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Things I don't know, but need to know, for fourth year > O & G > Flashcards

O & G Flashcards

1
Q

Hepatitis B in Pregnancy

A

C - section doesn’t reduce vertical transmission
Breastfeeding is safe
Chronic or Acute infection = Immunoglobulin and vaccination
All pregnant women offered screening

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2
Q

At what level of anaemia do you treat during the 1st trimester?

A

<110

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3
Q

At what level of anaemia do you treat in the 2nd/3rd trimester?

A

<105

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4
Q

At what level of anaemia do you treat anaemia in the post part period?

A

<100

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5
Q

What is fatal fibronectin?

A

It is released from the fatal gestational sac. It is linked to an early labour.

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6
Q

Does an elevated fatal fibronectin mean early labour is guaranteed?

A

No many women go on to deliver at term.

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7
Q

What is expectant management in an ectopic pregnancy?

A

Reassure Safety Net and reassess bhCG levels in 48 hours

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8
Q

When can expectant management be used in ectopic pregnancies?

A

Asymptomatic, bhCG <1000, no petal heart beat, <35mm, un ruptured,

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9
Q

Is expectant managment safe with another viable intrauterine pregnancy?

A

Yes

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10
Q

What is the medical management of a ectopic pregnancy?

A

Methotrexate + follow up

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11
Q

When can medical management be used in ectopic pregnancy?

A

<20mm, unruptured, no severe pain, no fatal heart beat, <1000 bhCG, no viable intrauterine pregnancy

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12
Q

What is the surgical management of an ectopic pregnancy?

A

Salpingectomy or salpingostomy

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13
Q

When is surgical management used in an ectopic pregnancy?

A

Rupture, >35mm, visible heartbeat

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14
Q

When would you suspect Pre Existing Hypertension in Pregnancy ?

A

Occurs before 20 weeks with no proteinuria or oedema

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15
Q

When would you suspect Pregnancy induced hypertension?

A

Hypertension occurring after 20 week but no proteinuria or oedema

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16
Q

What is given to a pregnant lady at increased risk of Pre Eclampsia and from when?

A

75mg of Aspirin from 12 weeks

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17
Q

What is the most effective form of emergency contraception?

A

IUD Copper

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18
Q

In what time frame can the IUD Copper coil be used?

A

Within 5 days of unprotected sex or within 5 days of suspected ovulation.

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19
Q

What is the time frame for Levonogestrel?

A

Within 72 hours

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20
Q

When do you double the dose of Levonegestrel?

A

If BMI >26 or >70kg

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21
Q

When can contraception be started in regards to Levonegestrel?

A

Hormonal contraception can be started immediately after.

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22
Q

What should be done in a women who has taken EllaOne or Uliprital?

A

If breastfeeding stop for one week

If on hormonal contraception use another form of protection for five days.

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23
Q

What is the time frame of us for EllaOne?

A

120 hours

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24
Q

What is 1st line for Vaginal Thrush

A

Single dose oral Fluconazole

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25
Q

When is a Vaginal Pessary or topical considered?

A

If pregnant or with vulval involvement.

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26
Q

What is Gastroschisis?

A

Anterior abdominal wall defect lateral to the umbilicus

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27
Q

How is gastroschisis managed?

A

Vaginal delivery but straight to surgery

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28
Q

What is Exompholus or Omphalocoele?

A

Abdominal cavity contents protrude out but are covered in amniotic sac

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29
Q

What is the management for omphalocoele?

A

C section at 37 weeks

Stepwise surgery slowly moving contents back in.

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30
Q

What criteria must a HIV +ve woman have in order to be allowed a vaginal delivery?

A

Viral load of <50

Antiretroviral

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31
Q

Are pregnant HIV +ve women allowed to breastfeed

A

No

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32
Q

When are neonatal antivirals required in HIV?

A

If maternal load is >50 - triple therapy
If maternal load if <50 - Zidovudine
Both given for 4-6 weeks

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33
Q

If a patient has a cervical smear come back as inadequate how should they be treated?

A

Repeat smear in three months

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34
Q

If a patient has had two smears comeback as inadequate how should they be treated?

A

Referred for colposcopy

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35
Q

A woman has a suspected DVT in pregnancy how is she managed?

A

LMWH then investigated

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36
Q

What anticoagulant is used in a DVT in pregnancy?

A

LMWH

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37
Q

A woman <20 weeks pregnant is exposed to Varicella what is the management?

A

Immunoglobulin

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38
Q

A woman >20 weeks pregnant is exposed to Varicella what is the management?

A

Immunoglobulin

Or Acyclovir 7-14 days after exposure

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39
Q

When can Gestational Diabetes be diagnosed?

A

Fasting >5.6
2 hr >7.8

remember 5678

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40
Q

What is the screening test used in gestational diabetes and when is it used?

A

Oral Glucose Tolerance Test

Booking and 24-28 weeks

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41
Q

If a pregnant lady presents with a fasting glucose over 7mmol what is her management?

A

Insulin - short acting

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42
Q

If a fasting glucose is identified as less than 7 what is trialed. After 1-2 weeks this fails to correct her blood glucose. What would she be switched to?

A

Lifestyle and dietary advices trailed for 1-2 weeks. If this is unsuccessful then Metformin is used.

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43
Q

A pregnant lady who has a fasting glucose between 6.0-6.9 is found on routine scan to show fatal macrosomnia what is her diabetic medication of choice?

A

Insulin is used first line if any signs of complications

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44
Q

Signs of Ovarian Hyperstimulation Syndrome

A

Increased Oestrogen
Nausea + Vomiting
Fluid Retention -> Weight Gain
Abdominal Discomfort from enlarged ovaries.

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45
Q

First Degree Perineal Tear - Classification and Management.

A

Superficial

No treatment - clean etc

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46
Q

Second Degree Perineal Tear - Classification and Management.

A

Perineal mucosa and Muscle but no sphincter involvement.

Managed by trained midwife or clinician.

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47
Q

Third Degree Perineal Tear Type A - Classification and Management.

A

Perineal Mucosa, Muscle and <50% of External Anal Sphincter

Surgical Repair by Surgeon

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48
Q

Third Degree Perineal Tear Type B - Classification and Management.

A

Perineal Mucosa, Muscle and >50% of External Anal Sphincter

Surgical repair

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49
Q

Third Degree Perineal Tear Type C - Classification and Management.

A

Perineal Mucosa, Muscle , External Anal Sphincter and Internal Anal Sphincter.

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50
Q

Fourth Degree Perineal Tear - Classification and Management.

A

Perineal Mucosa, Muscle, Both EAS and IAS, Rectal Mucosa

Surgery

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51
Q

Management of Moderate to Severe PMS

A

COCP 1st line

SSRI

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52
Q

What is the time frame for a Amniotic Fluid Embolism

A

During and up to 30 minutes after delivery.

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53
Q

Management of a Amniotic Fluid Embolism

A

Supportive management only

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54
Q

If someone has been treated for CIN II when should they undergo a cervical smear test again?

A

6 months - used as a test of cure

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55
Q

When should the booking visit be done?

A

8 - 12 weeks

ideally <10

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56
Q

What is done in the booking visit?

A

BP, Urine Dipstick, BMI

Give Folic acid Vitamin D

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57
Q

What is screened for in the booking visit?

A 
Blood group
Rhesus status
Autoantibodies
Haemaglobinopathies 
Hep B 
Syphilis
HIV
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58
Q

What is done between 10-13 weeks?

A

Early scan for dates + exclude multiple pregnancy

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59
Q

What is done at 18 weeks?

A

Anomaly scan

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60
Q

What is done at 28 weeks?

A

Routine Care
Second anaemia and antibody screen
Anti D prophylaxis is rhesus -ve

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61
Q

Management of chicken pox exposure in any pregnant lady?

A

Check for antibodies prior to treatment

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62
Q

A pregnant lady <20 weeks , who has had no vaccine or exposure to chicken pox identified on antibody testing. Has been exposed what is the management?

A

Immunoglobulin ASAP

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63
Q

A pregnant lady >20 weeks gestation has been exposed to chicken pox. After testing for antibodies it is found she is not immune. What is the management?

A

Immunoglobulin or acyclovir after 7-14 days post exposure

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64
Q

If a pregnant lady is presenting with chickenpox what is the management?

A

Seek specialist advice. Usually acyclovir if >20 weeks

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65
Q

In a FtM transgender man taking testosterone what kind of contraception in contraindicated?

A

COCP as the oestrogen can counteract the testosterone reducing its effect.

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66
Q

Strawberry Cervix, Offensive yellow green frothy discharge

A

Trichomonas Vaginallis

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67
Q

What screening tests does a woman undergo if she is has had previous gestational diabetes?

A

OGTT at booking and 24-28 weeks

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68
Q

List medications that should be avoided in pregnancy?

A

Tetracylines
ACEi
Statins

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69
Q

Levels required for Iron Supplementation

A

First trimester - <110
Second and Third Trimester - <105
Postpartum <100

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70
Q

If iron levels don’t improve after 2 weeks of iron therapy what should happen?

A

Further investigations for an other cause

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71
Q

If someone during their first week of COCP misses two. What should they do?

A

Take both pills and use contraception for 7 days

Emergency contraception is needed

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72
Q

If someone on their second week of COCP misses two pills what should they do?

A

Take both pills alongside using other contraception for 7 days.

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73
Q

If someone of their 3rd week of COCP misses two pills what should they do?

A

Take both pills and use extra contraception for 7 days

Miss out pill free period

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74
Q

Which kind of Progesterone only pill has a 12 hour window compared to a 3 hour window?

A

Cerazette (desogestrel)

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75
Q

In a POP if someone has missed their three hour window what should they do?

A

Take pill ASAP and use contraception for 48 hours.

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76
Q

What is the management in premature rupture of membranes?

A

Admit for 48 hours
Antibiotics - erythromycin 10 days
Steroids
Deliver if >34 weeks

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77
Q

Menopausal
Tender lump
Green discharge
Smoker

A

Mammary duct ectasia

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78
Q

Nipple Bloody discharge

A

Duct Papilloma

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79
Q

When would you offer GBS prophylaxis and what is it?

A

Previous GBS

Benzylpenicillin

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80
Q

When is Benzypenicillin given if they are GBS negative?

A

Preterm labour

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81
Q

Day 21 ( or 7 days before end of cycle) progesterone level

A

<16 - repeat then refer
16-30 - repeat
>30 - ovulation

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82
Q

Vaginal delivery in a previous C section

A

Only if previous C section was a low incision - over 2 is contraindicated
75% success rate
Aim for >37 week gestation

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83
Q

Indication for forcep delivery

A 
Cephalic presentation
Cervix fully dilated
Ruptured membranes
Engaged presentation
Empty bladder
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84
Q

Persistent Abdominal pain with vaginal bleeding post C section

A

Endometritis - Antibiotics required

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85
Q

If GBS is found asymptomatically on a swab in a patient who’s had no previous GBS infection before. What is the management?

A

Intrapartum Benzylpenicillin is required.

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86
Q

Hepatic adhesions with a history of Pelvic Inflammatory Disease

A

Fitz Hugh Curtis Syndrome

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87
Q

If a child present at breach during C section or Vaginal delivery what must they undergo?

A

6 week hip USS

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88
Q

Signs of neonatal hypoglycaemia

A 
Autonomic dysfunction - tachycardia, apnoea, hypothermia
Jittery
Irritant
Hypotonic
Seizures
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89
Q

Management of neonatal hypoglycaemia

A

Mild and transient - ensue good feeding and monitor

Severe or symptomatic - Neonatal referral + IV 10% dextrose

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90
Q

In duct ectasia if the discharge is causing distress what is the management ?

A

Microductectomy - young

Total Duct excision - old

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91
Q

Management of Placental Abruption

A

<36 weeks - stable no foetal distress - admit + steroids + no tocolytics
- foetal distress - C Section
>36 weeks - stable no foetal distress - Vaginal delivery
- Distress - C Section
Foetal death - induce vaginal delivery

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92
Q

Cervical smear during pregnancy

A

If previously normal wait till 12 weeks post partum

If abnormal - ask for specialist advice

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93
Q

What can be used to medical shrink fibroids?

A

GnRH

94
Q

Patch contraceptive guidelines

A

<48 - replace immediately and no extra contraception is needed
>48 -change + 7 days of cover
- UPSI during that time or within last 5 days - emergency contraception is needed

95
Q

In a lady who is under 35 and presenting with a simple ovarian cyst what is the management?

A

Repeat USS in 8-12 weeks

96
Q

In any post menopausal women with an ovarian cyst on USS what is the management?

A

Refer regardless of size or nature

97
Q

What treatment is used in keratinised genital warts?

A

Cryotherapy

98
Q

What treatment is used in non keratinised fleshy genital warts?

A

Podophyllum

99
Q

What is diagnostic of a miscarriage on transvaginal USS?

A

Crown rump length >7mm + no foetal heart beat

100
Q

What should be given to the mother if their breastfeeding child develops a cows milk protein intolerance?

A

Vitamin D and calcium

101
Q

What is the management of anyone over 30 with a suspicious breast lump?

A

Referral

102
Q

Bishops score

A

<5 - spontaneous labour unlikely

>8 - spontaneous labour likely - no need for induction

103
Q

Induction of labour

A 
Membrane - nulliparous 40 and 41 weeks or Multiparous 41 weeks - can be done by midwife
Vaginal Prostaglandin
Maternal oxytocin
Membrane rupture
Cervical balloon
104
Q

Name a tocolytic drug used in cervical overstimulation

A

Terbutaline

105
Q

What the commonest breast cancer immunologically?

A

HER2 -ve

ER / PR +ve

106
Q

Prior to breast cancer surgery a woman, with no palpable axillary lymph nodes, should undergo what other investigation?

A

Axillary Node USS -> if positive they should have a lymph node biopsy

107
Q

If prior to surgery a woman is found to have palpable lymph nodes and or positive metastases on lymph node biopsy. How does this change her management?

A

She should undergo axillary node clearance.

108
Q

If a woman is found to have no palpable lymph nodes or nothing on her sentinel node biopsy what is her management in surgery?

A

She should undergo sentinel node biopsies.
<3 positive - no axillary node clearance
>3 positive - axillary node clearance

109
Q

What are some indications for a mastectomy?

A

Multifocal lesion
Large tumour in small breast
DCIS >4cm
Centrally located tumour

110
Q

What are some indications for a wide local excision?

A

DCIS <4cm
Peripherally located tumour
Single tumour

111
Q

Indications for radiotherapy in breast surgery

A

Anyone who has had a wide local excision
Mastectomy - T3/4
Four or more positive axillary nodes

112
Q

Endocrine and biological therapy in breast cancer

A

Tamoxifen - Pre or Peri menopausal women - ER +ve
Lestrozole or anastrozole - Post menopausal women - ER +ve
Trastuzumab - HER2 +ve

113
Q

What should be taken alongside tamoxifen?

A

Contraceptive

114
Q

When should trastuzumab be avoided?

A

Any heart disease

115
Q

What chemotherapy is used in higher grade breast cancer with auxiliary node involvement?

A

FEC - D

5-fluorouracil, epirubicin, cyclophosphamide and docetaxel

116
Q

How often should someone with HIV undergo cervical cytology?

A

Every year

117
Q

Primary Dysmenorrhoea - diagnosis and management

A

No underlying pathology - started soon after menarche
Pain occurs just before period
NSAIDs and Mefenamic acid -> COCP

118
Q

Secondary Dysmenorrhoea - diagnosis and management

A

Started years after menarche
Pain occurs days before period
Endometriosisn Adenomysosis, PID, IUD, fibroids
NSAIDs + refer to gynaecology

119
Q

What is done between 11-13 weeks

A

Down syndrome scan including nuchal thickness

120
Q

What is done at 16 weeks gestation?

A

Info on anomally scan

121
Q

When do primiparous women receive extra routine care?

A

25 weeks

31 weeks

122
Q

What is done at 34 weeks?

A

Second anti D prophylaxis

Information on labour and birth plan

123
Q

What is done at 36 weeks

A

Check presentation and offer external cephalic presentation

124
Q

What is offered at 41 weeks

A

Possibility of induction

Membrane sweep

125
Q

What is offered at 40 weeks

A

Routine care
Discuss plans for prolonged pregancy
Membrane sweep if primiparous

126
Q

What is the inheritance of rhesus D?

A

Rhesus D +ve is inherited in an Autosomal Dominant fashion

127
Q

How does a mother develop Anti D IgG antibodies?

A

A rhesus -ve mother becomes sensitised if they have a rhesus +ve child and there is exposure to the foetuses blood.

128
Q

How do Anti D antibodies affect the foetus?

A

These can cross the placenta and cause extravascular haemolysis
Hydrops faetalis, kernicterus, HF all develop due to products of extravascular haemolysis

129
Q

When should a rhesus -ve be offered Anti D prophylaxis?

A

Routine 28 and 34 weeks
Within 72 hours if -
delivery of a Rh +ve infant, whether live or stillborn
any termination of pregnancy
miscarriage if gestation is > 12 weeks
ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required)
external cephalic version
antepartum haemorrhage
amniocentesis, chorionic villus sampling, fetal blood sampling
abdominal trauma

130
Q

What test can be used to determine rhesus status?

A

Coombs

Kleinhauer test - used if exposed during 2/3 trimester after Anti D is given

131
Q

Eczematous pruritic rash

A

Atopic eruption of pregnancy
Commonest rash during pregnancy
No treatment

132
Q

Last trimester

Pruritic rash occurring within abdominal striae

A

Polymorphic eruption of pregnancy
Emollients
Topical steroids
Oral steroids

133
Q

How long post termination of pregnancy can a urinary pregnancy test remain positive for?
If it is still positive after this time frame what may it indicate?

A

4 weeks post termination is normal

After 4 weeks consider incomplete termination or trophoblastic disease

134
Q

Management of menorrhagia

A

Asymptomatic thickening on TVUSS - periodic review

IUS first line - especially if looking for contraception - avoid in distortion
NSAID -> mefenamic acid -> tranexamic acid -> COCP -> oral progesterone -> injectable progesterone

135
Q

When is someone with a positive pregnancy test referred immediately to an early pregnancy assessment clinic?

A

Any abdominal pain, cervical motion pain or pelvic tenderness
> 6 weeks + Bleeding

136
Q

When is someone with a positive pregnancy test and bleeding not referred?

A

<6 weeks + no pain + no risk factors for ectopic pregnancy

Told to return if
Bleeding continues and pain develops
Repeat pregnancy test in 7-10 days time is still positive

137
Q

Can ulliprastal be used more than once in a menstrual cycle?

A

yes

138
Q

Contraception time scales till effective if not stated on the first day of the period.

A

IUD - Immediatly
POP - 48 hours
COCP, Implant, Injection, IUS - 7 days

139
Q

Down syndrome Screening

A

Combined Test 10-13 weeks - bhCG + PAPP-A + Nuchal thickness
14-20 weeks - if missed appointment - AFP, unconjugated estradiol, bhCG, inhibin A

Down syndrome shows low PAPP-A AFP Inhibin A Estradiol
- high bhCG

140
Q

Layers cut through in C section

A 
Skin 
Superficial Fascia
Deep Fascia 
Anterior Rectus Sheeth 
Rectus Abdominus muscle - stretch using hands
Transversalis Fascia
Extraperitoneal connective tissue
Peritoneum
Uterus
141
Q

What is classed as reduced foetal movements?

A

Less than ten within two hours

142
Q

How is reduced foetal movements managed?

A

Hand held Doppler is first line

  • +ve for heart beat -> cardiotocogram for 20 mins
  • -ve for heart beat - USS
143
Q

If there have been no foetal movements by 24 weeks what is the management?

A

Referral to foetal medicine

144
Q

If a pregnant ladies urinalysis came back with trace 1+ amounts of glucose. What is your management?

A

Reassure and recheck next assessment
OGTT if - 1+ glucose on two separate occasions
- 2+ glucose on one occasion

145
Q

bhCG

A

detected as early as day 8

Secreted by syncytiotrophoblasts

146
Q

When are breast fibroadenomas excised?

A

If over 3cm or causing significant distress or discomfort

147
Q

Criteria for admission with Hyperemesis Gravidum

A

Unable to tolerate food drink or oral antiemetic
5% body weight loss or Ketonuria
Unable to take medication for underlying health condition

148
Q

Management of hyperemesis gravidum

A

First line - Cyclizine or Promethazine
Second line - ondansetron - increased cleft palate risk
- metaclopramide - used for less than five days due to extrapyramidal effects

149
Q

VTE in pregnancy

A

Previous VTE - LMWH from presentation to 6 weeks postpartum

At risk of a VTE - LMWH from 28 weeks to 6 weeks postpartum

150
Q

Management of placental praevia

A

Low lying at 20 weeks -> rescan at 34 weeks
Low lying at 34 weeks - Grade I/II rescan every two weeks
36/37 weeks with grade III/IV at 37/38 weeks elective C section
- grade 1 attempt normal vaginal delivery
Known placental praevia with spontaneous labour ->emergency C section

151
Q

Only hormonal contraception not affected by Liver Enzyme Inducers or Inhibitors

A

Depo Provera

152
Q

Why is depo provers not offered to women over 50?

A

Reduces bone density

153
Q

How long should menopausal women be on contraception for?

A

If under 50 = 2 years after last period

If over 50 = 1 year after last period

154
Q

A lady with premature ovarian failure should be offered what?

A

HRT or COCP until 51

Ovarian failure is not an effective method of contraception

155
Q

Indications for a CTG

A 
Temperature >38 or sepsis or chariomanionitis
Severe hypertension >160
Oxytocin se
Significant Meconium 
Fresh vaginal bleeding during labour
156
Q

CTG Basics

A

Loss of variability - <5 a minute - premature or hypoxia

> 160bpm - maternal pyrexia, chorioamnionitis, hypoxia

<100bpm - increased foetal vagal tone i.e maternal beta blockers

Early Decelerations - reassuring

Late decelerations - if doesn’t return to baseline after 30 seconds - foetal distress

Variable Decelerations - no link to contractions - chord compression

157
Q

Medications which are safe to breast feed with.

A

Penicillin, Cephalosporins, trimethropin, steroids, levothyroxine, sodium valproate, salbutamol, theophylline, TCA, Antipsychotics (not clozapine), B blocker, warfarin, heparin, digoxin

158
Q

Medication to avoid in breast feeding

A

Ciprofloxacin, Tetracyline, Chloramphenicol, Sulph…, Lithium, BDZ, Aspirin, Carbimazole, Methotrexte, Sulfonylurea, Amiodarone

159
Q

What is the wiff test?

A

Adding alkali to bacterial vaginosis creates a strong fishy smell

160
Q

Endometriosis management

A

NSAID -> COCP or progestogens
Refer to secondary care -> Goserelin
-> surgery - increases fertility

161
Q

Do you stop metformin when adding insulin in pregnancy?

A

No it is added on top off

162
Q

Contraceptives and there main function

A 
COCP - inhibit ovulation
Desogetrel only pill - inhibit ovulation
POP - Thickens cervical mucous 
Depo provera - inhibit ovulation
Implant - inhibit ovulation
IUD - decreases sperm mobility 
IUS - prevents endometrial proliferation
163
Q

Which type of HRT is preferred?

A

Cyclical as gives more predictable bleeds

164
Q

In a pregnancy of unknown location what might help you localise it?

A

bhCG >1500 - might indicate a ectopic

165
Q

What is the definitive management of PPH caused by placental acreta?

A

Hysterectomy

166
Q

HRT types and breast cancer

A

Combined Oestrogen and Progesterone = increased risk

Oestrogen only = reduces risk of breast cancer

167
Q

HRT types and endometrial cancer

A

Combined = Reduced endometrial cancer

Oestrogen only = Increased endometrial cancer risk

168
Q

Pre Eclampsia risk factors

A 
>40
Nulliparity
>10 years since last pregnant 
FH
PMH of preeclampsia 
>30 BMI
Vascular disease
Renal disease
Multipregnancy
169
Q

History of PPH + signs of pituitary failure

A

Sheehans

170
Q

History of surgery or trauma to internal uterus + infertility

A

Ashermans - uterine adhesions

171
Q

Chlamydia management

A

Doxycycline 7 days - azithromycin if doxycycline is contraindicated

Men with urethral symptoms - all partners notified 4 weeks prior to onset
Women and asymptomatic men - 6 months prior

All partners who receive a notification are treated with antibiotics whilst awaiting test results

172
Q

Hyperemesis gravidum - managment

A

1st line =Oral antihistamines - promethazine, cyclizine

2nd line = Anti emetics - Ondansetron and Metoclopramide - both carry risks

173
Q

> 30 + unexplained breast lump

A

Urgent referral

174
Q

Cervical screening

A

Every 5 years from 25 - 64

175
Q

Maternal exposure to parvovirus

A

Check maternal IgG and IgM - as causes hydrops fetalis

Intrauterine blood transfusions required for the baby.

176
Q

bhCG rise in ectopic vs viable intrauterine

A

Ectopic bhCG will increase up to 63%

Beyond 63% increase it is likely to be due to a viable intrauterine pregnancy.

177
Q

Starting hormonal contraception after emergency contraception.

A

Ellaone - wait 5 days

Levonella - start immediately

178
Q

If someone is in the early stages of labour with their amniotic sac still intact and the baby is found to be in a transverse lie. What can be done?

A

External Cephalic Conversion

179
Q

Endometriosis management

A

Primary care - Analgesia -> COCP or POP -> refer

Secondly Care - GnRH analogues or Surgery (best for fertility)

180
Q

When is an APGAR at 10 minutes required?

A

If score less than 7 at 5 minutes

181
Q

PCOS management

A

Weight loss and exercise
Fertility - clomifene -> + metformin -> gonadotrophins
Dysfunction - Co Cyprindol, COCP, Metformin

182
Q

Dysmenorrhoea in PCOS

A

Induce bleed by giving a cyclical progestogen then refer for vaginal USS

If >10mm endometrial thickness -> biopsy to exclude endometrial hyperplasia

If <10mm - COC POP IUS etc

183
Q

Dysmenorrhoea - Management

A

NSAID or Mefenamic acid

COCP

184
Q

What are some normal lab findings in pregnancy?

A

Decreased serum urea
Decreased serum creatinine
Increased urinary protein loss

185
Q

Primary herpes infection during pregnancy - management

A

Oral acyclovir 400mg TDS till delivery

186
Q

Whats the commonest cause of a reduced variability lasting less than 40 mins?

A

Foetus sleeping

187
Q

What are some other causes of a reduced variability on CTG?

A

Maternal opioids BDZ beta blockers
Foetal acidosis due to hypoxia
Prematurity - below 28 weeks

188
Q

Benefits of the subdermal implant?

A

Most efective method
Effective for three years
Safe for use in VTE and migraine with aura
Can be inserted immediately post TOP

189
Q

Breast and axilla mass + breast augmentation + snowstorm appearance of USS

A

Breast implant rupture

190
Q

Management of mild PMS

A

Regular exercise

Small regular meals rich in complex carbohydrates

191
Q

In a patient avoiding HRT who’s main complaint is flushing what can be used?

A

SSRIs

192
Q

Baby Blues

A

3-7 day postpartum
Very common
Anxiety and crying
Reassurance and support

193
Q

Post Partum Depression

A

1 month post partum
1 in 10
Reassure -> sertraline or paroxetine

194
Q

Post partum psychosis

A

0.2% develop
2-3 weeks postpartum
Admit to mother and baby unit
25-50% recurrence risk

195
Q

What the first line antibiotic for a UTI in breast feeding?

A

Trimethropin

AVOID - nitrofurantoin as G6PD risk

196
Q

PPH management

A

IV syntocinin -> IV ergometrine -> IM carboprost -> Intrauterine Balloon Tamponade

197
Q

Placenta accreta

A

Chorionic villi are attached to myometrium

198
Q

Placenta Increta

A

Chorionic villi invade into myometrium

199
Q

Placenta Percreta

A

Chorionic villi invade into perimetreum

200
Q

Vaso Praevia

A

Painless vaginal bleeding
Ruptured membranes
Foetal bradychardia

201
Q

AFP and defect in utero

A

AFP raised in neural tube defects

AFP reduced in Down syndrome

202
Q

What can be used to stop lactation in certain circumstances?

A

Cabergoline - if still birth baby death etc

203
Q

If someone with a known coagulopathy has a miscarriage how should this be managed.

A

Medically with vaginal misoprostol

204
Q

Miscarriage management

A

Expectant is first line - 7-14 days watch and wait
Medical - vaginal misoprostol
Surgical - if signs of sepsis of haemodynamic instability

205
Q

Management of a suspected ovarian cancer if an abdominal mass is felt.

A

Urgent gynaecology referral
Skip USS
Take CA125 but don’t wait for results

206
Q

Placental abruption risk

A 
A = Abruption previously
B = BP -high or preeclampsia
R = Ruptured membranes
U = Uterine injury
P = Polyhydramnios 
T = Twins
I = Infection in uterus
O = Older than 35
N = Narcotic use - cocaine amphetamine etc
207
Q

When is treatment initiated in antiphospholipid syndrome?

A

Aspirin from positive urinary pregnancy test

LMWH from positive heart beat on USS

208
Q

History of endometriosis + acute abdomen + free fluid in pelvis + recent period or negative pregnancy test.

A

Ruptured endometrioma

209
Q

What may happen post successful treatment of syphilis and how is this managed?

A

Jarisch Herxheimer reaction - acute febrile reaction
Reassure that is subsides after 24 hours and provide paracetamol
Admit if seriously unwell

210
Q

Cause of pulmonary hypoplasia

A

Oligohydramnios

211
Q

Management of a molar pregnancy

A

Surgical curetage

Hysterectomy if completed their family

212
Q

Post molar pregnancy what surveillance is undertaken.

A

Partial molar - hCG done 4 weeks after - if normal = no surveillance
Complete molar - monthly hCG for at least 6 months

213
Q

Molar pregnancy

A

Partial - some embryonic tissue
Complete - no embryonic tissue
Risk of choriocarcinoma transformation and local invasion

214
Q

Mastitis managment

A

Ensure effective milk expression and analgesia

Antibiotics if - failure to resolve 12-24 hours after advice, fissure in the nipple, positive culture

215
Q

A pregnant lady on phenytoin should receive what extra care?

A

Vitamin K for the last month

216
Q

What tocolytic is first line in preterm labour?

A

Nifedipine -beware can cause maternal hypotension

217
Q

Bleeding for two weeks post birth.
Initially bright red but now a darker brown
Heavier in C-sections

A

Lochia
Completely normal - discharge and safety net
Return if - starts to smell, amount increases,

218
Q

Management of an complex ovarian cyst

A

Ca125 AFP bHCG and elective cystectomy

FNA isn’t done as this can facilitate the spread of the cancer

219
Q

After the 7 days of antibiotics in a UTI what else should be done? Pregnant

A

A urine culture should be sent as a test of cure

220
Q

What is the commonest ovarian cyst?

A

Follicular

221
Q

Which ovarian cyst is most likely to bleed?

A

Corpus Luteum cyst

222
Q

Whats the commonest epithelial ovarian tumour?

A

Serous cystoadenoma

223
Q

Complications associated with Mucinous Cystadenoma

A

Rupture can cause a pseudomyxoma peritoni

Have the potential to become massive - compress surrounding organs

224
Q

Guidance around emergency contraception and vomiting

A

If vomiting has occurred within 3 hours of taking another dose is required.

225
Q

What test is indicated in recurrent vaginal Candidas?

A

Test for diabetes

226
Q

Breast cancer screening

A

50 -75 years - mammogram every 3 years

227
Q

How long is the IUS effective for?

A

5 years

228
Q

How long is the IUD effective for?

A

5-10 years

229
Q

In an a c section what should be given to the mother?

A

Omeprazole - helps reduce risk of aspiration pneumonia

230
Q

What becomes first line for management of miscarriage over 12 weeks?

A

Medical - vaginal misoprostol

Things I don't know, but need to know, for fourth year (31 decks)

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