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#passmed 2023 > O & G > Flashcards

O & G Flashcards

1
Q

If a girl hasn’t had menarche (aka doesn’t bleed or have periods) but has cyclical pain, what’s the Dx?

A

Imperforate hymen

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2
Q

What is the FIRST line tx for Infertility bs PCOS, with NORMAL BMI?

A

Clomifene

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3
Q

What Tx can you give for infertility bc PCOS in OBESE pt?

A

Metformin

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4
Q

How does Ovarian Cancer usually spread?

A

Local invasion within pelvic region

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5
Q

When a woman with PPH has Uterine atony (aka soft uterus after giving birth) what should you do to stop bleeding?

A
  1. Bimanual compression
  2. Oxytocin (encourages contractions –> stops bleeding)
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6
Q

When should you do continuous CTG monitoring in labour? (6 things)

A

Any of these present / arise @ labour:
1. Sus chorioamniotis / sepsis
1. Temp 38C+
1. HTN 160/110
1. Oxytocin use
1. Meconium present
1. Fresh vaginal bleeding

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7
Q

What are the SSRI’s of choice for breastfeeding women? (2 things)

A
  1. Sitalopram
  2. Paroxetine
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8
Q

What is extreme N + V in pregnancy called?

A

Hyperemesis gravidaparum
(life threatening preg complication)

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9
Q

Why is Hyperemesis gravidaparum dangerous?

A

Causes:
1. Dehydration
1. Elec imbalance

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10
Q

What are the Tx options for Hyperemesis gravidaparum? (3 things)

A
  1. Anti-histamines (FIRST LINE)
  2. Ondansetron / metoclopramide (2nd)
  3. IV fluids
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11
Q

What are the complications of Hyperemesis gravidaparum? (3 things)

A
  1. Wernicke’s encephalopathy
  2. Mallory-Weiss tear
  3. Small baby / pre-term birth
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12
Q

How will a preg woman w Wernickes enephalopathy 2ndary to (Hyperemesis gravidaparum) present? (2 things)

A
  1. Diplopia (double vision)
  2. Ataxia (slurred speech + poor balance aka drunk)
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13
Q

What is the Tx for Wernickes enephalopathy 2ndary to (Hyperemesis gravidaparum)?

A

Pabrinex (IV vit B + C)

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14
Q

What meds are CI during breastfeeding? (9 things)

A
  1. Psych drugs (lithium / benzos)
  2. Abx (x3)
  3. Sulphonamides
  4. Sulfonylureas
  5. MTX
  6. Aspirin
  7. Carbimazole
  8. Cytotoxic drugs
  9. Amiodarone

PASS MACCA

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15
Q

What abx are CI during breastfeeding? (3 things)

A
  1. Ciprofloxacin
  2. TTC
  3. Chloramphenicol
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16
Q

When should you refer to Obstetrician if preg woman can’t feel baby kick?

A

24 weeks

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17
Q

What is the FIRST line med for Gestational HTN?

A

Oral labetalol

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18
Q

What CF / Hx would make you sus Ovarian cancer? (4 things)

A
  1. Old age
  2. Abd pain
  3. Bloating
  4. FHx of breast / ovarian cancer (BRCA involvment)
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19
Q

What med should you give in preparation of Hysterectomy for Fibroid removal?

A

GnRH agonist (e.g Leuprolide)

(Reduces fibroid size)

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20
Q

What should you give a pregnant woman w fever of 38+ C?

A

Benzylpenicillin

(for GBS prophylaxis)

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21
Q

What bac causes GBS in pregnant women?

A

Streptococcus agalacticae

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22
Q

What type of bacteria is Streptococcus agalacticae?

A

Gram positive

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23
Q

What can GBS cause in pregnant mother?

A

Usually asymptomatic

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24
Q

What can GBS cause in newborn? (3 things)

A
  1. Pneumonia
  2. Meningitis
  3. Sepsis
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25
Q

What is Lochia?

A

Passing blood / mucus / uterine tissue for 6 weeks after pregnancy

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26
Q

When should you do further investigation (US) for Lochia?

A

If persists past 6 weeks post-partum

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27
Q

What is a common cause of itchiness in 3rd trimester of pregnancy?

A

Intrahepatic cholestasis of pregnancy

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28
Q

What are the CF of Intrahepatic cholestasis of pregnancy? (3 things)

A
  1. Itch
  2. Jaundice
  3. No rash
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29
Q

What will the bloods say in Intrahepatic cholestasis of pregnancy? (3 things)

A
  1. Raised LFTs
  2. Raised bilirubin
  3. Anaemia
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30
Q

What is the Mx of Intrahepatic cholestasis of pregnancy? (3 things)

A
  1. Ursodeoxycholic acid (symptom relief)
  2. Weekly LFTs
  3. Induce @ 37 wks
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31
Q

What are the CF / Hx of Sheehan’s syndrome (aka post-partum pituitary necrosis)? (4 things)

A
  1. Hx of PPH
  2. Hypothyroidism (bc hypopituiary)
  3. Problems w milk prod
  4. Amenorrhoea
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32
Q

What blood results in pregnancy suggest the foetus has Downs syndrome? (3 things)

A
  1. ↑ HCG
  2. ↓ PAPP-A
  3. Thickened nuchal translucency

(defo pregnant, low pappa, thick nuchas)

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33
Q

What does a US finding of Retroplacental blood in pregnant woman mean?

A

Placental abruption

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34
Q

How do you Mx Placental abruption if foetus alive + well and less than 36 weeks? (2 things)

A
  1. Admit pt + monitor
  2. IV Corticosteroids
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35
Q

What is the Dx measurement for Gestation DM? (2 things)

A
  1. FBG 5.6+
  2. 2 hour glucose: 7.8+

(either one)

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36
Q

What should you monitor when you give Magnesium sulphate? (2 things)

A
  1. Reflexes
  2. Resp rate (bc resp depression)
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37
Q

What does the Bishop score tell you?

A

Need for induction

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38
Q

What do the numbers of Bishop score tell you?

A
  • Less than 5: Needs induction bc labour won’t start
  • More than 9: Labour will happen spotaneously
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39
Q

What can a high AFP in pregnancy mean? (3 things)

A
  1. NTD (e.g anencephaly)
  2. Abd wall defects (e.g omphalocele)
  3. Multiple pregnancy
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40
Q

What can a low AFP in pregnancy mean? (3 things)

A
  1. Downs syndrome
  2. Trisomy 18
  3. Maternal DM
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41
Q

What can women who stop breastfeeding sometimes get?

A

Galactocele (grape sized lump on breast)

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42
Q

What are the CF / Hx of Galactocele?

A
  1. Recently stopped breastfeeding
  2. Well circumscribed
  3. Aspiration –> white fluid (milk)
  4. Painless
  5. No local / systemic inf signs
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43
Q

What are some funny named Placenta disorders in pregnancy? (3 things)

A
  1. Placenta accreta (least severe)
  2. Placenta increta
  3. Placenta percreta (most severe)
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44
Q

What can the Placenta increta / percreta lead to?

A

PPH

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45
Q

What happens in Placenta accreta?

A

Chorionic villi attach to Myometrium but DON’T invade

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46
Q

What happens in Placenta increta?

A

Chorionic villi invade Myometrium –> cause PPH

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47
Q

What happens in Placenta percreta?

A

Chorionic villi invades Perimetrium

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48
Q

What are the folic acid req in pregnancy?

A
  • All women: 400mcg daily
  • High risk women: 5mg daily
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49
Q

Who are the High risk women that require 5mg folic acid daily? (4 things)

A
  1. Obese
  2. On epilpetics
  3. DM / Coeliac disease / Thalassaemia
  4. Either partner has Hx / FHx of NTD
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50
Q

When should Folic acid be taken until in the pregnancy?

A

First 12 weeks

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51
Q

What are the Vit D requirements in pregnancy?

A

Vitamin D 400IU once daily
For whole pregnancy

(all women)

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52
Q

What is the FIRST line SURGICAL Mx of PPH if all medical options fail?

A

IU Bakri catheter (aka balloon tamponade)

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53
Q

What are the CF of Turners syndrome? (4 things)

A
  1. Primary amenorrhoea (aka no menarche)
  2. No 2ndary sexual characteristics
  3. Widely spaced nipples
  4. Raised FSH / LH
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54
Q

What is the Mx if an ectopic pregnancy feotus has a HEART BEAT?

A

Surgical Mx aka Salpingectomy

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55
Q

Do you need to investigate with swabs if Vaginal candidiasis CF are obvious?

A

No

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56
Q

What should you do if you sus Vaginal candidiasis?

A

Give Oral fluconazole

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57
Q

What will Ovarian torsion show in US?

A

Whirpool pattern in R/L IF

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58
Q

When you have Cord prolapse what should you do to avoid compression? (5 things)

A
  1. Use Tocolytics
  2. Push foetus back in
  3. Advise pt to go on all 4s
  4. Do not push cord back in
  5. Immediate C section
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59
Q

If a pt has HTN before 20 weeks, what the Dx?

A

Pre-existing HTN, because you can’t get pregnancy induced HTN / Pre-eclampsia before 20 weeks

60
Q

What should you check for in US for Monochronic (aka one placenta) Twins between 16-24 weeks?

A
  • Twin to Twin Transfusion Syndrome (TTTS)
  • Because one twin can take all the blood
61
Q

What is a FIRST degree tear in delivery according to RCOG? (2 things)

A
  1. Superficial damage w NO muscle involvement
  2. DOESN’T require repair
62
Q

What is a SECOND degree tear in delivery according to RCOG? (3 things)

A
  1. Perineal muscle torn
  2. NOT involving anal sphincter
  3. Requires suturing on WARD (midwife can do, remember Stella said she done it)
63
Q

What is a THIRD degree tear in delivery according to RCOG? (3 things)

A
  1. Perineal muscle torn
  2. Anal sphincter complex involved
  3. Requires repair in THEATRE (Th for Th)
64
Q

What is a FOURTH degree tear in delivery according to RCOG? (4 things)

A
  1. Perineal muscle torn
  2. Anal sphincter complex involved
  3. Rectal mucosa also involved
  4. Requires repair in THEATRE (Th for Th)
65
Q

What is the FIRST line tx for Pregancy Cholestasis (presents with itching)?

A

Ursodeoxycholic acid

66
Q

What meds can you give to shrink Fibroids?

A

GnRH agonists

67
Q

What are the side fx of GnRH agonists? (3 things)

A
  1. Loss of bone mineral density
  2. Hot flushes
  3. Vaginal dryness
68
Q

What is the screening tool for Post-natal depression?

A

Edinburgh scale
(nas scotlanda mudapriseen ya)

69
Q

What are the FIRST line anti-emetics in Pregnancy? (2 things)

A
  1. Promethazine
  2. Cyclizine
70
Q

What is the FIRST line Tx for Fibroids (as long as no uterine cavity distortion)?

A

Levonorgestrel intrauterine system (LNG-IUS)

71
Q

What is the only effective Tx for infertility caused by Large fibroids?

A

Myomectomy

72
Q

What should you do if baby in Breech before 36 weeks?

A

Wait until 36 weeks and see
(if still breech do external cephalic version ECV)

73
Q

What should you sus if a 50+ yr old woman has IBS CF (cramping, bloating, diarrhoea)?

A

Ovarian cancer (check CA-125 levels)

74
Q

When should you sus Ovarian cancer? (4 things)

A

Over 50 with:
1. LOA
2. Bloating
3. Pelvic / abd pain
4. Urgency / Frequency

75
Q

What is the normal level of CA-125?

A

35 (less than that)
(i7na sakneen wen fil Sudan)

76
Q

What does adding progestogen to HRT increase the risk of?

A

Breast cancer

77
Q

What type of HRT doesn’t increase risk of VTE?

A

Transdermal HRT

78
Q

What is a RT for Hyperemesis Gravidarum (N+V in preg)?

A

Twin pregnancy

79
Q

If the foetus is having decelerations in CTG, with pre-eclampsia of mother, what should you do?

A

Emergency C section (not induction of labour)

80
Q

What is a long term complication of Vaginal hysterectomy w Ant-Post repair?

A

Vaginal vault prolapse

81
Q

If a pregnant woman has exposure to Chicken box before 20 weeks what should you do?

A

Give VZIG

82
Q

When should you start Active Mx in labour?

A

3rd stage

83
Q

How long does Active Mx in labour last?

A

30 mins

84
Q

What does Active Mx in labour involve? (3 things)

A
  1. Uterotonic drugs (oxytocin / ergometrine)
  2. Defer clamping + cutting cord (for 1 minute, but b4 5 mins)
  3. Controlled cord traction after signs of placental separation (aka first gush of blood)
85
Q

When is Ergometrine CI in Active Mx in labour?

A

HTN

86
Q

What is the CI for using Epidural anaesthesia ring labour?

A

Coagulopathy
(3ashan 7ashikook, n ur gonna bleed)

87
Q

What should you do with a pregnant woman with abd trauma?

A

Rhesus testing (ASAP)
(if Rh negative give anti-D)

88
Q

How do you differentiate between Placenta Praevia and Placental Abruption?

A

Placental Praevia = PAINLESS bleeding

89
Q

What comes first in Placental Abruption, pain or bleeding?

A

Pain (SEVERE)

90
Q

What are the NORMAL lab findings in pregnancy? (3 things)

A
  1. Reduced urea
  2. Reduced creatinine
  3. Increased urinary protein loss
91
Q

What heart signs are NORMAL in pregnancy? (3 things)

A
  1. Ejection systolic murmur (96%)
  2. Third heart sound (84%)
  3. Peripheral oedema
92
Q

What are the CF of Vasa Praevia? (2 things)

A
  1. Painless vaginal bleeding
  2. Fetal bradycardia
93
Q

Who does Vasa Praevia effect? (2 points)

A
  1. Can kill baby
  2. No major maternal risk
94
Q

What STI does gram-negative diplOcOccus cause?

A

GOnOrrhoea
(O O and O O)

95
Q

What STI gives a musty green discharge?

A

Trichomonas vaginalis

(mustee like a treechomonas)

96
Q

What is the first step in Chickenpox exposure in pregnancy?

A

Check antibodies

97
Q

What do you do if Chickenpox antibodies are positive?

A

She’s immune so reassure

98
Q

What do you do if Chickenpox antibodies are negative (aka not immune) and less than 20 wks?

A

VZIG

99
Q

What do you do if Chickenpox antibodies are negative (aka not immune), and more than 20 wks?

A

VZIG or oral aciclovir

100
Q

What is a obv CF of Endometriosis?

A

DEEP dyspareunia

101
Q

What is the cause of Primary amenorrhoea if the girl has breast tissue, but no axillary / pubi hair, but has elevated testosterone?

A

Androgen insensitivity syndrome

102
Q

What is the point of doing a Kleihauer test? (3 things)

A
  1. Done after heavy bleeding @ pregnancy
  2. Estimates volume of FMH (foeto-maternal haemorrhage)
  3. This tells you dose of additional anti-D you need to give
103
Q

What is the Dx when PID develops to RUQ pain (and referred shoulder pain)?

A

Fitz-Hugh-Curtis Syndrome

104
Q

What increases the risk of breast cancer?

A

HRT

105
Q

What should you do when you sus Obstetric cholestasis?

A

Check LFT

106
Q

What is the Combined Triple Test to see chances of foetus having Downs?

A
  1. b-HCG = High
  2. PAPP-A = Low
  3. Nuchal translucency on US = Thickened
107
Q

What do you do if Combined Triple Test says high chance of Downs syndrome?

A
  • Invasive: Amniocentesis
  • Non-invasive: Non-Invasive Prenatal Screen Test (NIPT)
108
Q

What dose of Folic acid do you give if Epilepsy + Pregnant?

A

5mg

109
Q

Why should Metoclopramide not be used for more than 5 days in Hyperemesis Gravidum?

A

Because risk of extrapyramidal side fx (tremor / increased tone)

110
Q

Who should have high dose Folic acid 5mg (apart from Epilepsy ppl)?

A

Obese
(mara kabeera lazim dose Kabeer)

111
Q

What is a side fx of Phenytoin?

A

Folic acid deficiency

112
Q

How do you differentiate between stages of labour?

A
  • Stage 1: Onset of true labour –> cervix fully dilated (10cm)
  • Stage 2: Full dilation to delivery of foetus
  • Stage 3: Until placenta completely delivered
113
Q

What is a common inf you get in pregnancy?

A

Vaginal candidiasis

114
Q

What are the CF of Vaginal candidiasis? (4 things)

A
  1. Cottage cheese thick discharge (not smelly)
  2. Vulvitis (superficial dyspareunia)
  3. Vulval erythema
  4. Itch
115
Q

What is the Tx for Vaginal candidias?

A

Clotrimazole pessary

116
Q

What surprisingly decreases risk of Hyperemesis gravidarum?

A

Smoking
(zab6aha be sijara)

117
Q

What is the Mx for only SYMPTOMATIC relief of Obstetric cholestasis?

A

Ursodeoxycholic acid (but evidence unclear)

118
Q

What is the definitive Mx for of Obstetric cholestasis?

A

Induction of labour @ 37 weeks

119
Q

What is the cut off to start Tx for Iron deficiency Tx?

A

110

120
Q

What additional measure can help in McRoberts manoeuvre?

A

Suprapubic pressure (not fundal pressure)

121
Q

When can you do US scan to check for Down syndrome, aka see nuchal screening?

A

11 - 13+6 weeks

122
Q

When is the booking clinic done?

A

8-12 weeks
(even tho I said before 10 weeks)

123
Q

When can you refer to Colposcopy despite 3 NORMAL cytology but HPV positive?

A

After 3 successive HPV positives
(aka you send her away and back after 1 year, 3 times)

124
Q

How many Inadequate samples of Cervical smears (aka send them and come back after 3 months) can you get before you send for Colposcopy?

A

2 inadequate samples

125
Q

What food should you avoid Pregnancy?

A

Cooked liver (bc vit A = teratogen)

126
Q

What increases the risk of Placental abruption? (3 things)

A
  1. Maternal age
  2. Multiparity
  3. Maternal trauma
127
Q

What are the options if HIV pt in labour has a viral load of less than 50?

A

Normal vaginal delivery
(0-50 normal range)

128
Q

What are the options if HIV pt in labour has a viral load of OVER than 50?

A

C section
(0-50 normal range)

129
Q

What should you do if you are delivery via C section bc HIV viral load is over 50?

A

Start antiretroviral infusion

130
Q

What should you do if you are delivery via C section bc HIV viral load is over 50?

A

Start antiretroviral infusion

131
Q

How long does bleeding carry on after vaginal delivery / C section?

A

2 weeks

132
Q

What is the name of the normal bleeding that happens for 2 weeks after delivery?

A

Lochia

133
Q

What are the characteristics of Lochia? (2 things)

A
  1. Bright red –> brown
  2. Pt stable (aka no temperature or anything)
134
Q

What is the Mx of GBS for delivery?

A

Intrapartum abx (aka when labour starts)

135
Q

What is the abx given @ GBS delivery?

A

IV benzylpenicillin

136
Q

What types of bleeding suggest Cervical cancer? (2 things)

A
  1. Post-coital bleeding
  2. Intermenstrual bleeding
137
Q

What can happen to fibroids during pregnancy?

A

They can grow

138
Q

Why can fibroids grow in pregnancy?

A

Bc increased oestrogen

139
Q

Apart from Post partum depression, what MH thing can happen after birth?

A

Post Partum Psychosis
(they go crazy)

140
Q

What is the Mx for Post Partum Psychosis?

A

Admit into hospital

141
Q

What are the stages of MH illnesses Post Partum? (3 things)

A
  1. Blues (60-70%)
  2. Postnatal depression (10%)
  3. PP Psychosis (0.2%)
142
Q

What are the complications of giving Ondansetron in pregnancy?

A

Small risk of Cleft lip / palate (but weigh risks to see)

143
Q

What are the timing for administering MgS for a pt who is having seizures in labour?

A

Give MgS until 24 hours after delivery OR 24 hours after last seizure

144
Q

What is the GOLD standard imaging for diagnosing Adenomyosis?

A

MRI

145
Q

What is the GOLD standard investigation for diagnosing Endometriosis?

A

Laparscopy

#passmed 2023 (39 decks)

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