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O&G Flashcards

1
Q

Herpes Mx in PregC

A

labour<6wks=CS aciclovir tds labour>6wks=reassure

Guidelines issued by the Royal College of Obstetricians and Gynaecologists state that women who present with first-episode genital herpes during their third trimester should be managed with daily suppressive oral aciclovir 400mg until delivery. Delivery should be by caesarean section due to a high risk of neonatal HSV (herpes simplex virus) transmission.

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2
Q

Headache in PregC (differentials)

A

Migraine-most common Viral meningitis- Cerbral vein thrombosis Subarachnoid Idiopathic intracranial hypetension

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3
Q

VZV infx in PregC Tx

A

Test for VZ Abs and give VZIG w/in 10 days

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4
Q

External cephalic version (Contraindications)

A

Offered from 36wks (37 in multiparous) Contraindications-Multiple pregnancy, Maj uterine abnorm, antepartum haemorrhage, rupture of membranes,

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5
Q

DM Mx postpartum

A

After eating and drinking ~6hrs sliding scale reduced to preprgC doses of insulin

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6
Q

SLE in PregC risks

A

Spont Miscarriage, fetal death, PET, Preterm, fetal growth restriction

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7
Q

Listeria trasnmission

A

Soft cheese and Pate

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8
Q

Toxoplasmosis transmission

A

Cats, faeces

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9
Q

Rashes in PrgC

A

Pemphigoid gestationis - Blistering of trunk, spreads from umbilicus PUPP - Abdo stretch marks and periumbilical sparing Prurigo gestationis - trunk+upper limbs abdo sparing Impetigo hepetiformis - blisting and febrile

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10
Q

Threatened miscarriage

A

PVB <24wks

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11
Q

Missed miscarriage

A

Loss of pregC w/o passage of the products of conception or PVB

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12
Q

Septic miscarriage

A

loss of PregC complicated w/ infx of the retained conceptus

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13
Q

Incomplete miscarriage

A

loss of PregC w/ PVB and passage of not all of the concptus Tx - med: misoprostol Surg: suction evacuation

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14
Q

Complete miscarriage

A

loss of PregC w/ all of products of conception expelled

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15
Q

Hyperemis Gravidarum

A

Px - Severe vomiting, dehydration, RF’s - multiple pregC Tx - fluid restoration and anti emetics

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16
Q

Fetal pole and fetal heart

A

6 wks

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17
Q

Blighted ovum/anembryonic pregC

A

Gestational sac w/o embryonic pole or yolk sac development Mx - 2 scans 10-14/7 apart

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18
Q

Ectopic PregC Mx med criteria (4)

A

Criteria: Small ectopic <3cm, no fetal pulse, no clinical compromise, no free fluid in the pouch of douglas, bHCG <3000

Med: Methotrexate IM (+/- another dose 7/7), monitor bHCG on days 4+7. Drop by 15% needed otherwise 2nd dose given

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19
Q

HRT risks

A

Inc risk of: Stroke, breat Ca, ovarian Ca, VTE, CAD

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20
Q

Epilepsy Mx in PregC

A

Carbamazepine lamotrigine

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21
Q

COCP

A

MOA - inhibits ovulation

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22
Q

POP

A

MOA - thickens cervical mucus

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23
Q

Desogestrel

A

MOA - inhibits ovulation, thickens cervical mucus

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24
Q

Injectable contraceptive/medoxyprogesterone acetate

Lasts how long?

A

MOA - inhibits ovulation, thickens cervical mucus

12wks

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25
Q

Implantable/etonogestrel/Implanon

A

MOA - inhibits ovulation, thickens cervical mucus

Lasts 3yrs

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26
Q

Itrauterine device

A

MOA - decreases sperm motility and survival

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27
Q

Intrauterine system/levonorgestrel

A

MOA - prevents endometrial proliferation, thickens cervical mucus

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28
Q

Levonorgestrel/Levonelle Emergency conc

A

MOA - Inhibits ovulation <72hrs 58% effective (24hrs 95% effective)

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29
Q

Ulipristal/ellaOne Emergency conc

A

MOA - Inhibits ovulation <120hrs effective condoms until next period

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30
Q

IUD Emergency conc

A

MOA - prevents implantation, spermicidal <5days after UPSI or expected day of ovulation

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31
Q

primary PPH

A

Def: minor 1000-500ml/maj>1000 blood loss from the genital tract w/in 24hrs Ax - 4 T’s: Tone, Tissue, Trauma, Thrombin

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32
Q

Fibroids

A

Def: benign smooth muscle tumours of the uterus, more common in black women Px - asymp, menorrhagia, lower abdo pain, bloating, urinary Sx, subfertility Ix - transvagianl US Mx - Sx Mx IUS,tranexamic acid, COCP, GnRH, myomectomy, uterine artery embolization

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33
Q

Menstrual cycle 6 steps

A
  1. GnRH released from hypothalamus 2. Inc FSH+LH released from ant pit. 3. FSH induces follicular growth creating oestradiol 4. Oestradiol inhibits other follicle development (only one follicle) 5. positive feedback and LH surge causing ovulation 36hrs after surge 6. Luteal phase of follicle (now corpus luteum) increases progesterone, enhancing endometrial receptivity
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34
Q

CMV infx in pregC Fetal effects (4)

A

Deafness IUGR Hydrocephalus Thrombocytopenia

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35
Q

DR C BRAVADO

A

Define risk - prev CS, PET, DM, PVB, IUGR Contractions - Baseline RAte - 110-160, tachy w/pyrexia, brady=distress Variability - 5-25, dec in fetal sleep, prolonged dec=bad Accelerations - 15 for 15s good, w/ contractions Decelerations - early/late/varied (varied=cord compression+oligohydramnios) Overall impression

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36
Q

Reiter’s syndrome ‘can’tx3’

A

Can’t see, can’t pee, can’t climb a tree conjunctivitis, urethritis, arthritis

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37
Q

Rise in this hormone maintains PregC if fertilized

A

Progesterone

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38
Q

Stimulates proliferation of stromal and glandular elements of endometrium

A

Oestradiol

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39
Q

3 P’s of labour

A

Power, passage, passenger

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40
Q

3 stages of labour

A
  1. From diagnosis of labour to full cervical dilation 10cm latent (<4) active (4-10) 2. From full dilation to delivery ~40mins nullips/~20mins multips 3. Delivery of fetus to delivery of placenta
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41
Q

Itching and derraged LFT’s esp. bile acid. Rsk=Stillbirth, preterm and meconium staining. Tx=induce @ 37-38 + Urodeoxycholic acid

A

Obstetric cholestasis

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42
Q

Ruptured membranes, Offensive pv discharge. Tx- Abx and induction of labour (removal of infx nidus)

A

Chorioamnionitis

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43
Q

Px - Severe vomiting, dehydration, RF’s - multiple pregC Tx - fluid restoration and anti emetics

A

Hyperemis Gravidarum

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44
Q

Ax - placental insufficiency Px - Microsomaly and microcephaly (head can be normal if placental insufficiency occurs later in PregC)

A

IUGR

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45
Q

Epx - under 35 Ax - 90% SCC + HPV RF: STI Px - PCB, IMB, deep dyspareunia, crampy lower abdo pain, cerval bleeding on contact Ix - Biopsy for staging Tx - surgical, chemo, radio

A

Cervical cancer

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46
Q

Def: implantation of a fertilized ovum outside of the uterus, mostly tubular Px - 6-8wks amenorrhoea, lower abdo pain, PVB, peritoneal bleeding (shoulder pain), Mx - methotrexate, or surgical

A

Ectopic PregC

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47
Q

Px - pelvic pain, fever, deep dyspareunia, discharge, menstrual irregularities, cervical excitation Tx - IMcef, po doxy, po met

A

Pelvic inflammatory disease

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48
Q

Px - sudden onset unilateral lower abdo pain, N+V, tender adnexa

A

Ovarian torsion

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49
Q

Px - chornic pelvic pain, dysmenorrhoea (pain before period), deep dyspareunia, subfertility, chocolate cyst

A

Endometriosis

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50
Q

Px - pressure/heaviness or bearing down sensation, urinary Sx i.e. incontinence, freq, urge

A

Urogenital prolapse

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51
Q

4 O’s: Obesity, O children, Oestrogen unopposed, O sugar (DM)

A

Endometrial Ca

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52
Q

Px - PVB 1st-2nd tri, uterus large for dates, hyperemesis gravidarum, snowstorm, ground glass?, inc hCG

A

Hydatidiform mole/molar PregC

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53
Q

Px - PVB 3rd tri, constant pain, signs of shock/hypovolaemia, woody uterus

A

Placental abruption

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54
Q

Px - PVB 3rd tri, no pain, non tender uterus, no BV

A

Placenta praevia

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55
Q

Ax - fetal bld vessels runs directly in front of presenting part Px - rupture of membranes followed immediately by large PVB, severe fetal distress, CS often not fast enough to save fetus

A

Vasa praevia

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56
Q

CTG normal ranges:

Baseline

Variability

Accelerations

Deeccelerations

A

Baseline - 110-160

Variability - >5 beats per minute

Accelerations - present

Decelerations - None

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57
Q

Fetal bld sampling indications

A

Pathological CTG

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58
Q

Fetal bld sampling risks/contraindications

A

Infx - HIV, HepC

Hb abnormalities - immune thrombocytopenia, Haemophilia B

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59
Q

Px - Umbilical cord below presenting part.

Important - Cord can become obstructed or spasm, starving the fetus of oxygen

A

Cord prolapse - Obs emergency

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60
Q

Cord prolapse Mx

A

Mx - Call fro help, IV access, stop woman pushing, elevate presenting part, deliver immediately (Instrumental/CS depending on quickest option)

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61
Q

Induction of labour indications (3 categories)

Contraindications (3 absolutes)

A

Fetal - suspected IUGR, Antepartum haemorrhage, prolonged pregnancy

Materno-fetal - PET, DM

Maternal - social, in utero death

Contraindications - acute fetal compromise,

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62
Q

Prostaglandin E2 (PGE2) PV

A

Induction of labour - starts labour/ripens cervix to allow amniotomy

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63
Q

Oxytocin infusion and ARM

A

Induction of labour

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64
Q

CTG sens and spec

A

High sens low spec

high Sens - 100 people w/ disease 98 will have +ve result

High Spec - 100 people who don’t have disease 98 won’t have it

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65
Q

Inductin of labour w/ intrauterine death

A

po mifepristone + po/pv misoprostol

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66
Q

Epidural contraindications (4)

A

Hypotension, abnormal lie, placenta praevia, pelvic obsruction

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67
Q

Ax - Chorionic vili in contact with the myometrium

Px - Rsk of PPH

Mx - Syntocinon, Balloon tamponade, iliac artery ligation, hysterectomy

A

Placenta accreta

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68
Q

Fetal cariac physiology (6)

A

Umbilical arteries occluded causing:

Reduced venous return to the right side of the heart

Therfore right atrial pressure closing the foramen ovale

Breathing causes dec pressure in pulmonary circulation=inc rt ventricular output

Pulmonary artery vasodilates

Inc pressure on left side

PDA closes due to rising oxygen levels

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69
Q

Large and small villi w/ scallpoed outlines+ trophoblastic hyperplasia

A

Hydatidiform mole

70
Q

Ext. tender fluctuant swelling on labia minora

A
71
Q

Mx of urge incontinence

A

Cons: Bladder retraining min 6wks

Med: Oxybutynin

72
Q

Pretermination assessment

A

Abx prophylaxis for chlamydia

Contraception discussion

Risks of STOP

Risk of uterine perf is 1 in 300

73
Q

Bonemarks of the pelvic outlet (3)

A

Pubial arch, ischial tuberosities, coccyx

74
Q

Most inferior aspect of the peritoneal cavity

A

Pouch of douglas

75
Q

Px - sudden onset epigastric pain, N+V, jaundice, high uric acid, hypoglycaemia, high uric acid

A

Acute fatty liver of PregC

76
Q

Px - Pain in suprapubic area that radiates to upper thighs and perineum, worse on walking

A

Smphysis pubis dysfunction

77
Q
A

Brow presentation

78
Q

DM complicates what % of PregC

A

2-5%

79
Q

% of babies born from DM mothers >50th percentile

A

85%

80
Q

Rsk of major congenital malformation if 1st maternal HbA1c>10%

A

25%

81
Q

Rsk of recurrence of gestational DM in future PregC

A

60%

82
Q

% of women who will develop T2DM in next 10 years (after gestational DM)

A

50%

83
Q

Perimenopausal woman w/ uterus

A

Cyclical combined hormone replacement therapy

84
Q

Postmenopausal amenorrhoeic women w/ uterus

A

Continuous combined hormone replacement therapy

85
Q

Postmenopausal amenorrhoeic woman w/o uterus

A

Oestrogen-only hormone replacement

86
Q

Osteoporosis Tx

A

Bisphosphonates

87
Q

Infx prophylaxis in preterm rupture of membranes

A

Erythromycin

88
Q

Abx assoc w/ necrotizing enterocolitis

A

Co-amoxiclav

89
Q

Px - severe abdominal pain, cessation of contractions, significant fetal distress, VBAC,

A

Uterine rupture

90
Q

Px - PVB @ ROM/ARM, CTG abnormalities,no pain

A

Vasa praevia

91
Q

Resp rate in PregC

A

Stays the same

92
Q

Hb Conc in PregC

A

Decreases

93
Q

Renal bld flow in PregC

A

Increases

94
Q

Albumin changes in PregC

A

Decreases

95
Q

Heart Rate in PregC

A

Increases

96
Q

Px - PCB, Wt loss, ealry sexual activity, multiple partners, smoking

A

Cervical Ca

97
Q

Px - IMB, menorrhagia, bado swelling, bulky uterus, subfertility, dyspareunia

A

Fibroids

98
Q

Px - Bright red growth of speculum

Mx - avulsed and cauterized

A

Cervical polyps

99
Q

Absolute contraindications to COCP w/ respect to

VTE

Arterial disease

Migraines

A

VTE: personal Hx of VTE BMI>39, 2 of - Fhx, obesity>30, varicose veins, immobilization

Arterial dis (2 of): Fhx, DM, smoker, HTN, >35yo, obese

Migraine: migraine wiyth typical aura

100
Q

Anti-D prohylaxis for miscarriage after how many weeks?

A

12wks

101
Q

Sensitizing events warranting anti-D prophylaxis (6)

A

Antepartum haemorrhage

Closed abdominal injury

external cephalic version

invasive prenatal diagnosis

intrauterine procdures

intrauterine death

102
Q

Rheus prophylaxis dose <20wks

Rheus prophylaxis dose >20wks

A

250iu

500iu

103
Q

Commonest (~85%) oestrogen producing tumour

20-30yo

A

Mucinous adenocarcinoma

104
Q

commenest of all ovarian malignancies

30-40, 30% bilateral, 30% malignant

A

Serous adenocarcinoma

105
Q

Meig’s syndrome

A

Fibroma

Pleural effusion

Ascites

106
Q

Pseudomyxoma peritonei, jelly belly

A

Mucinous adenocarcinoma

107
Q

Arise from germ cells and contain ectodermal tissue

A

Teratoma

108
Q

CIN 2 or 3 Mx

30% will develop into Ca

A

Ablation (diathermy or cryocautery)

Excision techniques (cone biopsy or large loop excision of transformational zone/LLETZ)

109
Q

Cervical Ca stage *I and IIA Tx

*Excluding IA1

(Cevrical Ca stage IA1 Tx)

A

Wetheim’s procedure (Hysterectomy, upper 1/3rd of vagina, parametrium, pelvic lymph nodes +/- ovaries if not young)

(Cone biopsy)

110
Q

Cervical Ca >IIB Tx

A

Radio and chemo

111
Q

Cervical Ca stage IB1 Tx maintaining fertility

A

Radical trachelectomy

112
Q

Maternal jaundice, AST/ALT inc> ALP+GGT

(Hepatic picture)

A

Acute fatty liver of PregC

113
Q

Infx in PregC

Fetal: sensorineural deafness, cataracts, congenital heart disease, LD’s HepSplenMeg, microcephaly

Maternal: flu like Sx, rash

A

Rubella

114
Q

Infx in PregC

Fetal: dermatomal skin scarring, neurological defects, limb hypoplasia, eye defects

A

Varicella zoster

115
Q

Ovarian venous drainage

A

Pampiniform plexus in broad ligamnet, ovarian vein, right IVC/left renal vein

116
Q

Vaginal relations

Post

Lat

Ant

A

Post: Pouch of douglas, rectum, anal canal

Lat: Levator ani, visceral pelvic faschia, ureters

Ant: Base of the bladder, urethra

117
Q

Mesometrium, mesosalpinx, mesovarium

A

Broad ligament

118
Q

Infundibulum, ampulla, isthmus, uterine part

A

Fallopian tubes

119
Q

RF: ARM

A

Cord prolapse

120
Q

Mx of PPH (Atonic uterus)

A

Cons: Empty bladder, uterine massage,

Med: Oxcytocin infusion, carboprost

Surg: B-lynch suture, uterine artery ligation, hysterectomy

121
Q

Maximum diameter of the head has passed through the pelvic brim

A

Engagement

122
Q

Movement required for easy passage into the mid cavity

A

Flexion

123
Q

Levator ani muscles helps the head move into an OP position

A

Internal rotation

124
Q

Movement causes crowning of the head

A

Extension

125
Q

Movement that realigns the head w/ the shoulders

A

Restitution

126
Q

Subfertility, PMHx of surgery

A

Asherman’s syndrome

Adhesion

127
Q

Kielland’s foreceps

A

Rotation

128
Q

Neville-Barnes foreceps

A

Traction (w/ 3x contractions before CS)

129
Q

Most sensitive parameter to assess fetal growth and detect IUGR

A

Abdominal circumference

130
Q

Secondary dysmenorrhoea causes/associations

A

Endometriosis, PID, fibroids, LLETZ

131
Q

Secondary dysmenorrhoea Tx

A

Cons: Hot water bottle

Medical: NSAIDS (Ibuprofen/mefanamic acid), COCP, depot P

132
Q

Acute fatty liver of PregC vs Obstetric cholestasis

A

Pain in acute fatty liver

133
Q

Pain in suprapubic area that radiates to upper thighs and perineum, worse on walking

+Mx

A

Symphysis pubis dysfunction

confirmed by pain on increasing pressure on pubis

Mx - analgesics pelvic support braces

134
Q

Diamond shape

A

Anterior fontanelle

135
Q

Y shape or triangular

A

Posterior fontanelle

136
Q

Types of breech (most to least common)

A

Extended, flexed, footling

137
Q

Beta-agonist tocolytic

A

Ritodine

Inhibits smooth mucle contractions in an attempt to delay labour

Contraindicated in diabetes and cardiac disease

138
Q

Tx for menorrhagia

1st line

2nd line

3rd line

Surgical

A

1st line w/ contraception: IUS

2nd line (No contraception): tranexamic acid, NSAIDS (mefanamic acid)

2nd line (w/ contraception): COCP

3rd line: Progestogens, GnRH agonists

Surgical non-sterilizing- polyp removal, endometrial ablation, myomectomy, *uterine artery embolization

Surgical + sterilizing: Hysterectomy

*Fertility is reduced but classed as non-sterilizing procedure therefore contraceptives are advised afterwards

139
Q

Risk of malignancy index (RMI) calculation

A

U*M*CA125

U=ultrasound score

M=menopausal staus

RMI>250 referred

140
Q

Cervical tumour staging

A

0: Carcinoma in situ

I:lesion confined to cervix

II: Invasion into upper vagina but not pelvic wall

III: Invasion of lower vagina/pelvic wall, or causing ureteric obstruction

IV: Invasion of bladder or rectal mucosa

141
Q

Intermittent abdo pain relieved following sudden watery discharge

A

Fallopian tube carcinoma

142
Q

Hx of dilation and curettage (TOP), adhesions

dyspareunia, amenorrhoea, oligomenorrhoea, infertility

A

Asherman’s syndrome

143
Q

Secondary menorrhoea (6 causes)

A

Gonadal failure: premature ovarian failure

Pituitary dysfunction: pituitary tumour

Physiological causes: stress, travel and wt changes can reduce GnRH

Endocrine dysfunction: hypothyroidism

oestrogen metabolism dysfunction: anorexia nervosa

144
Q

Booking visit (6)

A

Info

BP

BMI

Urine dip + culture

Bloods: FBC, Rhesus, alloantibodies, Hbopathies, HepB, Syhpilis, rubella screen.

HIV

145
Q

Parvovirus B19 inf. What do the following mean:

IgG+ve IgM-ve

IgG-ve IgM+ve

IgG-ve IgM-ve

A

Immune to parvovirus - reassure

Non-immune recent infx <4wks - refer to ftal medicine

146
Q

Missed pills POP’s

Action <3hrs

Action >3hrs

A

<3hrs = no action

>3hrs = take as soon as possible

147
Q

Missed pills cerazette (desogestrel)

<12hrs

>12hrs

A

<12hrs no action

>12hrs take as soon as possible

148
Q

Cyclical combined HRT indications

A

LMP<1yr ago

149
Q

Continuous combined HRT indications

A

Taken cyclical combined for 1yr

>1yr since LMP

>2yr since LMP in premature menopause (<40)

150
Q

Continous oestrogen therpay indication

A

Hysterectomy

151
Q

Non-hormonal Tx for menopausal vasomotor Sx

A

SSRI’s (paroxetine, fluoxetine, citalopram, venlafaxine)

152
Q

Time until contraceptives effective:

IUD

POP

COCP, implant, injection, IUS

A

IUD: Immediately

POP: 2 days

COCP/Implant/Injection/IUS: 7 days

153
Q

Follicular cyst genesis

A

Non-rupture of the dominant follicle

Commonly regress

154
Q

Face presentation Mx

A

Emergency CS

155
Q

Mx of stress incontinence

A

Cons: Pelvic floor exercises (8contractions 3*day for min 3mnths)

Med: PV oestrogen/pessary

Surgical: TOT/TVT

156
Q

Antiemetics in hyperemesis gravidarum

A

Promethazine

157
Q

NSAID effective after CS, contraindicated during pregC

A

Diclofenac

158
Q

Main Oestrogen secreted by the ovaries prior to meonpause

A

17beta-Oestradiol

159
Q

Male cell that contains 23 single chromosomes prior to spermiogenesis

A

Spermatid

160
Q

Male cell that contains 46 double-structured chromosomes

A

Primary spermatocyte

161
Q

PE Mx

A

Enoxaparin 80mg BD

162
Q

Single episode of brown stained vaginal discharge

A

Atrophic vaginitis

2014 feedback

163
Q

UTI Tx in PregC

A

Nitro, Trimethoprim, Cefalexin

164
Q

PCOS Tx increasing fertility

A

Clomiphene

165
Q

Most common cause of male infertility

A

Varicocele

166
Q

Scrotal pain relieved on lifting

A

Epididimo-orchitis

167
Q

Fetal effects of Paroxetine

A

Cardiac abnormalities (VSD’s/ASD’s)

168
Q

Fetal effects of Fluoxetine

A

Persistent pulmonary hypertension of the newborn

169
Q

Mx of depressin in PregC

Preffered SSRI in PregC

A

Slowly withdraw and watchful waiting

Sertraline?

170
Q

Dysmenorrhoea vs Menorrhagia

Mx

A

Painful vs heavy

Dys: NSAIDs (Ibuprofen/Mefanamic acid), COC preparations, (3rd line POP)

Menorrhagia: NSAIDS (Mefanamic acid/tranexamic) or IUS, COCP, long acting progesterones

Specialities (4 decks)

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