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Qs Review Yr5 > O+G > Flashcards

O+G Flashcards

1
Q

What condition does unopposed oestrogen HRT increase the risk of?

A

Endometrial Cancer

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1
Q

What cardiac abnormalities are associated with Turner’s syndrome

A

Bicuspid aortic valve and Co-arcation of the aorta

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2
Q

What are the effects of COCP on gynaecological malignancies?

A

inc risk of breast and cervical

dec risk of ovarian and endometrial

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3
Q

What is the most common cause of miscarriage?

A

Anti-phospholipid syndrome

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4
Q

What food should be avoided in pregnancy?

A

Cooked liver - high in vit A - leads to birth defects

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5
Q

How does Ovarian Hyperstimulation Syndrome present?

A

GI symptoms - Abdo pain, N+V, blaoting, diarrheoa

SOB, fever, oliguria and peripheral oedema

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6
Q

If a pregnant women has previous VTE, what is their management?

A

LMWH throughout pregnancy until 6 weeks post partum

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7
Q

What is the management of atypical endometrial hyperplasia?

A

Total hysterectomy and bilateral salpingo-oophorectomy

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8
Q

What are the features of adenomyosis?

A

Dysmenorrheoa

menorrhagia

enlarged, boggy uterus

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9
Q

A patient is about to have surgery in a couple of months, what should she do about her COCP?

A

Stop 4 weeks before

Resume 2 weeks after

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10
Q

When are foetal movements felt, and when should they be referred for no foetal movements?

A

18-20

24 weeks

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11
Q

What UKMEC category does anti-phospholipid antibodies (SLE) get placed in?

A

UKMEC 4

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12
Q

What determines a simple ovarian cyst?

A

<5 cm

non-loculated

thin walled

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13
Q

What is the definition of a PPH?

A

500ml blood loss within 24hrs of the birth of the baby

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14
Q

What is placenta percreta?

A

When the chorionic villi invade the perimetrium

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15
Q

What are the first-line antidepressants for breast feeding women?

A

Sertraline and paroxetine

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16
Q

When does mesenteric adenitis often occur?

A

Presents after a viral infection

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17
Q

What is the recommended Ix for a pregnant women with a suspected DVT?

A

Compression duplex USS

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18
Q

A women with a vertical cervical scar requests a home birth, what should you do?

A

Classical cesarean scar is a contraindication to vaginal birth

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19
Q

What is the site of injury in Erb’s palsy

A

C5 - C6

commonly affecting the brachial plexus.
The classical sign of Erb’s palsy is the ‘waiter’s tip hand’.
This presents with internal rotation of the forearm plus wrist and finger flexion.

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20
Q

How do you manage urge incontinence?

A

Bladder retraining
Oxybutinin

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21
Q

How do you manage obstetric cholestasis?

A

Chlorphenamine and emollients - itching
Vit K - minimise risk of bleeding
Induction at 37-38 wks

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22
Q

What is hydrops fetalis and what condition is it associated with?

A

Swelling in at least 2 compartments seen on USS
Haemolytic disease of the newborn

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23
Q

What is the difference between complete and missed miscarriage?

A

Missed - no symptoms
Complete - symptoms have stopped, os is closed

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24
Q

What are the 3 most likely sites of an ectopic pregnancy?

A

Most common - Ampulla
2nd most - Isthmus
3rd - Fimbria

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25
Q

What is are other names for erythema infectiosum? And what are its complications in pregancy?

A

Slapped cheek syndrome, Fifth disease

Red cell aplasia leading to severe foetal anaemia - can cause hydrops foetalis and miscarriage

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26
Q

What is a pathological CTG

A

One with 1 abnormal or 2 non reassuring features

Normal:
Dr Define risk
C Contractions
Br Baseline rate (110 –160 bpm)
A Accelerations (15 bpm above baseline for 15 secs)
Va Variability (5-25 bpm)
D Decelerations (15 bpm below baseline for 15 secs)
O Overall impression

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27
Q

When should taking misoprostol for a medical termination be surpervised?

A

After 10 weeks gestation

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28
Q

How long before delivery is enoxaparin stopped?

A

24 hours

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29
Q

What are absolute contraindications of a COCP?

A

Previous history of venous thrombosis, cerebrovascular accident, ischaemic heart disease, severe hypertension or migraine with aura

Active breast cancer
Active endometrial cancer
Active or chronic liver disease
Inherited thrombophilia
Pregnancy
Smokers > 35 years old, smoking > 15 cigarettes a day
BMI > 40
Diabetes with vascular complications

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30
Q

How does Amniotic fluid embolism present?

A

chest pain,
sudden-onset dyspnoea,
seizures
cardiac arrest.

tachycardia
hypotension
hypoxia

Due to the disseminated intravascular coagulation that ensues, women also suffer from massive postpartum haemorrhage

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31
Q

What are causes of a prolapse involving the posterior vaginal wall? And how do you differentiate the two?

A

Rectocele
Enterocele (small bowel loops)

DRE

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32
Q

What is the difference between a complete and partial hyadatidiform mole?

A

Complete: single sperm and egg with no genetic material - no foetal tissue - swollen chorionic villi

Partial: 2 sperm and normal egg - foetal parts seen

33
Q

How do you investigate foetal anaemia? And how often should it be performed?

A

Doppler USS of middle cerebral artery - fortnightly for the remainder of the pregnancy

34
Q

How is the risk of malignancy index calculated?

A
35
Q

What obstetric complication is associated with hypothyroidism?

A

Pre-eclampsia

36
Q

What molecule does the ROM plus test identify to help diagnose PPROM?

A

Insulin like growth factor binding protein-1

37
Q

What is the most likely cause of miscarriages in the first trimester?

A

Genetic or Chromosomal abnormalities

38
Q

What investigation is used to monitor SGA foetuses?

A

Umbilical artery doppler

39
Q

What are you likely to see on an X-ray of a neonate with respiratory distress syndrome?

A

Bilateral diffuse granular opacities with air bronchograms

40
Q

What are causes of symmetrical Feotal growth restriction?

A

Infection - TORCH
Trisomies 13/18
Nicotine, Alcohol, Heroin

41
Q

What is tricuspid atresia and how does it present?

A

Tricuspid atresia describes a condition where the tricuspid valve does not develop resulting in no blood flow to the right ventricle.
This then leads to a small non-functional right ventricle (resulting in left axis deviation).
Blood flows between the left and right sides of the heart via atrial and ventricular septal defects and there is minimal flow through the pulmonary circulation.

Newborns often develop significant respiratory distress. It is usually managed acutely with a surgical intervention (e.g. Blalock-Taussig shunt insertion).

42
Q

What is the most common cause of purperal sepsis?

A

Strep. pyogenes

43
Q

When is amniocentesis offered?

A

15-20 wks

44
Q

What is a secondary PPH and what is the most likely cause?

A

PPH from 24hrs-12 weeks
Endometritis

45
Q

How do you investigate and manage PID?

A

Ix - UPT (rule our ectopic)
- Speculum and bimanual
- Endocervical swab

Mx -
Consider removal of IUD

Ceftriaxone 500 mg IM (single dose)
Doxycycline 100 mg BD (oral) for 14 days
Metronidazole 400 mg BD (oral) for 14 days

Alternative: ofloxacin + metronidazole for 14 days

46
Q

What can be given to a multiparous patient who’s in the second stage of labour and is failing to progress if her membranes have already ruptured?

A

Oxytocin infusion - augment contractions and help labour progress

47
Q

At what rate does the cervix dilate in the first stage of labour from 3-10 cm

A

1cm/hr

48
Q

What is the most common ground of the Abortion Act under which terminations of pregnancy are carried out in the UK?

A

Ground C

49
Q

How can neonatal HSV present?

A

Vesicles and pustules in face and mouth
CNS - encephalitis
Disseminated infection

50
Q

What is given to oligomenorrheic pts with PCOS to induce ovulation?

A

Progesterone for 10 days - as they may have a thickened endometrial lining so progesterone is given to induce a withdrawal bleed

Clomiphene - to induce ovulation

51
Q

How is nifedipine used in obstetrics other than BP control?

A

tocolytic

52
Q

What is length considered to be short for a cervix at 16-24 weeks gestation?

A

<25mm

53
Q

How does lichen planus present?

A

inflammatory skin condition
polygonal violaceous macules - itchy
dypareunia
oral mucosa - cobweb-like markings (Wickham Striae)

54
Q

How do you manage chickenpox exposure in pregnancy ?

A

Check for varicella antibodies in maternal blood
Oral aciclovir immediately or from days 7 to 14
previously - IVIG

55
Q

How do you manage chicken pox in pregnancy?

A

oral aciclovir should be given if the pregnant women is ≥ 20 weeks and she presents within 24 hours of onset of the rash
if the woman is < 20 weeks the aciclovir should be ‘considered with caution’

56
Q

How do you manage gonnorrhoea?

A

IM ceftriaxone STAT

57
Q

What HRT is best for perimenopausal and menopausal women?

A

Perimenopausal - Cyclic HRT
Menopausal - continuous combined HRT

58
Q

What is systemic onset JIA (Still’s disease) and how does it present?

A

type of inflammatory arthritis

Salmon pink rash
Arthritis
Uveitis
myalgia
reduced appetite

59
Q

When are cleft lips and palates repaired?

A

cleft lip - first 3 months
palate - 6-12 months

60
Q

How do you manage menopausal symptoms in a pt with previous breast cancer?

A

SSRI - treat vasomotor symptoms

61
Q

What are causes of smelly lochia?

A

Endometritis

Retained products of conception

62
Q

When are patients advised to check the string on their IUD?

A

After mensturation

63
Q

How likely is it for a patient to develop Diabetes mellitus following GDM

A

50%

64
Q

How many weeks should do you take off following a vaginal hysterectomy?

A

4 weeks

total abdo (radical) - 6 weeks

65
Q

How do you manage a pregnant patient with a swollen leg? LMWH or dupplex USS first?

A

LMWH

66
Q

How do you manage an antepartum haemorrhage in a resus -ve women

A

Anti D and kleihauer test

handeld doppler USS (umbilical artery)
USS
CTG

67
Q

How do you manage a pt with an endometrial thickness of > 4mm on TVUSS?

A

Hysteroscopy and pipelle biopsy

W/o atypia:
Reverse risk factors (e.g. obesity, HRT)
Endometrial surveillance every 6 months (biopsies recommended in high-risk women)

1st line: progestogens (or observation):
* LNG-IUS - Keep for 5 years
* Oral progestogens (continuous progestogens should be used rather than cyclical)
This should continue for a minimum of 6 months to induce histological regression
2nd line: hysterectomy is an option

W atypia:
Fertility non-sparing à total hysterectomy (+ BSO if post-menopausal)
Fertility-preserving:
* 1st line: LNG-IUS
* 2nd line: oral progestogens
* Routine endometrial surveillance with biopsies (roughly every 3 months)
If 2 consecutive negative biopsies, follow-up can be extended to every 6-12 months

68
Q

How would you manage a 65F with a medium size multi loculated cyst on USS

A

Ca-125

Calculate RMI

RMI>200 - surgery
RMI<200 - monitor

69
Q

What is the most common side effect seen in patients with an implant?

A

Irregular bleeding

70
Q

How do you investigate and manage placenta preavia with bleeding?

A

Ix
TVUSS
FBC, U+Es, G+S, Clotting screen, LFT
Resus statsus - Kleihauer test - Anti D
CTG

Mx
Admit for 48 hours observation
General advice - no sex, delivery c-section

LLP at 20 weeks - rescan at 36 and 38 wks

C section

71
Q

How do you manage premenstural syndrome

A

Lifestyle advice, painkillers
COCP
COCP +CBT
SSRI

72
Q

How do you manage a bartholin cyst abscess?

A

Marsupialisation and doxycycline

73
Q

How do you manage a patient with urge incontinence which persists despite bladder retraining with a background of falls?

A

Mirabegron - beta 3 agonist

74
Q

How do you manage a pregnant woman with a UTI

A

7 day course of nitrofurantoin

Avoid at term
timethoporim is avoided in first trimester

75
Q

How do you manage a pregant woman presenting with genital hepres for the first time in her 1st trimester?

A

Oral aciclovir 36 weeks and C section

76
Q

How do you manage cord prolapse?

A

Emergency C - section

Elevate presenting part of foetus and knee to chest

if knee to chest fails - all fours

77
Q

What PCR value is diagnostic of Pre-Eclampsia

A

PCR>30mg/mmol in the context of high BP

78
Q

A 22 year old woman with cystic fibrosis attends the obstetric medicine clinic for preconception counselling. Development of which obstetric complication is she at greatest risk, given her pre-existing disease?

A

GDM - pancreatic insufficiency

79
Q

A 19 year old woman presents with an acutely painful large swelling near the opening of the vagina. She is unable to sit and passing urine is uncomfortable. Her last menstrual period started 2 days ago. Which is the most likely diagnosis?

A

Bartholin’s abcess - cyst is painless

80
Q

A 27 year old woman has a non-viable pregnancy at 6 weeks with a beta-HCG of 28,000 IU/L. What malignancy is she at greatest risk of developing?

A

Choriocarcinoma

81
Q

A 30 year old woman in the third trimester of her first pregnancy develops an itchy, bumpy rash on her abdomen, with sparing of the periumbilical area. She is usually fit and well and has had an uneventful pregnancy so far. What is the most likely diagnosis?

A

Polymorphic eruption of pregnancy

Qs Review Yr5 (3 decks)

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