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Year 5 > O&G > Flashcards

O&G Flashcards

1
Q

Cord Prolapse types

A

Occult- alongside baby

Overt- cord below baby

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2
Q

Risk Fx for cord prolapse

A 
What stops head being in pelvis??
Premature 
Breech
Abnormal lie
Polyhydramnosis
Grand multifarious 5+ labours 
Placenta prévia
Second twin
artificial rupture of membranes
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3
Q

Managing cord prolapse

A

Relieve pressure with position and manually elevate
Bladder catheterise and fill to elevate baby head
Tocolytics to stop contractions

Squished and cooling so will vasospasm avoid!

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4
Q

Signs of cord prolapse

A

Feral decels on Ctg

Feral bradycardia

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5
Q

Risk fx shoulder dystocia

A 
Maternal
Induction of labour 
Bmi >30
Diabetes 
Previous SD
Prolonged labour first or 2nd stage
Instrumented 
Augmented (syntocinon)

Fetal
Macrosomia (>5kg c section. 4.5kg discuss.

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6
Q

Pelvis shape at risk of shoulder dystocia

A

Out of gynacoid, anthropoid, platypelloid, Android:

Platypelloid and anthropoid

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7
Q

Complications of shoulder maternal and fetal

A

Maternal:Perineal tear

Baby: Baby clavicle and thumb fx
Contusion
Brachial plexus injury

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8
Q

Major causes of postpartum haemorrhage

A

4 T

Tone- uterine atony

Trauma- lower genital tract lac, anal sphincter injury

Tissue/ retained placenta

Thrombin- coagulopathy

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9
Q

Time for secondary PPH

A

24h-6weeks

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10
Q

Mx PPH

A 
Help
A-E
Treat cause
If trauma compress
Tissue remove and check clots
Thrombin give products
Tone bimanual compression and uterotonics
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11
Q

Causes of retained placenta

A

Uterine atony
Multiple pregnancy
Placenta accrete

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12
Q

Amniotic fluid embolisation risks

A 
Oxytocin
C section
AVB
Stillbirth
Polygydramnosis 
None ...
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13
Q

Signs amniotic fluid embolism

A

Tachy hypertensive fluid overloaded (cough, pulmonary oedema)

Maternal collapse (left lateral displacement)

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14
Q

How many mls a min does perimortem c section give mum

A

500ml a minute!!

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15
Q

Positioning in shoulder dystocia

A

McRoberts will already be in lithotomy

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16
Q

Which maternal conditions is ergometrine used in active management of 3rd stage labour

A

Severe hypertension

Severe cardiac disease

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17
Q

Manoeuvres in SD

A

Axial traction sideways

Delivery 6o clock posterior arm

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18
Q

Active management of 3rd stage vs 60mins definition of retained placenta

A

30mins if active 60mins if not

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19
Q

If woman needs transferred during cord prolapse what position

A

Left tilt in ambulance

All 4s is best when still

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20
Q

Cut off time by CS after CPR

A

4mins after collapse baby 5-6 mins after commenced CPR

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21
Q

Induction of labour

Augmentation

A

Use oxytocin

Start labour
Slow: 1:10 slow progress - give hormone

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22
Q

Terbutaline

A

Use if wait for theatre in cord prolapse

Delay contractions

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23
Q

Medical promotion of uterine contraction

A

Syntocinon
Ergometrine
Carboprost
Misoprostol

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24
Q

Reversible causes of collapse in pregnancy

A

Hypoxia hypothermia hyperkalaemia hypokalaemia hypovlycaemia

Toxin tension tamponade thrombus

Eclampsia (Mg toxicity) and ICH
Amniotic fluid embolism

Ie more bleeding risk and relative hypovolaemia
Peripartum cardiomyopathy, MI, aortic dissection
PE and other emboli
Suicide

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25
Q

Ccx of pre eclampsia

A 
ICH
Placental abruption and DIC
Eclampsia 
HELLP
Renal failure
Pulmonary oedema
Acute respiratory arrest
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26
Q

Fetal Ccx pre eclampsia

A 
IU growth restriction
Oligohydrannios
Hypoxia due to placenta insufficiency 
Placental abruption
Premature
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27
Q

Management of hypertension

A

Moderate BP 150-160 oral labetolol
Severe >180 oral/iv labetolol oral nifedipine
IV hydralzine

High dependency check BP every 15mins/30mins

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28
Q

Management eclamptic seizure

A

Left lateral position uterus
O2
Iv

Mg sulfate 4g in 5min to load
Reduce cerebral vasospasm

If severe and birth is planned or after fit
Continue for 24h

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29
Q

Why monitor urine output following MGSO4 in eclampsia

A

Renal excretion and risk of toxicity in oliguria

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30
Q

What to monitor when giving MGSO4

A

Urine out
Deep tendon reflexes
Hrly RE

INDICATE TOXICITY -> arrest

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31
Q

Managing MGSO4 toxicity

A

AE
STOP IT
IV calcium gluconaye 10ml 10%
Tube and ventilate

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32
Q

Signs of pre eclampsia

A

Severe HA
Epigastric pain
BP and Urine

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33
Q

Contraindications for LMWH

A

Vw disease
Severe liver disease
Severe renal disease (egfr <30 as its Renal elimination)

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34
Q

Sx of uterine fibroids

A 
Heavy menstrual bleed
Abdo swelling
Pressure
Subfertile
Difficult pregnancy (miscarriage and red degeneration)
Pain = Tortion

? Mass

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35
Q

Signs of PID

A 
Pyrex > 38C
Abdo distension and tender
RUQ? Suggests peri hepatic inflam = Fitz-Hugh-Curtis
Rebound and guarding
Discharge on speculum 
Tender VA
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36
Q

Ix PID

A 
Iron Bhcg 
FBC CRP
MSU
Swabs
TVU (tubo ovarian abscess)
Laparoscopy
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37
Q

Rx PID

A

Empirical ABx
Cef 500mg IM stay then oral doxy 100mg bD + metronidazole 400mg

Can give oral oflox

Pain relief

Refer GU med

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38
Q

Diagnosis ovarian cyst

A

US

CA125 CEA hCG aFP

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39
Q

Rx ovarian cyst

A

<6cm and no Sx can conservatively manage ?Ca125 and scan

> 6cm remove

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40
Q

Types of ovarian cyst

A

1: Functional

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41
Q

Sx endometriosis and diagnosis

A

Dysmenorrhoea
Dysparenuria
Pelvic pain
Sun fertile

Fixed tender retroverted uterus

TVU CA125 often up lap + biopsy

42
Q

Rx endometriosis

A

Conservative
NSAID Progesterone COCP Mirena

GnRH analogue prior to surgery

Can cauterise may need cystectomy

43
Q

Ovarian Cyst accidents and Ix

A

Tortion
Rupture
Haemorrhage
Infection

bhCG MSU FBC CRP CA125
TV US

44
Q

Pathophys of HPV and cancer

A

Subtype 16 and 18
Enters cell and release proteins E6 and E7
Keep it in the cell and then bind p53 and Rb
Leaves cells open to unchecked proliferation
Interferes at the transitional zone leading to CIN and SCC

45
Q

HPV vaccine schedule

A

2 injections or 3 if delayed to 15
GARDISAL covers 6,11,16 and 18
Protects against cervical vulval anal and warts
12-13 years

46
Q

Ix if abnormal cervix on visualisation

A

Punch biopsy and large loop excision of transformation zone (LLETZ)
Refer
Colposcopy

47
Q

Cervical cancer appearance

A

Acetowhite
Punctated
Mosaic
Abn vessels

48
Q

Rx CIN

A

Cold coagulation / cryotherapy

LLETZ laser excise

49
Q

Sx cervical cancer

A

Unscheduled bleeding
Offensive discharge
Obstructive uropaphy
Supraclav node

50
Q

Staging cervical ca

A

FIGO

Includes examination under anaesthesia (bimanual/PR)
MRI

Sizing stage 1
Stage 2 involvement of upper vaginal 11b = parametrium
III: lower 1/3 vagina b= pelvic wall/hydronephrosis
IV: spread

51
Q

Treatment options cervical cancer

A

LLETZ

Trachectomy

HYSTERECTOMY ? Nodes

Radical hysterectomy stage 1b and 2a

Chemorad /NACT

May need urostomy

52
Q

Risk fx vulval cancer

A 
Smoking
HPV
ALTERRED IMMUNE
Age
Lichen sclerosis
53
Q

Types Vulval cancer

A

Most SCC

Also adeno/melanoma/BCC etc

54
Q

Types of vulval cancer and histology

A

Usual (thick, high nuclear to cytoplasm, mitotic figures)
Warty (multinucleate cells, koliocytes
Basaloid (less differentiated and high N:C)
Differentiated (enlarged keratinocytes thick epidermis)

55
Q

Sx VIN

A 
Pruritis 
Pain
Ulcer
Leukoplakia 
Lump
ASx
Labia majora, minora and posterior fourchette
56
Q

Rx VIN

A

Surgery - radial? Laser?
Ablation- chemo (imiquimod)
Laser
Photodynamic

57
Q

Complications o inguinofemoral lymphadenectomy

A

Wound breakdown increase

Cellulitis / erisipalis

58
Q

Male factors in subfertility

A

AZOO:
1- Obstructive azoospermia - not getting into ejaculate ?CF
2- NON OBSTRUCTIVE (testicular failure or small volume ?XXY
3- no spermatic Emed is in hypogonadotrophic hypogonadism

59
Q

Female factors in subfertility

A

1- Ovulatory
Regular cycle? Check mid luteal pg day 21
Amenorrhoea- HPG (HP failure rate ?tumoir ?BMI)
HP dysfunction (PCOS, prolactin up, thyroid)

Fertilisation

Implantation

60
Q

Rx PCOS

A

BMi

Clomifene (SERM)
Letrozole (aromatise inhibitor)
Metformin

Ovarian drilling

ART

61
Q

Ix incontinance

A 
Abdo and bimanual
Vaginal inspection (bivalve, speculum, ?prolapse ?atrophy ? Fistula ? Ulcer
Cough - leak?

Urine dip and culture
Bladder diary
Cystoscope and renal imaging
Urodynamic in those with failed conservative, before surgery, rx complications

62
Q

Manage incontinance

A 
Lifestyle, PR, bladder retrain
ABx
Anticholinergics (oxybutanin, solfenacin
B3 agonist
Duloxetine

Surgery - sling, colposuspension,

63
Q

Side fx anticholinergics

A

Dry mouth eyes and constipation

64
Q

Components of a partogram

A 
Dilation
Descent in relation to ischial spines 
Frequency on contractions
Status of membranes and ?blood/meconium
Drugs and fluids
Maternal HR
Baby HR
65
Q

Indicators of a problem on partogram

A

Alert and action

66
Q

What does progression of labour depend on?

A

Power
Passenger
Passage

67
Q

Management of failure to progress

A

Artificial rupture of membranes
Oxytocin infusion
Instrument delivery
C section

68
Q

Fetal varicella syndrome

A

Skin scar eye defect limb hypoplasia neuro (microcephaly cortical atrophy mental restriction)

69
Q

Pep for newborn drug

A

Zidovudine within 4h birth for 4 weeks. Avoid breastfeeding risk 5-20%.

70
Q

Antenatal and postnatal findings haemolytic disease of newborn

A

Ante: polyhydramnios, thick placenta, hydrops (subcut oedema, pleural and pericardial effusion, ascites, hepatosplenomegaly), death

Post: jaundice, hepatosplenomrgaly, kernicterus, hypoglycaemia

71
Q

Pathology of maternal rhesus-ve group +ve fetus

A

Maternal IgG crosses placenta and destroys fetal RBC

72
Q

Preventing rhesus disease

A

Blood transfusion

AntiD prophylaxis

73
Q

When is AntiD required

A 
After ectopic 
After molar
After termination
<12 week vaginal bleed which is heavy 
<12 week medical or surgical management of miscarriage 
Sensitising event post 12 week

After delivery testing of infant cord and mat blood

74
Q

Derm disease in pregnancy

A 
Acne
Psoriasis
Infection (candida, varicella, warts)
Atopic eruption
AI (SLE, pemphigus)- pemphigus gestationis
Obstetric cholestasis
75
Q

Atopic eruption of pregnancy types and appearance

A

Exzematous- rough and red. Face, neck and creases.

Prurigo- bumps widespread

76
Q

Manage atopic eruption of pregnancy

A 
Aqueous cream
Topic steroid
Antihis 
Narrow band UVB
ORAL steroids
77
Q

Polymorphic eruption of pregnancy site and rx

A

Lower abdomen and striae. Umbilical soaring.

Self care, emollient, moderate topical CS, antihis for sleep (itch ie chlorphenamine

78
Q

Risks of pemphagoid gestationis

A

Fetal growth restrict
Blistering of inane
Secondary infection

Due to IgG binding BM

79
Q

Polyhydramnios clinical suspicious

A

Large for dates
Tense abdomen
Unable to feel foetal pets
Amniotic fluid index >90th centiles by measuring single deepest vertical pool

80
Q

Risks and associations of polyhydramnios

A 
Placental abruption
Malpresentation
Cord prolapse
Large for dates
C section
PPH
Premature 
Perinatal death
81
Q

Associations with oligonydramnios

A 
Poor outcome
Prolonged pregnancy
Ruptured membranes
IUGR
Fetal renal congenital abnormalities 
Hypoxia in cord compression
82
Q

Risk fx for gestational diabetes

A

FHx
BMI >30
Previous macrosomic baby
Previous GDM

83
Q

Pro pregnancy hormones and factors vs pro labour

A

Preg: progesterone, NO, catecholamines, relaxin

Labour: oestrogen, oxytocin, PGs (promote cervical ripening and uterine contractility from COX -> arachnidonic acid) , CRH, inflam mediators (IL8, TNfa, IL6 -> pro inflammatory TF and cervical ripening)

84
Q

Cervical ripening

A

Cervix softens and effaces
PG increase this by inhibiting Collagen synthesis and stimulating collagenase (via fibroblasts) to break down the collagen in the cervix

85
Q

Bishop score

A

Cervical ripening

86
Q

Induction of labour- methods

A

Unfavourable bishop score <=6 PGs (PGE2 gel in posterior forbid). Artificial rupture when score >6. Can cause GI upset.

Favourable ARM and syntocinon with CTG

87
Q

Pain relief in labour

A 
Mat support (less analgesia)
Environmental (music mobilisation)
Birth pool 
Education
Inh analgesic entonox 
Systemic opioid diamorphine with antiemetic unless delivery within 4h 
Pidendal analgesia
Regional (epidural can prolong 2nd stage and incidence of instrumental delivery; spinal for theatre pt
General
88
Q

Puerperal Pyrexia

A

Usually genital tract ie endometritis or UTI
?breast
?DVT
MSSU and swabs

89
Q

Management genital warts

A

Podophyllotoxin caution in pregnancy
Imiquimod
Cryotherapy

Leave 12/12

90
Q

Smelling discharge

A

Bacterial vaginitis

91
Q

Bacterial vaginosis

A

Reduced lactobacilli and more Gardenerella vsginalis
Alkaline discharge smell worse after sex as more alkaline!!!
Associated with preterm labour

Ix: vagina wall pH swab alkaline />4.5 with Amsels criteria
DDx: candida (itch)/ trichimonas (discomfort)
Rx: metronidazole 5d (no alcohol)

92
Q

Trichomonas

A

Flagellated protozoan
30% have co-infection with gonorrhoea and chlamydia
Detrimental to pregnancy
Malodorous discharge and dysparenuria

93
Q

Unprotected anal and oral intercourses male male

A

CT/NG NAAT throat rectum and urine

94
Q

Rx gonorrhoea

A

Ceftriaxone

95
Q

Candida

A

Sx: itch, pain, discharge, dysparenuria
Swelling, fissure, discharge, vulvovaginitis

Rx- clotrimazole pessary and ? Fluxonazole tablet unless risk of pregnancy (pessary)

96
Q

Tertiary syphilis

A

Gummma
CV
neuro

Post chacre … rash (2ary)

97
Q

Clinical indicators HIV

A 
Thrombocytopenia 
CIN2
Recurrent shingles
Recurrent bac pneumonia
Dementia
STI
98
Q

When to not medically manage ectopic

A 
HD unstable 
>3.5cm
Pain ++
Intrauterine pregnancy 
Can’t be followed up post methotrexate

Choice 1500-5000 with no pain, Unruptured, smaller than 35mm, no heartbeat, no intrauterine

Give anti D Ig if R-ve

99
Q

Rx PPROM

A 
Ix = FBC and CRP USS CTG Doppler
Rx= steroids, erythromycin 10d/till delivery (whatever is sooner)
100
Q

Complications of PPROM

A

Mat

Fetal

Year 5 (11 decks)

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