Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MD > MD3 ONG > Flashcards

MD3 ONG Flashcards

1
Q

Best way to estimate the duration of a pregnancy on palpation?

A

From Pubic symphysis to top of palpable uterus (fundus) - at 20 weeks fundus will be at belly button, at 40 weeks it will be just below the rib cage. Between them around 30 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How can you tell if a baby is getting ready to come on palpation?

A

Head will descend (in non-breach) and will lose mobility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the normal number of weeks before labour and at what point after this period is the baby at risk?

A

37 to 42 weeks, a week after that, risk of stillbirth begins to rise.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What actually is amniotic fluid?

A

Baby pee - marker of well hydrated and nourished baby.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the cutoff for pre-eclampsia and which 3 areas of the body are uniquely at risk?

A

140/90.
Vessels - made stiff - leads to hypertension
Kidneys - hypertension/placental mystery molecules cause proteinuria
Brain - low threshold for seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is HELLP syndrome?

A

Think of it is a severe form of pre-eclampsia.
H - haemolysis
EL - elevated LFTs causes DIC as all coags are up.
LP - low platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the medication given to raise seizure threshold in pre-eclampsia?

A

Magnesium sulphate - but makes patients feel like shit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the only true cure for pre-eclampsia and what are some temporary measures?

A

true cure - remove placenta

in the meantime - atenolol, hydralazine, and mag sulph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define the following acronyms: EDD, GTT, PPH, LMP

A

Estimated date of delivery
Glucose tolerance test
Post partum haemorrhage
Last menstrual period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which two conditions are key to specifically touch on in past obstetric hx at the booking visit?

A

HTN and diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the tool to test for perinatal depression?

A

Edinburgh Post-natal depression score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When does everyone do a GTT? What about if Hx of gestational diabetes?

A

28 week visit.
Earlier if PHx. (do twice)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Mnemonic for Ix performed at initial antenatal visit?

A

FBI RUSHH (CVS)
FBE
Blood group and Rhesus
Iron
Rubella
Urine (MSU for UTI, consider STIs)
Syphilis
Hep B and C
HIV

Consider CVS - CST (opportunistic), varicella serology and scan (USS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define primary and secondary PPH and major and minor PPH.

A

Primary = in first 24 hours after birth
secondary - 24hrs to 12 weeks after.

Minor = 500ml to 1000ml blood loss.
Major is over 1000 or signs of shock.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is 3rd stage of delivery?

A

between baby and placenta delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the main management difference between a minor and major PPH?

A

Major needs transfusion immediately, start O neg then switch, consider also FFP and cryoprecipitate (has fibrinogen that’s why).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe these 3 major acute causes of PPH - uterine atony, placenta accreta, placenta previa.

A

atony - uterus not contracting, contraction squeezes blood vessels shut normally.

Accreta - placenta imbedded into uterine wall - doesnt detach with birth - bleeds heavily

previa - placenta covering cervix.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

One pharm and one surg Mx for uterine atony.

A

pharm - oxytocin
surg - balloon tamponade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What medication may help prevent pre-eclampsia and when should it be ceased?

A

low dose aspirin to be ceased at 36 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is an ECV?

A

Extra cephalic version - palpate the baby away from breach position into better position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

3 major Ix/interventions performed at the 28 week appointment vs the 36 week?

A

28 - FBE, anti-D if needed, GTT

36 - FBE, anti-D if needed, GBS swab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Who needs Anti-D?

A

Rho neg mums with + babies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When are the two main USS done for most women?

A

12 and 20 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which complication does folic acid aim to avoid?

A

Spina bifida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Is warfarin safe for pregnancy?

A

No, it is teratogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

List 4 key discussion topics for the initial pregnancy visit

A
  1. confirm pregnancy/dates
  2. folate
  3. medication check
  4. Lifestyle/diet tips
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Approximately when do most pregnant women stop working?

A

Week 34

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the main two complications to look for at each antenatal visit?

A
  • pre-eclampsia (HTN)
  • Poor growth (IUGR/placental insufficiency)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Are proteinuria and glucosuria common in pregnancy?

A

Yes both in small amounts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is chorioamnionitis? Which complication is it closely linked with?

A

Infection of the chorion/amnion with vaginal flora. Closely linked with pre-term labour.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

List some risk factors and signs of chorioamnionitis.

A

Risks - long labour and multiple examinations in labour

Signs - foul amnion, fever, tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Abx treatment for chorioamnionitis?

A

IV Amp + gent/ceft, and metranidazole or clindamycin for anaerobes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Which bacteria typically causes post-partum sepsis?

A

Group A Strep (pyogenes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Mx for positive GBS swab?

A

IV benpen prophylactically at delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

CMV is associated with which fetal complication?

A

Deafness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

When are the 4 doses of Hep B vaccine?

A

At birth, then at 2, 4 and 6 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Which medicine can be given as prophylaxis for HBV vertical transmission in a HBV + mum?

A

tenofovir (if viral load above 200,000)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

If active HSV lesions are present during late term, what is the best mx?

A

Ceasar instead of vaginal birth
acyclovir for prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the two biggest causes of maternal mortality in Australia?

A

Cardiac Disease and DVT.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the key physiological cardiac change during pregnancy and how does this impact the risk of associated pathologies?

A

cardiac output MUST rise during pregnancy. If there is an underlying pathology that is worsened by higher CO (eg. aneurysm) or that prevents a rise in CO (eg. a left sided stenotic valve) then this is DANGEROUS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Which cardiovascular condition has the highest risk of maternal death in pregnancy?

A

Pulmonary Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the physiological changes to the respiratory system in pregnancy?

A
  • airway edema common
  • RR up
  • diaphragm pushed up by uterus reduced functional residual capacity (FRC) which acts as an O2 storage.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Is breathlessness normal in pregnancy?

A

Yes very common but it is important to seperate it from a potential PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

List two physiological changes that put the airway at risk in pregnancy.

A
  • laryngeal/airway swelling
  • reduced osephageal sphinctre tone increasing reflux
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How do sugar levels change in pregnancy and how might this impact a type 1 diabetic?

A

Pregnancy requires both hyperglycemia and hyperlipidemia to feed baby - T1DM will need more insulin during pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How does pregnancy impact blood/plasma?

A

Levels greatly increase, causing haemodilution.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How are T and B cells impacted by pregnancy?

A

T cells usually inhibited to allow for fetal growth - this may mean autoimmune diseases flare less when pregnant.

B cells are unimpaired which is why vaccines still work during pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Why does lying position impact pregnancy?

A

Aortocaval compression = compression of the IVC and aorta due to the position of the fetus.
Solution = left lateral tilt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Is it safe to defib while pregnant?

A

If a woman’s heart is not working then the baby is in danger, it is safest to defib. The most unsafe thing for the baby is for the mother to die.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Can rubella and varicella vaccines be given during pregnancy?

A

These are live vaccines so cannot be given in pregnancy. Can be given in planning or afterward.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the mx for pregnant women with a clot risk?

A
  • clexane subcut
  • educate around DVT/PE signs and symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Signs of pre-eclampsia?

A

Headaches, visual changes, swelling, N+V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

When do fetal movements usually start for mum?

A

Around 17 weeks but everyone is different

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What Ix would you order for reported reduction in fetal movements?

A
  • CTG and USS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is primigravid?

A

First pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is a fetal station?

A

How far down the baby’s head is in pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What does an USS look for when looking for reduced fetal movements?

A

placental insufficiency as evidenced by DVP. Deepest vertical pocket of amniotic fluid. If less than 2cm = placental insufficiency.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is macrosomia and what are the delivery options?

A

Big baby.
1. Watch and wait - risk of obstruction (ceasar) and risk of shoulder dystocia

  1. Ceasar - bleeding risk and longer recovery (4-6 weeks)
  2. Induction eg. balloon dilatation and ARM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is a key medical thing to do for women moving forward after a stillbirth?

A

Lactation suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is an amniotomy and what is syntocinon?

A

Amniotomy (ARM) = artifical rupture of membranes

syntocinon = synthetic oxytocin to force contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is meconium and what does it mean if it is present in the amniotic fluid?

A

First poop of baby - sticky green bile stuff. If present in amniotic fluid it may be a sign of fetal distress or an overdue baby - CTG.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are the 3 stages of delivery?

A

First phase - labour until full dilation
Second - full dilation to birth
Third - birth to placental delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is station 0 for the fetus?

A

Head is at level of ischial spines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is caput?

A

Swelling of the baby’s head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is crowning?

A

baby’d head no longer retreats after contractions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Why is oxytocin given after baby is born?

A

To prevent PPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

How does pregnancy impact clotting factors?

A

They go up massively (800% up) to prep for delivery haemorrhage. DVT risk massive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How does delivery of the baby impact the cardiac system?

A

All of the fluid that was shunting into the placenta returns to the system - strain on heart.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What are the main two groups of medications used for analgesia in delivery?

A
  • nitrous oxide for contractions
  • opioids, typically morphine - 10mg IM 2-3 hourly.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

How can an epidural help pre-eclampsia?

A

An epidural and spinal can cause hypotension due to shutting off the sympathetic mechanisms in the spine. This lowered BP can help in those with HTN.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Which combo of medications are given in an epidural?

A

Local anaesthetic: bupivicaine or ropivicaine

+ opioid - fentanyl

CAN DO IT AS A PCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Why would you avoid GA in pregnancy?

A

Many reasons. Very risky in pregnancy due to airway risks, aorto-caval compression may not be recognised, hypoxia risk due to reduced FRC, and GA will cross to baby.
Plus partner cannot be in the room to be involved.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Explain gravida vs parity?

A

gravida = number of times pregnant
parity = birth of fetus over 20 weeks (live or stillbirth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is the average baby birth weight? (at 40 weeks)

A

3.5kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Why might appendicitis be missed in pregnancy?

A

McBurney’s point MOVES due to growth of abdomen and some symptoms may be similar to regular pregnancy symptoms eg. nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What pharm management can help in pre-eclampsia and in IUGR (intra uterine growth restriction)?

A

low dose aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

To really clarify someone’s gestation period you can which two methods?

A

USS - 7 weeks sac + CRL + heart rate.
5 weeks just sac, 6 weeks just sac and CRL.
CRL often dates pregnancy.

Serial BHCG - should double every 48 hrs in successful pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

If BHCG is rising weirdly and not doubling every 48 hrs as expected, what might you consider?

A

ectopic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

When is the NIPT done?

A

10 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What is the chance of miscarriage on average before 3 months?

A

Around 30-40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

When to the first and second visits tend to be in pregnancy and what is done at these?

A
  • first visit is the ‘i am pregnant visit’ around 6 weeks. Confirm pregnancy (BHCG) and discuss folate, discuss lifestyle changes, removing teratogenic meds.
  • next visit = 12 weeks. Blood tests. FBI RUSHH (+varicella, CMV, etc depending on clinician). Combined first trimester screening = USS for nuchal translucency and then the triple blood test algorithm.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What blood tests are part of the triple blood test for the combined first trimester screening?

A

BHCG, alpha fetoprotein, PAPP-A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What are the two diagnostic tests for aneuploidy and what are their risk levels?

A

amniocentesis - 16 weeks - 0.5% risk

chorionic venous sampling - 13 weeks - 1% risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

When is the 3rd major pregnancy visit? What is done?

A

20 weeks - morphology scan.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Describe the main tests done at the 28 and 36 week visits?

A

28 weeks - anti D if needed, FBE, iron, Ab test (always every fkn visit). GTT

36 weeks - GBS swab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What are some reasons for a planned ceasar?

A
  • mum’s choice
  • active HSV
  • breach
  • giant baby
  • transverse lie
  • abnormal placenta (accreta, previa, vasoprevia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Why does hardly anyone in the western world go beyond 41 weeks + 3?

A

Risk of stillbirth rises each day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What is the normal baby position on vaginal delivery?

A

occipital-anterior.
Occipital bone of baby against mum’s anterior side (pubic symphisis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What are the 3 stages of pregnancy?

A

1 = in labour but not fully dilated to 10cm
2 = fully dilated until birth
3 = post birth until placenta delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Which two injections are given to the baby within an hour of being born?

A

Hep B and Vit K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What 4 things are tested for on the fetal heelprick?

A
  • PKU
  • congenital hypothyroid
  • cystic fibrosis
  • congenital adrenal hyperplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What is the ‘normal’ timeline for physiological neonatal jaundice ?

A

Between 24hrs and 2 weeks jaundice is likely normal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What is the cause of physiological jaundice in neonates?

A

Babies need high Hb (around 180) to deal with the hypoxic conditions of the womb and the delivery - once born they no longer need this Hb so the heme is broken down into bilirubin. Their inefficient livers are unable to conjugate this bilirubin leading to increased unconjugated bilirubin levels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What is the validity of different oral contraceptive pills following pregnancy?

A

mini pill - no side effects. Safe once baby is born.

combined pill - estrogen will turn off lactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What day is usually the peak of physiological jaundice?

A

Day 5 or so

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What is the most common cause (by far) of pathological neonatal jaundice? What usually leads to this pathology?

A

Haemolysis. 99/100 says John Mills.
USUALLY this is due to iso-immunisation - i.e the crossing of maternal IgG across the placenta to target baby antigens. Nowadays this is typically ABO cross reactivity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Which iso-immunisations are most common?

A

In the olden days Rhesus disease (Ab made by Rhesus neg mum in response to Rhesus positive baby following maternal sensitisation due to prior pregnancy or maternal fetal haemorrhage) was the most common cause of iso-immunisation and subsequent neonatal jaundice. Now we give anti-D.

Now the most common cause is ABO cross reactivity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What percentage of women are rhesus negative and how does anti-D work?

A

15% are rhesus negative.
Anti-D mimics the maternal Ab that would be produced and mops up the fetal DNA that leaks across the placenta so that the mother herself does not mount an immune response and make her own Ab.
This is given before and after birth.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What is a dangerous complication of fetal anemia (ie due to haemolysis)?

A

hydrops fetalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What six blood tests are done for jaundiced baby?

A
  1. Bilirubin level (conjugated as well)
  2. Baby blood group
  3. Direct Antigen test (Coombs) tests for Ab in fetal circulation
  4. Hb
  5. G6PD - haemolysis due to oxidative stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Which population is most likely to get G6PD and what are 3 main causes?

A

South East Asian.
Legumes (Flava beans), anti-TB drugs and sulphur antibiotics.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What is the main treatment for pathological neonatal jaundice to avoid bilirubin buildup leading to kernicterus? What is the second line in extreme cases?

A

Phototherapy.
If it is really bad: exchange blood transfusion - blood goes in and out at some time manually in 20ml aliquots.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

If, more than 2 weeks post birth, a baby becomes jaundiced and bilirubin levels are largely conjugated, what would you suspect?

A

Obstruction - conjugated bilrubin is spilling out the liver into the blood instead of into the bowel. Query biliary atresia (non-formation of biliary system and gallbladder).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What are the key components of a post-natal checkup? (POSSIBLE OSCE)

A
  • how is baby (but leave most of it for GP/peadiatrician)
  • how is mum
  • breastfeeding
  • mood - edinburgh depression score
  • bleeding, discharge (period)
  • bowels/bladder
  • lifestyle things like return to exercise
  • CST
  • contraception
  • immunisations
    +/- exam for scars/sutures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Jaundice after 2 weeks may be due to which common cause?

A

Breast milk jaundice - in some women a molecule in breast milk inhibits conjugation of bilirubin in liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

It’s important not to forget that _____ can cause pathological neonatal jaundice.

A

sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What are the cut off values for the 3 stages of the oral GTT?

A

Fasting - should be below 5
after 1 hr - should be below 10
After 2 hrs - should be below 8.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

How often should women with gestational diabetes test their sugars?

A

4x a day, 1 first thing fasting and then 3x in the day 2 hours after each meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What is the typical first line management for gestational diabetes?

A

Insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Which blood test may serve as an indicator of future pre-eclampsia?

A

PAPP-A (part of the combined first trimester blood screen) may indicate future pre-eclampsia if it is low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What is the realistic earliest point you can deliver a baby and it still lives normally (with assistance initially) ?

A

26 weeks though some may survive even at 22 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Why is fetal haemolysis such a risk ?

A

Haemolysis leads to anaemia which in the fetus can cause hydrops fetalis - cerebral palsy risk etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

List some causes of antepartum bleeding.

A
  • Miscarriage
  • Labour
  • Placental abruption (maybe linked to pre eclampsia)
  • Uterine rupture
  • Placenta previa
  • Placenta accreta
  • Vaso previa (painless)
  • Infection eg. chorio
  • GYNAE causes: STI, fibroid, polyp, gynae cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What is the pain level in placenta accreta, previa and vasoprevia

A

usually all are painless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Which 3 questions do you ask all pregnant women regardless of gestation?

A
  • pain
  • bleeding/discharge
  • fetal movements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Instructions for GTT?

A

Fast 8-12 hours before, so often light snack before bed because don’t want to be over fasted. Just water the morning of the procedure.
3 blood tests over 2 hours, drink the drink.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What is lichen sclerosis and what is the long term risk?

A

Vulval skin changes appearing like plaques - precursor to squamous cell carcinoma

118
Q

Can you do CST and DTP vaccine antepartum?

A

Yes both!
DTP often given in third trimester and CST ‘anytime, anywhere’

119
Q

What do the ovaries feel like on bimanual exam on a normal person?

A

Not palpable

120
Q

What are the degrees of vaginal tears in labour?

A

(They build upon each other)
First degree - vaginal mucosa
Second - perineum
Third - anal sphincter
Fourth - anal mucosa/rectum

121
Q

Non-pharm intrapartum mx for preventing tears?

A

Warm compress to vasodilate perineum

122
Q

What is the most common side effect of ergometrin (used PPH and induction)?

A

Vomiting - most vomit

123
Q

Defining features of pre-eclampsia? What is the difference to eclampsia?

A
  • hypertension
  • small baby
  • proteinuria
  • low PAPP-A

Real eclampsia = seizures

124
Q

After 32 weeks, Lionel says you really have to check 3 things:

A
  • size of the baby
  • pre - eclampsia
  • which way is the baby facing
125
Q

What is a missed abortion?

A

Miscarriage with no fluid from the vagina, cervix still shut but baby has no heart beat.

126
Q

Which hormone causes muscle aches in pregnancy?

A

Relaxin

127
Q

What is the significance of a cervix length under 25mm?

A

Short cervix one ultrasound is increased risk of pre-term birth.

128
Q

What is the risk of a low lying placenta?

A

Risk of placenta previa

129
Q

What is the feared complication of congenital parvovirus?

A

Fetal anemia

130
Q

Goal for a pre-eclamptic mum with a small baby at 31 weeks?

A

Must come out or it will die

131
Q

Risk of vasoprevia, management?

A

In labour baby will descend and burst a vessel lying in the way of the uterus - very quick fetal death. Management is an early Caesar, can’t risk labour.

132
Q

What are some causes for repeat miscarriages?

A
  • coagulopathy
  • SLE/anti-phospholipid
  • chromosomal abnormality (worst one, no fix)
133
Q

Advice for mums to avoid CMV?

A

Avoid little kids, under 2 are the biggest risk, don’t hate cutlery, kiss on the head not the mouth.

134
Q

Initial mx for gestational diabetes?

A

Lifestyle + exercise

135
Q

What is metaraminol?

A

Alpha 1 agonist (indirect) used to raised BP in spinal/epidural patients.

136
Q

What is miscarriage risk of an 8 week embryo with normal CRL+HR on USS with healthy mum?

A

Below 5%

137
Q

When do stop aspirin in pre-eclampsia risk
?

A

Stop 36 weeks

138
Q

Difference between minor and major PPH and primary and secondary PPH?

A

Minor = 500 to 1000ml
Major = over 1000ml

Primary - within 24 hrs of birth
Secondary - between 24 hrs and 6 weeks after birth

139
Q

What are the causes of a primary PPH?

A

The 4 T’s: (in this order)
- tone (uterine atony)
- tissue (retained intrauterine products)
- trauma (from birth eg, forceps)
- thrombus

140
Q

Two main causes of secondary PPH?

A
  • retained uterine products
  • infection
141
Q

List two causes of polyhydramnios and two causes of oligohydramnios:

A

Remember amniotic fluid is baby pee.

Oligo: placental issue (no nutrients for baby to make pee) OR kidney issue - baby can’t make pee

Poly: baby can’t swallow (producing pee but not swallowing it) and gestational diabetes

142
Q

Some considerations for a First Nations/regional pregnant woman?

A
  • Koori Maternal services
  • fetal monitoring/scans can be done regionally
  • telehealth for some visits is possible
  • Birthing on country may be important to some
  • placental rituals are common in First Nations groups
  • can suggest relocating for a short time at the 34 week mark or so
143
Q

Extra referral made antenatally for twins?

A

Lactation consultant - breastfeeding twins can be tough, best to prepare

144
Q

What is AEDF?

A

Absent End Diastolic flow - on umbilical cord using doppler - sign of fetal distress

145
Q

When is the usual cutoff for IV steroids to increase surfactant for baby?

A

Usually before 34 weeks.

146
Q

Pharm Mx for chorio?

A

Gent, Amp, Clinda (or Metro)
For PROM - premature rupture of membranes (risk of chorio)
- add IV steroids for baby surfactant

147
Q

How long ago must last period be to be defined as menopause?

A

12 months

148
Q

What is ITP?

A

Immune thrombocytopenic purpura - low platelets

149
Q

What is aplastic anaemia, how does it impact an FBE?

A

Autoimmune destruction of the bone marrow (can be cause by many things eg. radiation, chemo, infection, congenital etc). Virtually everything on FBE will be low - Hb, WBC, platelets, reticulocytes etc.

150
Q

Vaginal bleeding in an obese, post-menopausal woman should ring alarm bells for?

A

Endometrial cancer - fat produces estrogen, and after menopause this unopposed estrogen is a risk for gynae cancers.

151
Q

What is the likely management of a post-menopausal woman with endometrial cancer?

A

Likely a hysterectomy with bilateral oophorectomy due to no longer being fertile.

152
Q

What is Asherman’s syndrome?

A

intrauterine adhesions (often from past surgery) that may cause pelvic pain, amenorrhea, abnormal uterine bleeding or an inability to get and stay pregnant.
(SECONDARY AMENORRHEA)

153
Q

What is fragile X and what are some key clinical findings?

A

Genetic cause of mental retardation.
Findings include long face, large ears, prominent jaw, macro-orchism, mitral prolapse

154
Q

What is the Abx for pertussis?

A

Macrolide - azithro or erithro

155
Q

What are the 3 diseases screened for in basic carrier screening?

A

CF, spinal muscular dystrophy and Fragile X.

156
Q
A
157
Q

3 key mx in urge incontinence:

A
  1. Bladder diary
  2. Retraining - pelvic physio
  3. Pharm eg. Oxybutinin
158
Q

Which two mechanisms allow progesterone only contraception to impair fertility?

A
  • thins endometrium preventing implantation
  • thickens cervical mucus prevent travel of sperm and egg
159
Q

When is anti D given to rhesus negative mums?

A

28 and 34 weeks

160
Q

What is the most effective emergency contraception?

A

Copper IUD

161
Q

Syphilis pathogen?

A

Treponoma pallidum

162
Q

What weeks is Anti-D given in?

A

28 and 34

163
Q

When is GTT done?

A

28 weeks unless prior dx then first one is at around 14 weeks

164
Q

When is GBs swab taken?

A

36 weeks

165
Q

What is sulfasalazine?

A

DMARD

166
Q

What is folic acid for in pregnancy?

A

reduces spina bifida risk

167
Q

When to stop work in pregnancy?

A

Around 34 weeks

168
Q

CMV congenital risk?

A

deafness

169
Q

If mum is Hep B+ at birth?

A

Hb IG given to baby. (tenofovir given to mum beforehand prophylactically).

170
Q

Active HSV lesions at time of labour mx?

A

ceasar

171
Q

Which abx class is contraindicated in pregnancy?

A

tetracyclines (and obviously also trimethoprim).

172
Q

How does pregnancy impact insulin requirements in T1DM?

A

need more

173
Q

Which vaccines should not be given during pregnancy?

A

Live - varicella or MMR.

174
Q

Signs of pre-eclampsia?

A

Headache, swelling, visual changes.

175
Q

What is a Bishops score?

A

estimation of how successful an induction will be

176
Q

Ix for decreased fetal movements>?

A

CTG and USS.

177
Q

Meconium liquor is indicative of?

A

fetal distress

178
Q

Tx for aorta-caval compression?

A

left lateral tilt

179
Q

Analgesia in labour?

A

Morphine IM 10mg. 2-3 hrly.
Consider Nitrous oxide.

180
Q

Spinal level aim epidural?

A

L3-4

181
Q

List the 3 ligaments that must be passed through to do an epidural?

A

supraspinous, interspinous, ligamentum flavum.

182
Q

Medicines used for epidural?

A

local eg. bupivicaine
and opioid - usually fentanyl.

183
Q

when to re-check GTT in diabetics?

A

6 weeks post-partum

184
Q

When is a CRL usually visible on USS?

A

6 weeks gestation

185
Q

Risks for ectopic?

A

past ectopic, current IUD, surgery in pelvis, PID.

186
Q

Dermoids are a risk for which condition?

A

ovarian torsion

187
Q

Timeline for meconium passage in neonates?

A

Should pass it in 48 hrs

188
Q

2 month vaccinations?

A

hexa - DTP, Hib, HBV, polio
pneumococcal
rotavirus

189
Q

Tapeworm that causes liver cysts?

A

Echinococcus

190
Q

White stool in neonate =

A

biliary atresia

191
Q

Causes of primary PPH vs secondary PPH.

A

Primary 4T’s:
Tone, tissue, trauma, thrombin.

Secondary:
retained products or infection

192
Q

When does peri-natal depression peak?

A

4 weeks after pregnancy. Whereas post-partum blues in earlier.

193
Q

When can a mirena be put in post-vaginal birth?

A

4-6 weeks.

194
Q

Advice post-vasectomy?

A

Still fertile for 3 months.

195
Q

Which medication can be given to increase lactation?

A

donperidone

196
Q

white nipple with breastfeeding pain Dx and mx?

A

vasospasm - like raynauds.
heat application or nifedipine

197
Q

mastitis abx?

A

oral fluclox

198
Q

Ages for CST and mammogram screening?

A

CST - 25-74
Mammogram: 50-74

199
Q

Insanely high bHCG suggests?

A

Molar pregnancy/trophoblastic disease

200
Q

Agents used in hyperemesis gravidum?

A

promethazine, ondansetron, prochlorperazine, pyroxidine, STEROIDS

201
Q

Brown/prune juice coloured antepartum bleed is classic for?

A

ectopic

202
Q

How does molar pregnancy look on USS?

A

Bunch of grapes

203
Q

Mx molar pregnancy?

A

D+C, treat as if regular birth tbh with oxytocin etc. Weekly BHCGs afterwards until normal.

204
Q

Most ectopics are located where?

A

Ampulla (in the tube)

205
Q

AMH hormone is tested for what purpose?

A

Anti-mullerian hormone tests how many eggs a woman has left.

206
Q

Classic finding on USS for placental abruption?

A

retroplacental hematoma

207
Q

When to give ante-natal steroids?

A

If baby being born before 35 weeks.

208
Q

Sats aim with neonates on supplemental oxygen?

A

91-95%

209
Q

use of caffeine in preemies?

A

prevents apneas

210
Q

Signs of necrotizing enterocolitis in babies?

A

bilious vomits
PR bleed
abdo distension

211
Q

Molecule with a high negative predictive value for risk of pre-term birth?

A

Fetal fibronectin

212
Q

Medication to prevent pre-eclampsia?

A

low dose aspirin until about 36 weeks.

213
Q

Swelling of neonate head that doesn’t conform to suture lines = ?

A

subgaleal haemorrhage - emergency - can easily bleed out

214
Q

one palmar crease in neonates is suggestive of?

A

trisomy 21

215
Q

Where should saturation probe be placed for pre-ductal sats in neonate?

A

right hand

216
Q

Findings on CXR for RDS?

A
  • ground glass opacity
  • air bronchograms
  • underinflated lungs
217
Q

How to test if discharge is amniotic fluid?

A

amnisure

218
Q

HTN in pregnancy with clonus and brisk reflexes indicates?

A

severe pre-eclampsia

219
Q

Ix for endometrial hyperplasia?

A

Urgent hysteroscopy D+C with biopsy

220
Q

Tamoxifen moa and cancer risk?

A

Tx for breast cancer by reducing estrogen levels in the breast but increases estrogen levels in uterus - increased endometrial cancer risk.

221
Q

First line PCOS tx?

A

COCP

222
Q

How long should a period be?

A

No longer than 8 days

223
Q

FSH level in ovarian insufficiency?

A

High

224
Q

NOF exam findings?

A

Shortened leg and externally rotated

225
Q

surgery for vaginal (recto or cysto-cele) prolpase?

A

Colporrhaphy

226
Q

surgery for vaginal enterocele prolpase?

A

hysterectomy

227
Q

Main endometrial cx type?

A

Endometrial (endometroid) carcinoma

228
Q

Main type of cervical cx and finding on histo?

A

Squamous cell carcinoma - keratin swirls on histo.

229
Q

Primary differential for dysmenorrhea?

A

endometriosis

230
Q

Dysparaneuria is classically caused by?

A

endometriosis. Typically ‘dee[ dysparanueuria’

231
Q

‘chocolate cyst’ on laparascopy is typical of?

A

endometriosis - endometrioma

232
Q

Bulky, tender uterus is a classic description of?

A

Adenomyosis

233
Q

Role for screening in ovarian cx?

A

none

234
Q

Risk reduction for ovarian cx?

A

OCP, Mirena, aspirin

235
Q

Which cancers are at risk in Lynch syndrome patients?

A

bowel, endometrial, prostate, pancreas, ovarian.

236
Q

Lynch syndrome best risk reduction in females?

A

hysterectomy with bilateral salpingooopherectomy

237
Q

Peutz-jeghers syndrome is typically associated with with finding on examination?

A

Brown spots on lips, oral mucosa, fingers and nose. High cancer risk.

238
Q

BRCA is largely indicated in which two big groups of cancers?

A

Breast and ovarian

239
Q

Most common site for endometriosis?

A

Ovaries

240
Q

Chemo for ovarian cx?

A

Carboplatin or new PARP drugs

241
Q

Tumour markers for ovarian cancer?

A

CEA, CA19-9 and CA125.

242
Q

Cutoff BP value for pre-eclampsia?

A

140/90

243
Q

Normal baby head position in birth?

A

Occipito-anterior

244
Q

Tests on heelprick?

A
  • CF
  • PKU
  • hypothyroid
  • CAH
245
Q

How to check hypoxic threat to newborn baby?

A

Cord lactate, above 7 is a worry.

246
Q

GTT cutoff scores?

A

fasting 5.1
1 hr 10
2 hr 8.5

247
Q

Early GTT for high risk women date?

A

14-16 weeks then the normal one again 28 weeks.

248
Q

Which HTN drugs are teratogenic?

A

ACEi

249
Q

Blood test that may indicate risk of pre-eclampsia?

A

low PAPP-A

250
Q

Hormone that causes the sore muscles/bones in pregnancy?

A

Relaxin

251
Q

Safe cervix length?

A

over 25mm

252
Q

Signs of cervical shock?

A

Hypotension + BRADYcardia (unlike other types of shock)

253
Q

what is plaquinil?

A

hydroxychloroquine

254
Q

What is a congenital diaphragmatic hernia?

A

Bowel in thorax on CXR. fucked.

255
Q

What is PUPS?

A

Generalised itch in pregnancy

256
Q

Uterus dermatome roots?

A

T10-12

257
Q

Two key medications to give in PPROM?

A

Abx and steroids if under 35 weeks

258
Q

Abx for bacterial vaginosis?

A

Metranidazole

259
Q

LLETZ?

A

Large loop excision of trasnformation zone

260
Q

Autoimmune fusing of vulva?

A

lichen sclerosis - steroids

261
Q

What is Turner’s syndrome?

A

XO chromosomes. Often amenorrhea.

262
Q

Causes of secondary amenorrhea?

A

PCOS
prolactinoma
pregnancy
etc

263
Q

Free fluid in the pouch of douglas in a suspected ectopic indicates?

A

rupture. It’s blood.

264
Q

‘slow rising beta’ is ONG code for?

A

ectopic

265
Q

Single methotrexate dose side effects?

A

N+V and dizziness.

266
Q

Ways to control vaginal bleeding:

A
  • NSAIDS
  • mefanamic acid (NSAID)
    -tranexamic acid
  • progesterone (takes a few days)
267
Q

Classic cause of non-bleeding pain in young girls/women?

A

Ovulation pain
Ovarian cysts

268
Q

if usual anti-emetics don’t work in morning sickness - best tx is?

A

steroids

269
Q

How long do you wait before reviewing an expectant option miscarriage?

A

2 weeks

270
Q

Hypoglycemia cuttoff neonates?

A

2.6

271
Q

Typical cause of early neonatal sepsis?

A

GBS (also listeria and e.coli)

272
Q

First line for neonatal hypoglycemia?

A

40% dextrose gel

273
Q

Main cause of seizures in neonates?

A

hypoxia.
(hypoglycemia can also cause but not as common)

274
Q

Maple syrup urine in neonates suggests which group of illnesses?

A

amino acid disorder.

275
Q

High LH:FSH ratio is typical in?

A

PCOS

276
Q

Which blood molecule is tested in spina bifida?

A

Alpha fetoprotein (high)

277
Q

naevus flammeus is also known as a ?

A

port wine stain

278
Q

FSh and LH levels in Turner syndrome?

A

High. LH and FSh trying to stimulate shit ovaries.

279
Q

active ingredient in Plan B?

A

levinorgestrel

280
Q

Which form of progesterone only contraception is contraindicated in patients with current breast cancer?

A

implanon

281
Q

Risks of IUD?

A

perforation
can cause PID if STI present at insertion.

282
Q

Ergometrine use?

A

Good with syntocinin for PPH but not appropriate for augmenting labour.

283
Q

TTN vs RDS timeline.

A

TTN - immediate, resolves within 24 hrs.
RDS - takes a few hours to appear. A week to resolve. Worst 72hrs.

284
Q

Risks for neonatal sepsis?

A

GBS +
too many vaginal exams
maternal fever/infection
prolonged rupture of membranes

285
Q

Abx for GBS prophylaxis?

A

IV Benpen

286
Q

Main risk factor for necrotising enterocolitis?

A

pre-maturity

287
Q

‘high pitched cry’ is a classic finding for which neonatal disease?

A

Meningitis

288
Q

HSP can lead to which bowel complication?

A

intussiception

289
Q

Histo findings in asthma:

A
  • goblet cell hyperplasia
  • hypersecretion of mucus
  • smooth muscle proliferation
  • wbc infiltration
290
Q
A

MD (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions