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Management Flashcards

1
Q

How would you prevent preterm labour?

A

Vaginal progesterone
Prophylactic Cervical Cerclage

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2
Q

How would you manage preterm labour?

A

Admit
Steroids
Administer Tocolytics
Magnesium Sulfate

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3
Q

How would you manage PPROM?

A

Admit, sterile speculum
Erythromycin
Mg Sulfate
CTG

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4
Q

What are the risk factors for preterm labour?

A

Smoking, multiple pregnancy , previous

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5
Q

How do you manage PROM?

A

IOL after 24 h
IOL if meconium

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6
Q

What are the risks of ECV?

A

50% success
Placental Abruption
Foetal Distress needing c section

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7
Q

Risks of breech vaginal birth?

A

40% c section

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8
Q

How would you induce labour?

A

Membrane sweep
vaginal prostaglandins
Amniotomy
Syntocinon

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9
Q

VBAC risks

A

Uterine rupture
75% successful, need for emergency c-section in 25%

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10
Q

How would you manage uterine rupture?

A

Senior
ABCDE (group and save)
Expedite delivery
Urgent surgery to repair the uterus

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11
Q

How would you manage PPH?

A

ABCDE
Senior, haemorrhage protocol
Massage uterus
Syntocinon
Ergometrine

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12
Q

How would you manage Hypertension in pregnancy?

A

Aspirin
Labetalol
Serial growth scans every 4 weeks

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13
Q

How would you manage diabetes in pregnancy?

A

Folic Acid
Monitor glucose
Foetal abnormality scan
Serial growth scans every 4 weeks
Elective birth between 37-38+6 weeks
Sliding scale during labour

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14
Q

When should you check thyroid function in pregnancy?

A

Every 2-4 weeks

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15
Q

How would you manage hsv in pregnancy?

A

Oral aciclovir & vaginal if 1/2 trimester
c section if birth within 6 weeks

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16
Q

HIV counselling pregnancy?

A

Joint clinic every 2 weeks
Monitor viral load and at delivery, might need c section.
Don’t breastfeed

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17
Q

When should a patient with pre-eclampsia be admitted?

A

>160/110
Symptoms of severe disease
Foetal compromise
Biochemical abnormalities

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18
Q

How should pre-eclampsia be monitored antenatally?

A

Deliver at 37 weeks
BP 4x a week
Bloods 2x a week
Growth scans every 2 weeks

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19
Q

Risk factors for pre eclampsia

A

Young/Old
Previous HTN disorder
Diabetes
Kidney Disease
Obesity

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20
Q

What are the risks of gestational diabetes?

A

Maternal: HTN, trauma, stillbirth
Foetal: big baby, neonatal hypo, congenital abnormalities

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21
Q

How would you counsel on obstetric cholestasis?

A
  • Risk Factors: personal or family history of OC, history of liver disease, multiple pregnancy
  • Explain diagnosis and risks (stillbirth and premature birth)
  • Explain need for early delivery (37 weeks)
  • Explain regular monitoring with weekly LFTs
  • Advise paying close attention to foetal movements
  • Symptomatic treatment with ursodeoxycholic acid and emollients (and maybe vitamin K)
  • High recurrence rate (up to 90%)
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22
Q

How is acute fatty liver of pregnancy managed?

A

Supportive in ITU
Expedite delivery as soon as stable

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23
Q

How is IUGR managed?

A

Growth scans every 2 weeks
Dopplers twice a week
Monitor movements
Delivery by 37 weeks as a consultant led decision

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24
Q

Placenta praevia counsel

A

PACES TIPS
• Risk Factors: previous placenta praevia, multiple pregnancy, previous C-section, smoking and drug use, advanced maternal age
• Presenting with Asymptomatic Low-Lying / Placenta Praevia
o Explaintheimportanceofthefinding(increasesriskofbleeding) o Explainthat90%ofplacentaswillmoveawayfromtheos
o Rescanat32weeksandthengofromthere
o Advisetoavoidhavingsex
• Presenting with Symptomatic Placenta Praevia (with bleeding)
o Admituntilbleedinghasstoppedandforafurther48hours
o Explaintheimportanceofthefindingandthatthefoetusneedstobemonitored o Explainthatpromptdeliveryneedstobediscussed(basedongestation)
o Explaintherisksofdelivery:
Major blood loss
May require a blood transfusion May require a hysterectomy

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25
How would you manage placental abruption?
• ABCDE approach o Gain2xIVaccess o Bloods(FBC,Rhesusstatus,cross-matchandclottingscreen) o Continuousfoetalmonitoring o Fluid,antifibrinolytics,blood,orblood-productreplacement,asindicated • Give anti-D immunoglobulin in Rh-negative women • Decide on delivery: o Ifmotherishaemodynamicallyunstableorthereisevidenceoffoetaldistress→ Expedite delivery (irrespective of gestation) o Ifmotherishaemodynamicallystable,andthereisnoevidenceoffoetaldistress→ If \>37 weeks gestation → induction of labour If \<37 weeks gestation → give steroids and admit to antenatal ward for close monitoring • If bleeding settles, consider discharging home with weekly serial growth scans until term
26
Miscarriage counselling
Risk Factors: advanced maternal age, previous miscarriages, chronic conditions (e.g. uncontrolled diabetes), uterine or cervical anomalies, smoking, alcohol and illicit drug use, underweight or overweight • Breaking bad news o Explain the diagnosis o Reassure that thisiscommonandunder-reported(1in5pregnancies) Explain that risk increases with age If asked about cause: explain that most of the time there is no cause o Explainthemanagementoptions(expectant,medicalandsurgical) If medical: explain what to expect (pain, bleeding, nausea) Antiemetics and pain relief will be given o Advisetodoapregnancytestafter3weeks • Safety net: return if symptoms get worse, bleeding persists after 7-14 days
27
ectopic counselling
28
How would you manage gestational trophoblastic disease?
Anti-D Suction curettage Pregnancy test after 3 weeks.
29
How would you manage PCOS?
Rotterdam Criteria COCP/POP Co-cyprindol for hirsutism Clomifene if fertility needed Weight loss
30
Counsel PCOS
31
Counsel TOP
32
Counsel HRT
33
Counsel PID
34
Counsel Incontinence
35
Endometriosis Counsel
36
Counsel Fibroid
37
How might you manage lichen sclerosus?
Good skin care, emollients steroid biopsy if persistent
38
How might you manage PMS?
39
CIN management
A1 Conservative Radical hysterectomy and lymphadenopathy Chemo/radio if more severe
40
Counsel CIN
41
Counsel Endometrial hyperplasia
42
Counsel Ovarian cancer
43
Counsel Down's Syndrome
44
Counsel Neonatal jaundice
45
Counsel asthma
46
How is croup managed?
Mild = Dexamethasone Moderate = Dexamethasone Oxygen Severe = Dexamethasone Oxygen Nebulised Adrenaline
47
CF counsel
48
Viral induced wheeze counsel
49
Coeliac counsel
50
Counsel Constipation
51
GORD counsel
52
Intussusception counsel
53
Counsel meningitis
54
How would you investigate a fever in a child with red flag symptoms?
Immediate transfer to A&E FBC, CRP, Culture XCR, LP, Electrolytes, VBG
55
How would you manage an AKI?
STOP AKI Sepsis Screen Toxins Optimise volume/BP Prevent harm
56
Counsel ITP
Benign, acute 6-8 weeks IVIG and steroids if severe
57
What are the x ray findings of SUFE?
Trethowan's sign Klein line asymmetry
58
Counsel ADHD
59
Counsel Autism
60
Counsel cerebral palsy
61
How would you manage status epilepticus?
ABCDE IV lorazepam Senior Help Phenytoin
62
How is anaphylaxis managed?
IM adrenaline Oxygen IV fluids IV chlorphenamine + IV steroids
63
Counsel anaphylaxis
64
Counsel NAI
65
How would you assess cognition?
AMTS MMSE Addenbrokes Cognitive Exam Frontal Lobe testing Depression Screening

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