13cm (brow presentation - too large for vaginal birth) – The pelvic mid-cavity diameters are 11cm in transverse and AP, the pelvic outlet diameters are 11cm transverse and 12.5cm AP (inlet diameters are 13cm T and 11cm AP)

501
Q

Ix if PPROM suspected but no amniotic fluid visualised on speculum?

A

consider IGFBP-1 (insulin like growth factor binding protein -1) or PAMG-1 (placental alpha microglobulin -1)test

502
Q

Tx of toxoplasmosis in pregnancy? What is added if congenital infection suspected?

A

Spiramycin

+sulfadiazine and pyrimethamine

Oishi's 5th year flashcards (8 decks)

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