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MSRA > O&G > Flashcards

O&G Flashcards

1
Q

When is anti D given

A

to rh negative mothers at 28 and 34w or whenever risk of maternal-foetal blood mixing

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2
Q

what happens to hb during preg

A

drops

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3
Q

dating scan is when

A

11-14w

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4
Q

anomaly scan is when

A

18-21 weeks

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5
Q

What screen is done around time of dating scan

A

combined screen for Down’s, Edwards and Pataus
USS+blood (hCG and PAPP-A) + maternal age

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6
Q

What is an alternative to combined screening

A

quadruple screen (for down’s only using hcg, AFP, inhibin A and oestriol)

In this case the anomaly scan would be used for Edwards and Pataus.

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7
Q

Does the combined/quad screening give you a specific chance?

A

No just more or less than 1/150

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8
Q

If you get higher chance in the screenings what are your options

A

NIPT

OR

diagnostic tests-

1) CVS at 11-14 weeks
2) amniocentesis at 15-18 weeks

both have chance of miscarriage

after this terminate or continue

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9
Q

What vaccines do pregnant women get

A

flu
rubella at 20-32 weeks
Pertussis 16-32 weeks

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10
Q

rx for obstetric cholestasis

A

ursodeoxycholic acid and induce at 37 weeks

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11
Q

snowstorm on USS is

A

molar pregnancy

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12
Q

risk of molar pregnancy

A

can get persistent tissue that becomes malignant choriocarcinoma (give MTX)

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13
Q

antiemetics to use in hyperemesis

A

promethazine or cyclizine

2nd line metoclop/ondansetron

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14
Q

Last resort rx for hyperemesis

A

corticosteroids

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15
Q

what is defined as low birth weight

A

<2500g (at whatever gestational age)

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16
Q

what age do you feel foetal movement

A

18-20 weeks (max is 24 weeks)

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17
Q

definition of prolonged gestation

A

exceeding 42 weeks

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18
Q

When is induction offered

A

41-42 weeks

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19
Q

What gestation is PPROM

A

before 37 weeks

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20
Q

Management of PPROM if evidence of chorioamnionitis

A

Betamethasone 12mg IM
Deliver
Broad spec abx

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21
Q

Mx of PPROM if no evidence chorioamnionitis

A

-Admit, observe for 48h then can take their own temp at home.
-Betamethasone 12mg IM - 2 doses 12h apart.
-Abx- erythromycin
-OP monitoring until induction at 34 weeks

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22
Q

When should pre-eclampsia deliver?

A

34w+

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23
Q

Complication of pre-eclampsia/eclampsia

A

HELLP syndrome
haemolysis
elevated liver enzymes
low platelets

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24
Q

treatment for HELLP

A

deliver

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25
Q

what extra monitoring do diabetic mothers need

A

extra growth scans 28,32,36w

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26
Q

gest diabetes increases risk of what complication during labour

A

shoulder distocia

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27
Q

VQ scan for PE increases risk of

A

childhood leukaemia for baby

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28
Q

CTPA for PE increases risk of

A

breast ca for mum

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29
Q

Treatment for VTE in pregnancy

A

LMWH

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30
Q

How should a woman with previous VTE be managed

A

LMWH for 6w post partum

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31
Q

How should a woman with prev recurrnt VTE
or
prev VTE + FHx
be managed

A

LMWH antenatally and until 6w post partum

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32
Q

How should a woman with 3 persisting risk factors for VTE in pregnancy be managed

A

LMWH from 28 weeks until 6w postnatal

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33
Q

Woman with 4+ vte risk factors mx

A

lmwh immediately until 6w postnatal

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34
Q

When should VBAC be offered

A

singleton who is cephalic at 37weeks

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35
Q

absolute contraindications to VBAC

A

prior high vertical section

foetal distress

transverse lie

placenta previa

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36
Q

What is the risk in vbac

A

uterine rupture

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37
Q

What extra medicaiton should preg women with epilepsy get

A

5mg folic acid
oral vit k in the last 4 weeks

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38
Q

Safest AEDs in pregnancy

A

carbamazepine and lamotrigine

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39
Q

When is medical mx of ectopic indicated (MTX)

A

<35mm
HCB <1500
No heartbeat

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40
Q

How long to wait before conception after medically managed ectopic

A

3 months

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41
Q

UTI treatment in pregnancy

A

nitro in new
Trimethoprim at term (avoid in 1st trimester - NTD as folate antagonist)

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42
Q

Recurrent miscarriage is how many

A

3 consecutive

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43
Q

Medical management of miscarriage

A

mifepristone –> misoprostol

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44
Q

Antiphospholipid ix

A

lupus anticoagulant
anticardiolipin ab

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45
Q

what type of decels are concerning on a CTG

A

late

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46
Q

what foetal pH is worrying on blood sampling

A

<7.20 –> deliver

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47
Q

What are methods of induction

A

membrane sweep

Vaginal prostaglandin

Amniotomy

IV syntocinon for cervical dilatation

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48
Q

When is external cephalic version done

A

36 weeks in nullip
37w multip

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49
Q

Management of slow progress in labour

A

ARM
Syntocinon
C section

If fully dilated- assisted vaginal delivery (forceps etc)

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50
Q

Mx shoulder distocia

A

McRoberts
Suprapubic pressure
Episiotomy

Rotate anterior shoulder
Deliver posterior arm
Break clavicle
Emergency C section

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51
Q

Preterm labour is defined as what gestation

A

<30 weeks

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52
Q

Mx preterm labour if membranes ruptured

A

No tocolysis
Coticosteroids
MgSO4
Consider infection

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53
Q

Mx preterm labour if membranes intact

A

Nifedipine for tocolysis
corticosteroids
MgSO4

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54
Q

How to differentiate antepartum haemorrhage vs threatened miscarriage

A

+ or - than 24 weeks

55
Q

What does a ‘woody’ uterus indicate

A

placental abruption

56
Q

mx bleeding placenta previa

A

inpatient until delivery
C section at 39 weeks

57
Q

What is each type of vaginal tear

A

1st- vaginal walls
2nd- perineum
3rd- ext anal sphincter
4th - int anal sphincter/rectal mucosa

58
Q

what drug might be used in the active mx of 3rd stage of labour

A

syntometrine/Ergometrine

59
Q

when can IUS be inserted after birth

A

within 48h

OR

after 4 weeks

60
Q

Need for contraception after the menopause

A

12 months after the last period in women > 50 years
24 months after the last period in women < 50 years

61
Q

when can u restart hormonal contraception with levornogesterel

A

immediately

62
Q

when can u restart hormonal contraception with ullipristal

A

5 days

63
Q

if given IUD for emergency contraception and they want it out, when can it be removed

A

until after next period

64
Q

Down’s is suggested by what on combined test

A

↑ HCG, ↓ PAPP-A, thickened nuchal translucency

65
Q

second pregnancy but had prev gestational diabetes- when to do OGTT?

A

ASAP

66
Q

hyperemesis gravidarum diagnostic triad

A

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

67
Q

When to time a blood test to check for ovulation

A

serum progesterone level 7 days prior to the expected next period (‘mid luteal’)

68
Q

which women should take aspirin in pregnancy from 12 weeks

A

1 high risk for pre eclampsia or 2 moderate risk

69
Q

Moderate risk factors for pre eclampsia

A

-first pregnancy
-age 40 years or older
-pregnancy interval of more than 10 years
-body mass index (BMI) of 35 kg/m² or more at first visit
-family history of pre-eclampsia
-multiple pregnancy

70
Q

High risk factors for pre eclampsia

A

-hypertensive disease in a previous pregnancy
-chronic kidney disease
-autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome
-type 1 or type 2 diabetes
-chronic hypertension

71
Q

GDM mx if the fasting plasma glucose level is < 7 mmol/l

A

a trial of diet and exercise should be offered

72
Q

GDM mx if the fasting plasma glucose level is > 7 mmol/l

A

Insulin

73
Q

When else to offer insulin in GDM?

A

evidence of complications such as macrosomia or hydramnios

74
Q

previous group b strep baby , next birth should recieve what?

A

intrapartum IV benpen

75
Q

spot urine protein:creatinine ratio of ?mg/mmol or more is used as the threshold for significant proteinuria in pregnancy

A

30

76
Q

when are women with pre-eclampsia likely to be admitted and observed

A

BP >160/110

77
Q

Blood results in PCOS

A

chronically elevated LH –> increases androgen production–> these are converted to oestrogen peripherally which perpetuate chronic anovulation.
Chronically supressed FSH (no cyclical rise and fall)- new follicular growth continuously stimulated but not to the point of full maturity

SHBG decreased, so circulating testosterone is increased

78
Q

Low FSH and LH indicates

A

hypogonadismH

79
Q

High FSH and LH indicates

A

menopause/prem ovarian failure

80
Q

High LH, low FSH indicates

A

PCOS

81
Q

PCOS rx

A

COCP

82
Q

Medical mx for urge incontinence

A

anticholinergics- oxybutynin, solifenacin

83
Q

PID rx

A

doxy
cef IM
met

84
Q

What is Fitz Hugh Curtis syndrome

A

RUQ pain- perihepatitis secondary to PID

85
Q

what type of ovarian cyst may become huge

A

mucinous cystadenoma

86
Q

Medical termination of pregnancy what to give

A

mifepristone then in 48 hrs misoprostol

87
Q

HRT if have no periods

A

oestrogen and progest daily

88
Q

HRT if have periods

A

oestrogen daily
progesterone on last 14 days of cycle (or last 14 days every 3 months if irreg periods)

89
Q

IF start COCP on day 1 of period, when is it effective

A

immediately

90
Q

IF start COCP on not day 1 of period, when is it effective

A

7 days

91
Q

When is POP effective

A

day 1-5 of cycle immediately
any other day- 2 days

92
Q

When is post vasectomy semen analysis done

A

12 weeks after and after 20 ejaculations

93
Q

chlamydia rx

A

single dose azithro
7 days doxy

94
Q

gonorrhoea rx

A

IM cef and 1g azithro po

95
Q

gonorrhoea micro appearance

A

gram -ve diplococcus

96
Q

trichomonas rx

A

metro stat or 5-7 days (longer course only for men)

97
Q

clue cells indicates what

A

BV

98
Q

Penile issue
-white plaques
-red papules
-can’t retract foreskin
-fissures around foreskin

A

candidal banalitis

99
Q

painless mucocutaneous lesions on penis that looks like psoriasis, associated with reiters syndrome

A

circinate balanitis

100
Q

poorly demarcated plaques of thickened skin on scrotum or labia majora

A

lichen simplex

101
Q

pale, atrophic genital skin with erosions, telangectasia, adhesions, loss of architecture

A

lichen sclerosis

102
Q

lichen sclerosis has risk of what

A

SCC

103
Q

white lacy papules and itching

A

lichen planus

104
Q

syphilis rx

A

benpen

105
Q

is chancre painful?

A

NO

106
Q

Management of hot flushes if they dont want hormones

A

SSRI/SNRI

107
Q

Endometriosis rx

A

NSAIDs and/or paracetamol are the recommended first-line treatments for symptomatic relief

if analgesia doesn’t help then hormonal treatments such as the combined oral contraceptive pill or progestogens e.g. medroxyprogesterone acetate should be tried

Consider GnRH analogue (to ‘induce menopause’) or surgery

108
Q

If forget to change contraceptive patch what to do

A

If the contraceptive patch change is delayed greater than 48 hours, the patch should be changed immediately and a barrier method of contraception used for the next 7 days.

109
Q

symptoms of ovarian hyperstimulation syndrome in IVF

A

vomiting
ascites
oliguria
VTE

110
Q

Recurrent thrush regime

A

induction: oral fluconazole every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 months

111
Q

Coag findings in Von Willebrand

A

prolonged bleeding time
APTT may be prolonged
factor VIII levels may be moderately reduced
defective platelet aggregation with ristocetin

112
Q

alternative condom in latex allergy

A

Polyurethane

113
Q

What menopause treatment may cause irreg bleeding within the first 12 months

A

tibolone

114
Q

UKMEC 3 for COCP

A

more than 35 years old and smoking less than 15 cigarettes/day

BMI > 35 kg/m^2*

family history of thromboembolic disease in first degree relatives < 45 years

controlled hypertension

immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)

current gallbladder disease

115
Q

UKMEC4 for COCP

A

more than 35 years old and smoking more than 15 cigarettes/day

migraine with aura

history of thromboembolic disease or thrombogenic mutation

history of stroke or ischaemic heart disease

breast feeding < 6 weeks post-partum

uncontrolled hypertension

current breast cancer

major surgery with prolonged immobilisation

positive antiphospholipid antibodies (e.g. in SLE)

116
Q

Early referral for infertility criteria (6m rather than 1 y)

A

Female
Age >35
prev pelvic surgery
Prev STI
amenorrhoea
abnormal genital exam

Male
prev genital surgery
prev STI
varicocele
sig systemic illness
abnormal genital exam

117
Q

Cervical excitation is found in

A

pelvic inflammatory disease and ectopic pregnancy.

118
Q

After 20 weeks, symphysis-fundal height in cm should =

A

gestation in weeks

119
Q

Simple ovarian cyst on USS management

A

Repeat ultrasound in 12 weeks.

120
Q

What is Meigs syndrome

A

Meigs’ syndrome is a benign ovarian tumour (usually a fibroma) associated with ascites and pleural effusion

121
Q

Most common benign ovarian tumour in <25yo

A

Dermoid cyst (teratoma)

122
Q

most common cause of ovarian enlargement in women of a reproductive age

A

follicular cyst

123
Q

Are follicular or corpus luteum cysts more likely to present with intraperitoneal bleeding

A

Corpus luteum

124
Q

Ruptured mucinous cystadenoma can cause

A

pseudomyxoma peritonei (jelly belly)

125
Q

most common benign epithelial tumour

A

Serous cystadenoma

126
Q

single painless genital lesion

A

Syphilis

127
Q

single painful genital lesion

A

H. ducreyi

128
Q

Multiple painless genital lesions

A

HPV warts

129
Q

Multiple painful genital lesions

A

herpes simplex

130
Q

most common ovarian ca

A

Serous carcinoma

131
Q

Which emergency contraception can they have if breastfeeding

A

LNG ok

Ullipristal stop breast feeding for a week

132
Q

If a pregnant woman is not immune to rubella, she should be offered the MMR vaccination when

A

in the post-natal period

133
Q

First line PPH mx

A

manual compression
IV oxytocin

134
Q

urge incontinence in frail older woman medication?

A

avoid oxybutynin
can have mirabegron if concern re anticholinergic SEs

MSRA (21 decks)

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