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PACES > O&G > Flashcards

O&G Flashcards

1
Q

Advice if taking levonorgesterol or ulipristal as emergency contraception

A

If vomit in next 3 hours then need to come back and retake
Not 100% effective so need to take pregnancy test if next period over 7 days past expected date
Can affect menstrual cycle- irregular or early bleeding/ spotting
Ectopic risk so if get severe pain in abdo come to A and E

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2
Q

Symptoms to ask about in obstetrics history

A

Headache
Visual problems
Chest pain
SOB
Nausea and vomiting
Abdo pain
Reduced fetal movements
Urinary symptoms
Vaginal discharge or loss of fluid
Leg swelling
Pruritus
Fatigue, weight loss, fever

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3
Q

What goes into history talking about the current pregnancy

A

Gestational age
Any scans or screening, what results?
Multiple gestation?
Folic acid?
Have you thought about planning the delivery?
Immunisations?
Have there been any comlpications/unwell?
How been coping?

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4
Q

What goes into asking about previous pregnancies

A

Gravidity and parity
Clarify what happened in those pregnancies
- if at term- age, weight, method of delivery, complications
Before term
- management used

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5
Q

What goes into gynae part of history in obs history

A

Cervical screening- last date and result
Previous gynae conditions

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6
Q

Questions about vaginal discharge

A

Colour
Amount
Consistency
Smell

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7
Q

Questions for dyspareunia

A

Location- deep or superficial
Duration
Character

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8
Q

Contraception questions for history

A

What method
Is that what always have used
Plan for children in future

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9
Q

Counselling for miscarriage

A

Medical gives control over but has side effects
Surgical has associated risks however symptoms go straightaway

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10
Q

Estimated delivery date formulation

A

(LMP-3 months)+1 year and 7 days

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11
Q

How is shoulder pain a side effect of laparascopy

A

Gas inserted into abdomen which can irritate the diaphragm

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12
Q

Fever, tachycardia and fetal tachycardia after an episode of urinary incontinence and discharge

A

Chorioamnionitis
The discharge was waters breaking

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13
Q

Management plan for ovarian torsion

A

A-E
Pregnancy test
Bloods- G&S, clotting
TVUSS
Surgery referral (cystectomy, detorsion, oophorectomy)
Anti-emetics, analgesia, fluids

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14
Q

How break news about potential cancers

A

Say that plan is to refer for 2WW as what we want to rule out ovarian cancer
THEN PAUSE
Say that im not saying this is what it is, there are many other things it could be like etc

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15
Q

Counselling on a miscarriage

A

Say that scan showed your baby has no heartbeat

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16
Q

Counselling for VBAC

A

Is a safe option the majority of the time however there is a slight risk of uterine rupture
If wish to proceed
- will be carried out in a consultant led unit
- will have elctronic tracing of baby throughout

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17
Q

Investigations to do for contraception

A

Observations
BMI
STI screen if necessary

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18
Q

Advice if unprotected sex

A

Emergency contraception
STI check 3 weeks and also 3 months after

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19
Q

Adavantages and disadvantages of depo injection

A

Very effective
Do not need to remember to take

Return to fertility
Osteoporosis
Weight gain
Must use condoms as no STI protection

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20
Q

Adavantages and disadvantages of depo injection

A

Very effective
Do not need to remember to take

Ireegular bleeding
Spots and progesterone sx
Must use condoms as no STI protection

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21
Q

Adavantages and disadvantages of COCP

A

Effective
Side effects uncommon
Ease painful and heavy periods

Small risk of clots
Breast cancer risk
Have to remember to take everyday
Must use condoms as no STI protection

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22
Q

Adavantages and disadvantages of POP

A

Much smaller chance of clots

Must take same time every day
Irregular bleeding
Acne etc
Must use condoms as no STI protection

23
Q

Secondary amenorrhoea differentials and questions

A

Type 1- hypothalamic
- exercise
- stressed
- weight loss

Type 2- PCOS, thyroid, prolactin
- acne
- change in weight
- facial hair
- headache
- palpitations

Type 3- POI
- flushes
- dry vagina

24
Q

Investigations for amenorrhoea

A

Bedside
- examination inc visual fields
- observations
- BMI
- pregnancy test
Bloods
- hormone screen
Imaging
- consider hysteroscopy if asherman syndrome

25
Q

Differentials for dysmenorrhoea

A

Endometriosis
PID
Fibroids
Copper coil
Adenomyosis
Primary dysmenorrhoea
Cancer

26
Q

Investigations for dysmenorrhoea

A

Bedisde
- observations
- BMI
- speculum for swabs and abdominal examination
Bloods
- baseline
Imaging
- TVUSS

27
Q

Abdo pain differentials

A

To rule out
- ectopic
- torsion
Other
- miscarriage
- PID
- cyst
- ruptured cyst
- cancer
- mittelschmerz
- period pain
- bartholins

28
Q

PV bleeding differentials

A

PID
Breakthrough bleeding
Slipped coil
Miscarraige
Ectopic
Cancer
Ectropion

29
Q

PV bleeding investigations

A

Bedside
- observations
- speculum with swabs and abdo examination
- pregnancy test

Bloods
- baseline

Imaging
- TVUSS

30
Q

Abdo pain investigations

A

Bedisde
- observations
- examination- speculum including speculum
- pregnancy test

Bloods
- baseline infection looking for

Imaging
- TVUSS

31
Q

Urogynae differentials

A

STI/UTI
Atrophic vaginitis
Incontinence
- stress
- urge
- functional from DM
- overflow
Prolapse
Bladder cancer

32
Q

Urogynae investigations

A

Bedside
- BMI
- Sims speculum if prolapse
- urine dip and pregnancy test
- speculum for swabs if indicated
- bladder diary

Bloods
- HbA1c

Imaging
- urodynamics if indicated

33
Q

Primary amenorrhoea differentials

A

No secondary characteristics
- turners
- hypothalamic including kallmans

Secondary characteristics
- mullerian agenesis
- imperforate hymen
- transverse septum
- thyroid
- prolactin
- PCOS
- CAH and cushings

34
Q

Primary amenorrhoea investigations

A

Bedside
- observations
- head to toe examination
- pregnancy test
- karyotyping from saliva swab

Bloods
- hormone screen

Imaging
- TVUSS

35
Q

Important things to answer in TOP history

A

Obstetric history
Support at home- ask about partner
ICE
- why doing
- anything particularly worrying about the process

36
Q

Investigations for TOP

A

Bedside
- observations
- head to toe
- pregnancy test

Bloods
- beta HCG
- FBC
- U&Es
- group and save
- clotting screen

Imaging
- TVUSS

37
Q

Counselling for termination of pregnancy

A

Explain free under NHS and that all records are strictly confidential
Explain that next step is to refer on to specialist clinic where will carry out an assessment of yourself and discuss the options
Then at a later date you will have the procedure
Are you aware of the methods used?
2 main methods
- medical where give mifeprostone which stops pregnancy from continuing and then a second one a few days later which will cause the pregnancy tissue to be expelled
- surgical where place a tube into womb and remove the pregnancy

38
Q

Breathless differentials in pregnancy

A

PE
Infection
Pneumothorax
Cardiac problems
Anaemia
Asthma

39
Q

Questions for breathlessness in pregnancy

A

When breathless at
Chest pain
Haemoptysis
Cough
PE
- rfx
- leg pain
- haemoptysis
Anaemia

40
Q

Rfx for VTE in pregnanc

A

Pregnancy
- stasis
- over 35
- procedures
- pre-eclampsia

Inherited
- just say them

Acquired
- previous VTE
- obesity
- flight
- cancer
- sepsis

41
Q

How manage heparin during labour

A

Speak to someone ASAP as soon as start contracting as need to stop heparin

42
Q

Incidence of someone with HIV vertically transmitting to baby

A

No intervention- 30%
Intervene - under 1%

43
Q

Investigations if HIV identified in pregnancy

A

Bedside
- observations
- pregnant abdo exam
- urine dip
- swabs for STIs

Bloods
- baseline etc
- viral load, CD4, genotype of foetus
- syphyllis and hepatitis antibodies

44
Q

Questions to ask in HIV in pregnancy history

A

Infection screen
Previous history
Travel
Partners screen who have had sex with
Support at home

45
Q

Investigations for NVP

A

Bedside
- observations
- examination looking for signs of dehydration- sunken eyes, mucous membranes, CRT
- abdo examination looking for causes of vomiting
- neuro examination
- pregnant abdo exam
- urine dip
- BMI

Bloods
- FBC, U&Es, LFTs, Beta HCG, TFTs

Imaging
- if not had booking do TVUSS to exclude molar

46
Q

Management of HGV

A

Fluids
Anti-emetics
Thiamine
LMWH

47
Q

Investigations for reucrrent miscarriages

A

Karyotype parents
Genetic analysis of tissue
Bloods- diabetes, TFTs, APL screen
TVUSS

48
Q

Questions to ask in later pregnancy

A

Itching
Headache
Swelling
Visual problems

49
Q

Secondary post partum haemorrhage questions

A

How much have you been bleeding
Light headed or short of breath
Fever
Pain
Discharge
Pregnancy history especially labour
Sexually active
Pain on urinating and stool

50
Q

Investigations for secondary post partum haemorrhage

A

As actively bleeding A-E
- sats and lung exam
- c= BP, HR and ECG
- able to converse
- E= examine vagina with speculum and HVS

Bloods
- FBC, U&Es, LFTs, clotting screen, group and save
- blood cultures

Imaging
- TVUSS to rule out retained products of conception

51
Q

Counselling for SGA

A

As you know we have done the scan to check babys well which I can confirm they are doing, they have a strong heartbeat. Now one of the other things that we do is to check their size to see how they are growing and the scan today has shown that baby is a little bit smaller than we would expect for this number of weeks.
So what does this mean? In some cases this is completely normal for some babies to be a bit smaller just like with us adults some of you r friends will be tall and some will be small. What does worry us a little bit is when baby is small because their growth has been restricted for some reason or another and as a result they are not able to reach their biggest potential size. This occurs in a number of scenarios, it can be due to infections, problems with baby itself or most of the time when baby isnt getting all the necessary nutrients and oxygen

52
Q

Complications of SGA

A

Stillbirth
NEC
Imapired neurodevelopment
Hypoglycaemia
Later in life= metabolic syndrome

53
Q

Investigations for SGA

A

Bedside
- observations
- pregnant abdo exam
- urine dip
- saliva karyotyping

Bloods
- screen infections

Imaging
- TVUSS
- doppler

PACES (5 decks)

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