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Y5 Passmed > O&G Key Concepts > Flashcards

O&G Key Concepts Flashcards

1
Q

Which SSRI leads to QT elongation and torsades de pointes?

A

Citalopram

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2
Q

What is first-line treatment for menorrhagia?

A

Tranexamic acid

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3
Q

What is the definition of pre-eclampsia?

A

New-onset BP >140/90mmHg after 20w AND proteinuria/organ dysfunction

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4
Q

When can hormonal contraception be started again after using levonorgestrel for emergency contraception?

A

Immediately

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5
Q

How do you manage a pregnant woman with previous VTE history?

A

Prophylactic LMWH throughout pregnancy until 6 weeks postnatal

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6
Q

What does an older woman with a labial lump + inguinal lymphadenopathy suggest?

A

Vulval carcinoma

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7
Q

What should you do if you are presented with a case of FGM in someone under 18?

A

Report it to the police

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8
Q

How does ovarian cancer initially spread?

A

Locally into pelvic area

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9
Q

What advice should you give about contraception to patients assigned female at birth?

A

Can’t use any contraceptions with oestrogen in if they’re undergoing testosterone therapy as antagonises it

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10
Q

What does a complete hydatidiform mole (pregnancy) look like on ultrasound?

A

‘snow storm’ appearance on ultrasound scan

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11
Q

How are pregnant women >20w who present within 24 hrs of a rash appearing (chickenpox) treated?

A

Oral aciclovir

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12
Q

What sign is ovarian torsion associated with on ultrasound?

A

Whirlpool sign

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13
Q

For transgender males, does testosterone therapy provide protection against pregnancy and what effects can it have on the pregnancy if it doesn’t?

A

No it doesn’t

Teratogenic effects

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14
Q

What is an important risk factor for hyperemesis gravidarum?

A

Multiple pregnancy

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15
Q

What is the cervical screening timeline?

A 
25y - first invite
25-49 - every 3 years
50-64 - every 5 years
65+ not offered
delay 3 months post-partum unless missed previous or previous abnormal
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16
Q

What treatment is first-line for painful periods that are otherwise normal?

A

NSAIDs - inhibit prostaglandin synthesis (one of main causes of dysmenorrhoea pains)

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17
Q

What is the symphysis-fundal height, where is it measured, and what should you do if it’s abnormal?

A

Measure to establish whether small for dates, should be 1-2cm from the gestational age in weeks e.g. 24 weeks should have a SFH of 22-26cm.
Measured from top of pubic bone to top of uterus in cm.
Get ultrasound to confirm if foetus is small for gestational age.

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18
Q

What is the main investigation of suspected placenta praevia?

A

Transvaginal ultrasound

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19
Q

What are 2 common long-term complications of vaginal hysterectomy with antero-posterior repair?

A

Enterocele

Vaginal vault prolapse

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20
Q

Which emergency contraception should be used with caution in patients with severe asthma?

A

Ulipristal

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21
Q

What is the first step after a woman presents concerned about reduced foetal movements?

A

Handheld Doppler to confirm foetal heartbeat

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22
Q

How long does it take each contraceptive type to be effective after administration?

A

Instant - IUD
2 days - progesterone-only pill
7 days - combined oral contraceptive, injection, implant, IUS

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23
Q

What is a major risk factor for cord prolapse?

A

Artificial amniotomy/rupture of membranes

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24
Q

What is a potential complication of ovulation induction?

A

Ovarian hyperstimulation syndrome

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25
Q

Acute presentation of hours-ago onset abdominal pain + bloating that has been increasing. On exam abdo tenderness + ascites. Hx of IVF treatment (ovulation induction). Diagnosis?

A

Ovarian hyperstimulation syndrome

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26
Q

What is a major contraindication for injectable progesterone contraceptives?

A

Current breast cancer

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27
Q

What scale is used to screen for postnatal depression?

A

The Edinburgh Scale

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28
Q

How should you manage premenstrual syndrome?

A

SSRIs (fluoxetine) either continuously or during the luteal phase

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29
Q

What is the first-line treatment for a <35mm ectopic pregnancy with no heartbeat?

A

Methotrexate (interferes with DNA synthesis and disrupts cell multiplication so pregnancy doesn’t develop)

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30
Q

What is the definition of pregnancy-induced hypertension? (and what features does it lack that differs from pre-eclampsia?)

A

> 140/>90 mmHg after 20w

No proteinuria or oedema

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31
Q

How do you manage pregnancy-induced hypertension?

A

Oral labetalol

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32
Q

When must methotrexate be stopped for males AND females before conception?

A

At least 6 months in both men and women

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33
Q

What is the management if at the time of diagnosis of gestational diabetes, the fasting glucose is >7mmol/L?

A

Insulin (with or without metformin) should be started immediately

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34
Q

PPROM (preterm premature rupture of membranes) investigation steps

A

Sterile speculum exam

Then, if no fluid in posterior vaginal vault, use US to assess for oligohydramnios

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35
Q

How are perineal tears classified after birth?

A

1st degree - tear within vaginal mucosa only
2nd degree - tear into subcutaneous tissue (submucosa)
3rd degree - laceration extends into external anal sphincter
4th degree - laceration extends through external anal sphincter into rectal mucosa

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36
Q

What is the key clinical feature of placenta praevia?

A

Painless bleeding after 24w

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37
Q

How long are healthy couples expected to take to conceive and when would investigations be started?

A

Up to 1 year, investigations only started after 1 year of regular attempts to conceive

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38
Q

What are 3 important causes of placental abruption and what are their distinguishing features?

A

Placental abruption - abdominal pain + vaginal bleeding

HELLP (Haemolysis, Elevated Liver enzymes, Low Platelets) syndrome - Anaemia or low platelets seen in blood results
Cocaine use - Dilated pupils + hyperreflexia
Pre-eclampsia - absence of the other 2 and fit of clinical scenario

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39
Q

If 2 COCP pills are missed in week 3, what should the patient do?

A

Finish pills in the current pack and omit pill-free interval starting a new pack immediately

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40
Q

Appropriate management if breastfed baby loses >10% birth weight in first week of life?

A

Refer to midwife-led breastfeeding clinic

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41
Q

What are the 4 classic symptoms of endometriosis?

A

Pelvic pain
Dysmenorrhoea
Dyspareunia
Subfertility

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42
Q

What is tamoxifen a risk factor for?

A

Endometrial hyperplasia (anti-oestrogen effect in breasts hence anti-breast cancer use but PRO-oestrogen effect in endometrium - proliferation)

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43
Q

What treatment is used for Group-B Streptococcus prophylaxis?

A

Benzylpenicillin

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44
Q

When should Group-B Streptococcus infection be suspected or prophylaxis started?

A

Fever of >38 in labour (use benzylpenicillin)

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45
Q

What is the COCP a protective factor for?

A

Endometrial cancer (reduced proliferation of endometrium)

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46
Q

What are the long-term complications of PCOS?

A 
Subfertility
Endometrial cancer
Diabetes
Stroke and TIA
Coronary artery disease
Obstructive sleep apnoea
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47
Q

What is the difference between chronic/pre-existing hypertension, pregnancy-induced hypertension, and pre-eclampsia?

A

Pre-existing - BP >140/90 before 20w gestation with no new proteinuria (can have a small amount present from chronic hypertension), no oedema

PIH - BP >140/90 AFTER 20w gestation, no new proteinuria, no oedema

Pre-eclampsia - BP >140/90 during pregnancy WITH proteinuria (>0.3g/24hrs). Oedema may occur

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48
Q

When can contraception be stopped in women above and below the age of 50?

A

<50 - 2 years amenorrhoea

> 50 - 1 year amenorrhoea

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49
Q

What is the pathway that should be in your head for management of a pregnant patient at risk of exposure to chickenpox?

A

1) Ask mum about her chickenpox history
2) Check for varicella antibodies
3) If confirmed mum isn’t immune then give varicella immunoglobulin (effective any point during pregnancy up to 10 days after exposure)

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50
Q

Management of stress incontinence

A

1 - pelvic floor exercises
2 - consider surgery
3 - duloxetine if no surgery

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51
Q

Which component of HRT increases the risk of breast cancer?

A

Progestogen (remember POP is also contraindicated if Hx of breast cancer)

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52
Q

Process of medical abortion/ToP

A

Mifepristone + 1+ set of prostaglandins (vaginal)

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53
Q

Postpartum Hb cutoff for iron supplementation

A

100g/L (105 2nd trimester, 110 1st trimester)

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54
Q

1st line treatment for primary dysmenorrhoea

A

NSAIDs - mefenamic acid

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55
Q

Important cause of visual impairment in babies born before 32 weeks

A

Retinopathy of prematurity

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56
Q

AFP raised in…

A

Neural tube defects (meningocele, myelomeningocele, anencephaly)
Abdominal wall defects (omphalocele, gastroschisis)
Multiple pregnancy

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57
Q

AFP lowered in…

A

Down’s syndrome
Trisomy 18
Maternal DM

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58
Q

18y/o girl
Sudden onset sharp tearing pelvic pain + vaginal bleeding +/- shoulder tip pain.
Hypotensive, tachycardic, cervical excitation

A

Ectopic pregnancy presentation

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59
Q

25y/o lady
2 day RUQ pain, fever, white vaginal discharge.
Previous recent Hx of pelvic pain + dyspareunia

A

PID presentation

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60
Q

16 y/o girl
12hr pelvic discomfort otherwise well + LMP 2 weeks ago.
Mild suprapubic discomfort OE.

A

Mittelschmerz presentation

“middle pain”, pain halfway/14 days through menstrual cycle associated with ovulation, no Tx required

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61
Q

Risk factors for gestational diabetes

A 
BMI >30
Previous macrosomic baby ≥4.5kg
Previous GD
1st degree relative with diabetes
Family origin (South Asian, Black caribbean, middle eastern)
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62
Q

Investigation for gestational diabetes

A

OGTT - oral glucose tolerance test

- 24-28 weeks if risk factors +ve

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63
Q

Diagnostic thresholds for gestational diabetes

A

Fasting ≥5.6

2-hour ≥7.8

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64
Q

Course of action if 1 COC pill missed at any point

A

Take last pill even if this means 2 in one day + continue taking pills daily
No additional contraceptive needed

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65
Q

Course of action if 2 or more COC pills missed (w1, w2, w3)

A

Take last pill even if this means 2 in one day + continue taking pills daily + abstain/use condoms for 7 days of pills
W1 - emergency contra if unprotected sex in pill-free interval/W1
W2 - after 7 days consecutive pills no emergency contra needed
W3 - finish pills in current pack + start new pack next day leaving out pill-free interval

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66
Q

Chronic pelvic pain, secondary dysmenorrhoea starting days before bleeding, deep dyspareunia, subfertility.
On exam reduced organ mobility, tender nodularity in posterior vaginal fornix

A

Presentation of endometriosis

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67
Q

Gold standard investigation for endometriosis

A

Laparoscopy

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68
Q

Endometriosis management

A

1 - NSAIDs +/- paracetamol
2 - COCP or progestogens
3 - GnRH analogues
4 - surgery

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69
Q

Urge vs stress incontinence presentation

A

Urge - can’t get to toilet in time after urge comes on

Stress - small amounts come out on coughing/sneezing/laughing

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70
Q

Urge vs stress incontinence management

A

Urge - bladder retraining

Stress - pelvic floor muscle training

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71
Q

30w pregnant + intense itching on palms and soles, no rash.

A

Presentation of intrahepatic cholestasis of pregnancy (obstetric cholestasis)

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72
Q

Major complication of intrahepatic cholestasis of pregnancy

A

Stillbirth

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73
Q

Normal lab findings in pregnancy (different to non-pregnant)

A

Reduced urea
Reduced creatinine
Increased urine protein (increased loss in urine)

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74
Q

Caesarian section categories + reason

A

Category 1 - immediate threat to life of mum or baby
Category 2 - threat to mum or baby that’s not immediately life-threatening (deliver <75 mins)
Category 3 - delivery required but mum and baby stable
Category 4 - elective caesarean

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75
Q

Indications for Cat 1 c-section

A

Suspected uterine rupture
Major placental abruption
Cord prolapse
Fetal hypoxia or persistant fetal bradycardia

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76
Q

Levonelle vs ulipristal effective periods since UPSI

A

Levonelle (levonorgestrel) - 72 hrs (can go up to 96)

Ulipristal - 120 hrs

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77
Q

Prophylaxis in women at moderate to high risk of pre-eclampsia

A

Aspirin 75-150mg daily - 12w gestation until birth

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78
Q

Commonest adverse effect of progestogen-only pill

A

Irregular vaginal bleeding

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79
Q

Cervical screening test method

A

Tests for high-risk HPV strains first

Cytological exam only if HPV test positive

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80
Q

Cervical screening pathway

A

Negative hrHPV - return to normal recall

+ve hrHPV + abnormal cells = COLPOSCOPY

+ve hrHPV + normal cells = repeat 12mths and 24mths if still +ve + normal. Return to normal recall if -ve. If +ve after 24mths then COLPOSCOPY

Inadequate sample - repeat 3mths, COLPOSCOPY if 2 consecutive

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81
Q

Treatment for fibroids if wishing to preserve fertility

A

Myomectomy

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82
Q

COCP use can mask Sx that would exist without it for this condition

A

PCOS

Use of COCP masks hirsutism, infertility, oligo/amenorrhoea

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83
Q

HRT delivery route to avoid VTE?

A

Transdermal (NOT oral)

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84
Q

Investigation indicated for menorrhagia + Sx

A

ULTRASOUND

if abnormal exam findings, pelvic pain, intermenstrual or postcoital bleeding

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85
Q

Precautions needed when on POP + ABx

A

NO extra precautions needed (media hype is fake)

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86
Q

Date post-delivery contraception needed

A

21 days postpartum

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87
Q

Unopposed oestrogen is a major risk factor for this type of cancer

A

ENDOMETRIAL cancer (not breast, that’s progesterone)

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88
Q

Criteria for expectant management (close monitoring + 48hr B-hCG) of ectopic pregnancy

A 
Unruptured embryo
<35mm in size
No heartbeat
Asymptomatic
B-hCG <1,000IU/L and declining
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89
Q

Endometrial hyperplasia presentation

A

Intermenstrual bleeding
Post-menopausal bleeding
Menorrhagia
Irregular bleeding

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90
Q

Concerning symptom in pregnancy

A

Dysuria (pain on urination)

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91
Q

Management of cervical cancer to maintain fertility + stage

A

CONE biopsy + negative margins (stage IA)

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92
Q

Life choice that reduces incidence of hyperemesis gravidarum

A

Smoking

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93
Q

Normal CTG findings

A

Accelerations present
Variability >5bpm
No decelerations
HR 110-160

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94
Q

Main complication of induction of labour

A

Uterine hyperstimulation

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95
Q

Criteria for gynae oncology biopsy referral of ovarian cysts (‘M’ rules)

A 
'M' rules = malignant
Irregular, solid tumour
Ascites
4+ papillary structures
Irregular multilocular solid tumour diameter ≥100m
Very strong blood flow
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96
Q

FGM Act 2003 principle

A

All forms of female genital cutting/modification for non-medical reasons is ILLEGAL and cannot be performed under any circumstances
Illegal to perform the procedures but not illegal to discuss it

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97
Q

Features of threatened miscarriage

A

Bleeding + closed cervical os

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98
Q

Change in folic acid dose for pregnant women on antiepileptics

A

5mg folic acid OD (instead of 400mcg)

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99
Q

Investigation findings suggesting Down’s syndrome

A

Raised HCG
Decreased PAPP-A
Thickened nuchal translucency

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100
Q

Antibiotic group safe for use in pregnancy + examples

A

Cephalosporins (ceftriaxone, cefuroxime, cephalexin)

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101
Q

Recurrence rate of postnatal psychosis

A

25-50%

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102
Q

Blood test used to measure LMWH effect in both VERY small or VERY large women (<50, >90)

A

Anti-Xa activity

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103
Q

Preferred method of induction of labour

A

Vaginal PGE2 (prostaglandin) gel

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104
Q

Guideline on using MMR vaccines in pregnant or attempting-to-become-pregnant women

A

DON’T USE IT
Don’t administer at all, contraindicated in pregnancy
Instead advice - avoid becoming pregnant for 28 days after having the vaccine and stay away from people with one of the MMR diseases if not immuned

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105
Q

Wood’s screw manoeuvre + indication

A

Place hand in the vagina and attempt to rotate the foetus

Shoulder dystocia (shoulder stuck on pubic symphysis)

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106
Q

Management of transverse lie without amniotic sac rupture

A

External cephalic version

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107
Q

Indications for continuous CTG monitoring

A

Suspected chorioamnionitis or sepsis, or temp ≥38
Severe hypertension ≥160/110
Oxytocin use
Presence of significant meconium
Fresh vaginal bleeding develops in labour

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108
Q

Classic vasa praevia triad

A

Rupture of membranes followed by painless vaginal bleeding and foetal bradycardia

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109
Q

Group B strep treatment in pregnancy

A

Intrapartum IV benzylpenicillin

IV is key to make sure baby is protected too

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110
Q

Start time + dose of folic acid for women at risk of neural tube defects + reason

A

Start 0.4mg daily before conception and continue until 13 wks
Neural tube formed in 1st 28 days of embryo’s development so need to be on it before this and only come off it way after

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111
Q

Timeframe for Cat 1 c-sections to occur

A

Cat 1 = emergency

Within 30 minutes of making the decision

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112
Q

Treatment for delayed placental delivery in pts with placenta accreta

A

Hysterectomy

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113
Q

Polyhydramnios is a risk factor for…

A

Placental abruption risk factor

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114
Q

Turner’s syndrome expected bloods results

A

Raised FSH/LH (primary amenorrhoea due to gonadal dysgenesis so body trying harder to make the hormones)

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115
Q

SSRIs for breastfeeding women

A

Sertraline

Paroxetine

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116
Q

BMI indication for 5mg folic acid + recommended timeline of use

A

BMI ≥30

Daily until 13th wk of pregnancy

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117
Q

Pain present or absent in placenta praevia?

A

Absent

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118
Q

Mental health drug to be avoided in breastfeeding

A

Lithium

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119
Q

Bishop’s score for ripe or ‘favourable’ + significance

A

≥8
High chance of spontaneous labour
OR
High chance of response to interventions for inducing labour

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120
Q

Cyclical pain but no periods and otherwise well =

A

Imperforate hymen

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121
Q

How long before women can restart hormonal contraception after Ulipristal acetate

A

5 days

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122
Q

Investigations needed to differentiate between galactocele and breast abscess

A

None - clinical Hx + exam enough

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123
Q

Definition of Sheehan’s syndrome/postpartum hypopituitarism

A

Reduction in function of the pituitary gland following ischaemic necrosis due to hypovolaemic shock following birth
- amenorrhoea (GnRH), hypothyroidism, milk production problems

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124
Q

Expected results for Down’s syndrome - AFP, oestriol, -HCG, PAPP-A, nuchal translucency

A

AFP - low
Oestriol - low
PAPP-A - low (pregnancy-associated plasma protein A)

-HCG - high
Nuchal translucency - thickened

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125
Q

Points at which women with gestational diabetes in previous pregnancy should be offered an OGTT

A

Immediately after booking AND at 24-28 weeks (different to just 24-28 weeks in someone with just risk factors)

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126
Q

Most common explanation of short <40 min episodes of decreased CTG variability

A

Foetus is asleep

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127
Q

Contraception method most associated with weight gain

A

Injectable contraceptive (depo-provera)

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128
Q

Management of all postmenopausal women with atypical endometrial hyperplasia

A

Total hysterectomy + bilateral salpingo-oophorectomy

due to risk of malignant progression

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129
Q

Management of non-immune pregnant women exposed to varicella zoster virus + effective period

A

Single dose of varicella zoster immunoglobulin

Within 10 days of contact

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130
Q

Tiers of treatment for ectopic pregnancy

A

1 - methotrexate
2 - salpingectomy
3 - salpingotomy if risk factors for infertility as alternative to salpingectomy

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131
Q

Potential large side-effect of ovulation induction

A

Ovarian hyperstimulation syndrome

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132
Q

Gestation time where further investigation required if no foetal movements + management step

A

24 weeks - referral to maternal fetal medicine unit

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133
Q

Significant risk factor for placenta praevia

A

Assisted fertilisation (IVF)

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134
Q

Summary of increased risk and protective features of COCP

A

Increased risk - breast & cervical cancer

Protective - ovarian & endometrial cancer

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135
Q

Summary of 3 steps of gestational diabetes treatment

A

Fasting glucose <7 = trial of diet and exercise. If ineffective = metformin. If ineffective = insulin.

Fasting glucose >7 = insulin

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136
Q

Postnatal rule if patient receives antenatal VTE prophylaxis

A

Patient must receive 6 weeks of prophylaxis postnatally as well

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137
Q

Management of pregnant patient with Hx of VTE

A

Prophylaxis - LMWH antenatally + 6 weeks postpartum

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138
Q

Criteria for URGENT gynaecology referral if suspicion of ovarian cancer

A

Abdominal or pelvic mass palpable (skip CA125 and US tests and go straight to referral)

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139
Q

Management of placental abruption with alive fetus, <36wks, no fetal distress

A

Admit + give steroids + monitor both mum and baby

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140
Q

Management of ?PE in pregnant woman with confirmed DVT

A

Treat with LMWH FIRST

THEN investigate to rule in/out

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141
Q

Risk factor for shoulder dystocia

A

Diabetes mellitus (type 1 or 2)

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142
Q

McRobert’s manoeuvre process + why it works

A

Flexion + abduction of maternal hips - bringing mother’s thighs towards her abdomen

Increases relative anterior-posterior angle of pelvis and often facilitates successful deliver

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143
Q

1st line investigations in infertility

A

Females - day 21 progesterone

Males - semen analysis

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144
Q

How often progestogen injectable contraceptive given

A

Every 12 weeks

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145
Q

Placenta praevia vs placental abruption main difference

A

Praevia = no pain

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146
Q

1st line management of mastitis in breastfeeding women

A

Advise to continue breastfeeding and use simple analgesia and warm compresses

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147
Q

Cervical ectropion more common in which women

A

COCP users - due to higher oestrogen levels

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148
Q

Cause of oligohydramnios

A

Renal agenesis (amniotic fluid mainly derived from foetal urine)

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149
Q

Most specific sign to confirm pre-eclampsia

A

Brisk tendon reflexes (most specific, oedema diagnostic feature but non-specific)

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150
Q

Appropriate investigations for vaginal candidiasis

A

CLINICAL diagnosis

High vaginal swab NOT routinely indicated if clinical features are consistent with candidiasis

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151
Q

Most EFFECTIVE form of emergency contraception + not affected by BMI

A

Copper IUD

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152
Q

1st line treatment for intrahepatic cholestasis of pregnancy (obstetric cholestasis)

A

Ursodeoxycholic acid

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153
Q

Treatment for vaginal vault prolapse

A

Sacrocolpoplexy

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154
Q

Mirena effect on periods

A

Initial frequent/irregular bleeding later followed by light menses or amenorrhoea

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155
Q

Precautions for antibiotics when on POP + exception

A

None - no need for extra precautions

Exception is rifampicin

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156
Q

Decelerations - abnormal vs normal

A

Normal - deceleration commences and ends with onset/completion of contraction (head compression)
Abnormal - deceleration which lags behind contraction onset + doesn’t return to normal until 30 SECONDS after end of contraction (foetal distress)

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157
Q

Postpartum haemorrhage definition

A

Blood loss of 500ml or more within 24 hours of the birth of a baby

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158
Q

BMI threshold for 5mg folic acid instead of 400mg

A

BMI >30

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159
Q

Diagnostic investigations needed for diagnosis of postpartum thyroiditis

A

Clinical manifestations and thyroid function tests alone

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160
Q

5 parts of cord prolapse management

A

Advise patient to go onto all fours
Push back presenting part of foetus into uterus
Give tocolytics (terbutaline) to reduce cord compression and allow c-section
Deliver by immediate c-section

DO NOT push cord back into uterus

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161
Q

Breast-feeding changes needed when on antiepileptic drugs

A

None needed, BFing acceptable with nearly all anti-epileptics

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162
Q

Cervical screening time to wait until restart after pregnancy

A

3 months

Unless missed previous or previous abnormal

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163
Q

Teenager with primary amenorrhoea + regular painful cycles - leading differential?

A

Imperforate hymen

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164
Q

1st stage of labour definitions (active + latent)

A 
Latent = 0-3cm dilation
Active = 3-10cm dilation
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165
Q

Clinical features of infectious mastitis

A 
Breast pain (unilateral)
Erythematous, warm, tender area associated. Can have fever/flu-like sx
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166
Q

Treatment of infectious mastitis

A

Oral flucloxacillin + continue breastfeeding

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167
Q

Most common CO of infectious mastitis

A

Staph aureus

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168
Q

Treatment of stage 2-4 ovarian cancers

A

Surgical excision

Can be accompanied by chemo

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169
Q

Treatment for bacterial vaginosis

A

Oral metronidazole

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170
Q

Treatment for trichomonas vaginalis

A

Oral metronidazole

171
Q

Treatment for gonorrhoea

A

IM ceftriaxone

172
Q

Potential complication of HG in pregnancy + treatment

A

Wernicke’s encephalopathy

Supplementation with thiamine (vit B1) and vit B+C complex (e.g. Pabrinex)

173
Q

2 features indicative of Wernicke’s encephalopathy

A

Diplopia

Ataxia

174
Q

Management of PCOS woman with BMI >35 + wanting contraception

A

Progestogen IUS

175
Q

Management of PCOS woman with BMI <35 + wanting contraception

A

COCP

176
Q

When to refer to fertility services in case of PCOS

A

When cause of infertility is KNOWN (i.e. PCOS)

177
Q

Rovsing’s sign + significance

A

Palpation of LIF causes increased tenderness in RIF

- appendicitis

178
Q

Uterus size greater than expected for gest. age + abnormally high serum hCG - presentation of…

A

Complete hydatidiform mole

179
Q

Management of post-term pregnancy (41wks) in patient with pregnancy-induced hypertension

A

Medical induction of labour 1st line

C-section if foetal compromise

180
Q

When can postpartum women (BFing and non-BFing) start the POP again?

A

Immediately (don’t theoretically need to but can)

181
Q

When can BFing and non-BFing postpartum women start the COCP again?

A

Non-BFing - 3 weeks (UKMEC2) or 6 weeks (UKMEC1)

BFing - 6 weeks (UKMEC2) or 6 months (UKMEC1)

182
Q

Presence of foetal heartbeat in context of ectopic pregnancy means what for management

A

Indication for SURGICAL (both expectant and medical require no heartbeat)

183
Q

Date at which a mid-luteal progesterone level should be done

A

7 days before end of menstrual cycle

184
Q

Normal BP changes in pregnancy

A

Falls in 1st half of pregnancy

Rises to baseline in 2nd half

185
Q

Management of ?ruptured ectopic pregnancy

A

Resus + emergency laparotomy

186
Q

When can patients restart COCP post-partum and why

A

Minimum 3 weeks (if non-BFing)

Due to increased VTE risk post-partum

187
Q

Contraceptive patch regime

A

1 patch weekly for 3 weeks then 1 week no patch (repeat)

188
Q

COCP increased risk/protective factor for which cancers

A

Increased risk - breast, cervical

Protective - ovarian, endometrial

189
Q

Most important investigation to request in ?obstetric cholestasis

A

LFTs

190
Q

Medical management of PCOS-related infertility

A

Lifestyle changes (WL, exercise, no smoking)
Clomifene
+/- Metformin

191
Q

Induction of labour order of interventions

A 
1 - Membrane sweep
2 - Vaginal prostaglandins (Prostaglandin E2)
3 - Oxytocin
4 - Amniotomy (artificial ROM)
5 - Cervical ripening balloon
192
Q

Stress vs urge incontinence medical management

A

Stress - duloxetine

Urge - oxybutynin

193
Q

Drug that can cause folic acid deficiency

A

Phenytoin (antiepileptic - look for hx of epilepsy)

194
Q

Criteria for infectious mastitis diagnosis

A

Sx don’t improve/worsen after 12-24hrs despite effective milk removal
Nipple fissure present + infected
Bacterial culture positive

195
Q

Medical management of miscarriage

A

Vaginal misoprostol alone

196
Q

COs of late and early onset sepsis in neonates

A

Early <48hrs after birth = Group B Strep

Late >48hrs after birth = Staph epidermidis/aureus

197
Q

Rule for ‘Traditional’ POP missed pill

A

<3 hrs late - no action

>3 hours late - take missed pill asap, continue as normal, extra precautions until pill-taking for 48 hrs

198
Q

Rule for cerazette (desogestrel) POP missed pill

A

<12 hrs late - no action

>12 hours late - take missed pill asap, continue as normal, extra precautions until pill-taking for 48 hrs

199
Q

Booking visit date

A

8-12 weeks

200
Q

Early scan to confirm dates and exclude multiple pregnancy date

A

10-13+6 weeks

201
Q

Down’s syndrome screening + nuchal scan date

A

11-13+6 weeks

202
Q

Anomaly scan date

A

18-20+6 weeks

203
Q

Information on anomaly scan + blood results. Offer iron supp if Hb <11 (<110). Routine BP, urine dip. Date

A

16 weeks

204
Q

Post-20 weeks routine pregnancy appointments

A 
25 wks (if primip)
28 wks
31 wks (if primip)
34 wks
36 wks
40 wks (if primip)
41 wks
205
Q

Management of pregnancy-induced hypertension (of any form) + eclampsia

A 
Oral labetalol (beta blocker so contra in asthmatics)
Nifedipine and methyldopa are alternatives but methyldopa is contra in depression. 
Eclampsia = IV magnesium sulphate
206
Q

Contraception method associated with delayed return to fertility

A

Depo-provera (progestogen injection)

207
Q

Menorrhagia + subfertility + palpable abdo mass = ?

A

Fibroids

208
Q

Diagnosis process for ?atrophic vaginitis

A

Diagnosis of exclusion

- do TVUS for ?endometrial cancer first

209
Q

Antiepileptics ok for pregnancy

A

Lamotrigine
Carbamazepine
Levetiracetam

210
Q

Antiepileptics NOT ok for pregnancy

A

Phenytoin
Phenobarbitone
Sodium valproate

211
Q

Management of menorrhagia with/without desire for contraception

A

No contraception - TE acid or MN acid

Contraception - IUS 1st line, COCP, long-acting progestogens

212
Q

Short-term option to rapidly stop heavy menstrual bleeding

A

Norethisterone 5mg TDS

213
Q

Management of pregnant lady not immune to Rubella during pregnancy

A

Advise of risks of infection + need to keep away from infected individuals

214
Q

Investigations for urinary incontinence

A

URINALYSIS - rule out UTI and diabetes

215
Q

Continuous dribbling incontinence after prolonged labour + area with limited obstetric services

A

?Vesicovaginal fistulae

216
Q

Investigation for underlying cause of recurrent candidiasis?

A

HbA1c - exclude diabetes

217
Q

What is lochia?

A

Vaginal discharge after birth - can contain all sorts of material (blood, mucus, uterine tissue etc)

218
Q

When to investigate + investigation in patient with persistent lochia

A

If persists beyond 6 weeks

- ultrasound

219
Q

Pre-eclampsia effect on amniotic fluid

A

Oligohydramnios

220
Q

Infections to offer antenatal screening for

A

Hep B
HIV
Syphilis

221
Q

Management options (4) for HIV positive pregnant women

A

Maternal antiretroviral therapy (zidovudine)
Mode of delivery (c-section)
Neonatal antiretroviral therapy (zidovudine)
Infant feeding by BOTTLE (do not breast feed)

222
Q

Contraindication for COCP

A

Smoking >15 a day

223
Q

Definition of premature ovarian insufficiency

A

Onset of menopausal Sx + elevated gonadotrophin levels <40 y/o

224
Q

Treatment of premature ovarian insufficiency

A

HRT or COCP offered up to 51 years

225
Q

Investigation indicated if any of these on regular basis:

  • abdo distension
  • early satiety/loss of appetite
  • pelvic/abdo pain
  • increased urinary urgency/frequency
A

CA125 - checking for ovarian cancer

226
Q

Primary care management of positive pregnancy test + abdo/pelvic pain + cervical motion tenderness

A

IMMEDIATE EPU assessment referral (worried about ectopic)

227
Q

Examples of muscarinic antagonists used in treatment of urge incontinence

A

Oxybutynin
Tolterodine
Solifenacin

228
Q

2 treatments indicated for PMS

A

COCP
SSRIs
(NOT progesterone-only methods)

229
Q

3 factors for increased risk of placental abruption

A

Increased maternal age
Multiparity
Maternal trauma

230
Q

When is anti-D given and not given in management of ectopic pregnancy

A

If medical - NOT required

If surgical - required (potential of leak of Rho +ve)

231
Q

Ideal placement of implantable contraceptives

A

Subdermal, non-dominant arm

232
Q

Anti-D giving dates in Rhesus-negative pregnant women

A

28 weeks

34 weeks

233
Q

HRT giving in women with uterus or if has mirena or has vte risk near menopause

A

If has uterus - combined O+P required
If has mirena - just give oestrogen (progesterone will come from IUS)
If at risk of VTE - give transdermal NOT oral

234
Q

Antenatal complications of monochorionic twins

A

Polyhydramnios
Pregnancy-induced hypertension
Anaemia
Antepartum haemorrhage

235
Q

Management of premenstrual syndrome

A

New-gen COCP

If severe = SSRI

236
Q

Commonest + most severe sites of ectopic pregnancy

A

Commonest - ampulla of fallopian tube

Most severe - Isthmus

237
Q

First-line treatment for magnesium sulphate-induced resp depression

A

Calcium gluconate

238
Q

Principle concern with postmenopausal bleeding

A

Must rule out endometrial cancer

239
Q

Management of secondary dysmenorrhoea

A

Refer to gynae for investigation

240
Q

Management of pregnancy post-GBS treatment around delivery

A

INTRApartum antibiotics

- IV BenPen ASAP after start of labour

241
Q

Analgesic to be avoided in breastfeeding

A

Aspirin

242
Q

Management of PROM

A

Admit for 48hrs+
ABx
Steroids

243
Q

Chocolate cysts due to external appearance

A

Endometriotic cyst

244
Q

Commonest ovarian cancer

A

Serous carcinoma

245
Q

3cm ‘simple cyst’ on left ovary, asymptomatic

A

Follicular cyst

246
Q

Woman <6wks pregnant, vaginal bleeding, no pain. Management?

A

Expectant

- advise repeat preg test in 7/7. If negative = miscarriage. If positive or continued/worsened symptoms - refer to EPU

247
Q

Endometriosis RF for…

A

Ectopic pregnancy

248
Q

Complications + commonest of open myomectomy

A

Adhesions (most common)
Bladder injury
Uterine perforation

249
Q

Definitive management of obstetric cholestasis

A

IoL at 37-38 wks (ursodeoxycholic acid is only symptomatic relief)

250
Q

Aetiology of overflow incontinence

A

Bladder outlet obstruction

251
Q

High detrusor pressure + low peak flow rate = which incontinence

A

Overflow

252
Q

Nexplanon contraceptive type

A

Subdermal progesterone implant

253
Q

Macrosomia definition

A

Baby that’s >4kg at birth

254
Q

Adduction + internal rotation of arm in newborn

A

Erb’s palsy, ‘waiter’s tip’

255
Q

Aetiology of Erb’s palsy

A

Damage to upper brachial plexus due to shoulder dystocia. Common in macrosomia due to increased risk of dystocia

256
Q

Active management of 3rd stage of labour

A 
Uterotonic drugs (IM oxytocin)
Deferred clamping/cutting or cord (>1min post delivery but <5 min)
Controlled cord traction after signs of placental separation
257
Q

Increased nuchal translucency associated with…(2)

A

Down’s syndrome

Congenital heart defects

258
Q

Test results from ?molar pregnancy

A

High bhCG
Low TSH
High T4
(trophoblastic disease, ectopic source of T4)

259
Q

Most likley cause of vaginal discharge post-antibiotic treatment

A

Candidiasis

260
Q

Expected fundal height growth timeline

A

<24 weeks - 2cm per week

>24 weeks - 1cm per week

261
Q

When should fundus be palpable at umbilicus and xiphoid sternum during pregnancy

A

Umbilicus - 20 wks
Xiphoid - 36 wks
Anywhere in between this during this period

262
Q

First-line treatment for menorrhagia + requires contraception

A

IUS

263
Q

Definition of menorrhagia

A

An amount that the woman considers to be excessive

264
Q

Normal signs on cardiac exam for pregnant woman

A

Third heart sound
Ejection systolic murmur
Forceful apex beat

265
Q

Management of pregnant women with BP >160/110

A

Admit + observe

266
Q

Secondary amenorrhoea + low gonadotrophins

A

Hypothalamic cause

267
Q

Positive day21 progesterone challenge

A

PCOS

268
Q

Usual booking appointment tests

A

BMI
Urine culture for asymptomatic bacteruria
RBC alloantibodies
Hep B

269
Q

Investigation for ?vesicovaginal fistula (continuous dribbling incontinence)

A

Urinary dye studies

270
Q

Investigation for non-respondent stress incontinence to pelvic floor exercises

A

Urodynamic studies

271
Q

Investigation when cause of incontinence is uncertain or there are plans for surgery

A

Urodynamic studies (basically use at the end of investigations)

272
Q

2 rules for Cu IUD use as emergency contra

A

Within 5 days after UPSI in a cycle

Within 5 days after earliest estimated ovulation date

273
Q

Investigation for ?adenomyosis

A

MRI Pelvis

274
Q

Hep B mum, treatment for baby?

A

Hep B vaccine + 0.5ml HepB Ig <12hrs after birth

Then hep B vaccine 1-2mths + 6 mths

275
Q

Name for bleeding in 2wks post-birth

A

Lochia

276
Q

HNPCC/Lynch syndrome cancer RF

A

Endometrial cancer

277
Q

Acute intense abdominal pain + free fluid in abdomen + hx of endometriosis = ?

A

Ruptured endometrioma

278
Q

Increase in risk of cervical cancer by smoking

A

Smoke = two-fold increased risk of developing cervical cancer

279
Q

MAIx when endometrial pipelle biopsy is inconclusive

A

Hysteroscopy with biopsy

280
Q

Delayed patch change over 48 hours - next steps

A

Barrier protection/abstinence for 7 days
Emergency contra if required
Restart new patch immediately

281
Q

Primary MoA of contraceptive implant

A

Inhibition of ovulation

282
Q

Test to confirm menopause (if menopausal age) or premature ovarian failure (if younger)

A

FSH level

283
Q

Baby with umbilical hernia, large + protruding tongue, flattened face, low muscle tone

A

Down syndrome

284
Q

Indications for COCP in fibroids

A

If <3cm + not distorting uterine cavity - try medical treatment (before myomectomy)

285
Q

BMI at which 5mg folic acid given

A

BMI >30

286
Q

Initial definitive management of cord prolapse

A

Place hand into vagina to elevate presenting part (or by filling urinary bladder)

287
Q

Management approaches of ovarian cysts

A

Premenopause - conservative if small and reported as ‘simple’. Repeat US at 8-12 weeks + refer if persists
Postmenopause - urgent referral to gynaecology (any nature/size)

288
Q

Wheelchair use UKMEC for COCP

A

UKMEC 3 (risks outweigh benefits)

289
Q

Which contraceptive to stop after 50 y/o

A

Injectable (e.g. depo-provera)

290
Q

Amiodarone in breastfeeding?

A

AVOID

291
Q

Premature labour management

A

If early stage then admit + tocolytics/steroids (tocolytics stop labour, steroids develop baby’s lungs in case labour continues)

292
Q

Hyperemesis gravidarum diagnostic triad

A

5% pre-pregnancy WL
Dehydration
Electrolyte imbalance

293
Q

Manoeuvre to improve McRobert’s manoeuvre

A

Suprapubic pressure

294
Q

Commonest CO for PID

A

Chlamydia trachomatis

295
Q

Meigs’ syndrome associated cyst

A

Fibroma

296
Q

Commonest benign ovarian tumour <25y/o

A

Dermoid cyst

297
Q

Commonest ovarian enlargement at reproductive age

A

Follicular cyst

298
Q

Presentation of fibroid degeneration during pregnancy

A

Pregnant - low-grade fever, pain, vomiting

299
Q

Management of pregnancy with previous baby with GBS

A

Prophylactic IV abx for mum during labour

300
Q

6 steps in POST-PARTUM HAEMORRHAGE management

A 
Bimanual uterine compression
IV oxytocin/ergometrine
IM carboprost
Intramyometrial carboprost
Rectal misoprostol
Surgical - balloon tamponade
301
Q

Length of time urine preg test positive post-ToP

A

Up to 4 weeks (incomplete abortion or persistent trophoblast if still positive)

302
Q

2 blood thinners contra in pregnancy

A

Rivaroxaban

Warfarin

303
Q

Hormone responsible for fibroid growth

A

Oestrogen

304
Q

Management of placenta praevia

A

Grade I - trial vaginal delivery

Grade III/IV - elective c-section 37-38wks

305
Q

Syntocinon =

A

Oxytocin

306
Q

Oral hypoglycaemic safe for use in breastfeeding

A

Metformin

307
Q

Next action if semen sample abnormal

A

Repeat in 3 months (allow sperm to regroup)

Immediate recheck if sperm conc <5million per ml

308
Q

Site of ectopic pregnancy most associated with rupture

A

Isthmus

309
Q

Migraine with aura - contra choice?

A

Progesterone-only method (oestrogen increases risk of ischaemic stroke)

310
Q

Complete miscarriage diagnosis

A

Vag bleeding suprapubic pain followed by EMPTY uterine cavity

311
Q

Difference between gonadal dysgenesis + Kallman’s

A

GD (Turner’s) - high LH/FSH (gonadal issue)

Kallman’s - low GnRH, FSH, LH (hypothalamic issue)

312
Q

Ulcerated labia majora lesion

A

Vulval carcinoma

313
Q

Time period after which IUD/IUS can be inserted after childbirth

A

Within 48hrs of childbirth OR after 4wks

314
Q

Management of chickenpox in pregnant women

A

If <20wks and antibodies absent then VZIG

If >20wks and within 24hrs of rash then oral aciclovir

315
Q

Treatment for endometrial carcinoma (stages)

A

Stage I and II - total abdo hysterectomy + bilateral salp-oo-ectomy
Stage IIb - Wertheim’s radical hysterectomy (removal of LNs)
Provera - slows growth of malignant endometrial cells

316
Q

Treatment for perineal tears

A

1st degree - no repair required
2nd degree - suture by midwife/clinician on ward
3rd/4th degree - surgical repair in theatre

317
Q

When to admit in N&V in pregnancy

A

Ketonuria +/- WL DESPITE oral antiemetic use

318
Q

Short-term treatment for uterine fibroids

A

GnRH agonist (e.g. reduce size before surgery)

319
Q

Prophylaxis in PPROM

A

10d erythromycin

320
Q

When to give DOUBLE dose levonorgestrel

A

BMI >30 (clinically obese)

321
Q

If vomiting after taking levonorgestrel…

A

If within 3 hours of taking it, repeat dose

322
Q

Protocol for magnesium sulphate treatment in eclampsia

A

IV admin - 4g over 5-10 mins then 1g/hr
Monitor urine output, RR, sats, reflexes
Given calcium gluconate if resp depression occurs
Continue treatment until 24hrs post-seizure/delivery (whichever most recent)

323
Q

Cyst which can cause pseudomyxoma peritonei if rupture

A

Mucinous cystadenoma

324
Q

Summary of restart points for contraceptives after birth

A

IUS/IUS - <48hrs or 4wks
COCP/POP - 3wks
Implant - anytime

325
Q

Intrauterine sac with no fetal pole

A

MISSED miscarriage

326
Q

Therapeutic target for treatment of hypertension in labour

A

<135/85 (IV labetalol)

327
Q

3 components of Risk Malignancy Index (RMI) (prognosis in ovarian cancer)

A

US findings
Menopausal status
CA125 levels

328
Q

4 steps in ovulation induction

A

Exercise + WL
Letrozole
Clomiphene
Gonadotropins

329
Q

Uterus appearance in endometriosis

A

Fixed, retroverted uterus

330
Q

What changes in endometrium are classified as a premalignant condition

A

Atypical hyperplasia of the endometrium

331
Q

Ovarian tumour associated with development of endometrial hyperplasia

A

Granulosa cell tumours (secrete unopposed oestrogen)

332
Q

Sex cord stromal tumours

A

Thecomas
Fibromas
Sertoli cell
Granulosa cell (ass. w/endomet hyperplasia)

333
Q

Treatment for recurrent candidiasis

A 
Oral fluconazole (induction-maintenance)
Induction = oral flucon every 3 days for 3 doses
Maintenance = oral flucon weekly for 6 months
334
Q

Usual topical treatment for candidiasis

A

Topical CLOTRIMAZOLE (fluconazole sucks as cream so oral if recurrent)

335
Q

Preparations of iron supplements for pregnant women + length of dosage

A

Ferrous sulphate or ferrous fumarate

- continue for 3 months AFTER CORRECTION of iron to allow stores to replenish

336
Q

COCP changes around surgery

A

Stop 4 weeks before and restart 2 weeks after (VTE risk)

USE POP instead during COCP-free period

337
Q

Points at which pregnant women with T1DM should measure their blood glucose levels

A

Daily fasting, pre-meal 1-hour post-meal, and bedtime tests (should monitor very closely)

338
Q

Mutation conferring higher risk of breast and ovarian cancer

A

BRCA1

339
Q

Mutation conferring higher risk of Wilm’s tumour

A

WT1

340
Q

Mutation conferring higher risk of retinoblastoma

A

Rb

341
Q

Mutation conferring higher risk for Burkitt lymphoma

A

c-Myc

342
Q

First-line subfertility treatment in PCOS

A

Clomiphene

343
Q

First-line treatment for hirsutism features of PCOS

A

3rd gen COCP or co-cyprindiol (anti-androgen effects)

344
Q

Method to reduce BP in induced labour

A

Epidural anaesthesia

345
Q

MoA of implantable contraceptive

A

Inhibits ovulation

346
Q

First step if pregnant woman receives abdominal trauma

A

Blood type + rhesus testing (anti-D Ig given in 72hrs of trauma)

347
Q

Rokitansky protuberance =

A

Teratoma/dermoid cyst

348
Q

Absolute contraindication for IUD

A

Pelvic inflammatory disease (test with endocervical swab)

349
Q

Change to cervical screening if HIV +ve

A

Offer screen at date of diagnosis

ANNUAL cervical cytology due to increased CIN risk

350
Q

Worst (mortality+morbidity) breech presentation

A

Footling presentation at delivery

351
Q

Medication for suppressing lactation

A

Cabergoline (dopamine receptor agonist - suppresses prolactin production)

352
Q

Procedure with greatest risk of haemorrhage in newborn

A

Prolonged ventouse delivery (vacuum)

- cephalohaematoma or subgaleal haemorrhage if thrombocytopenia present (AI inherited)

353
Q

RFs for pre-eclampsia

A 
40+
Nulliparous
Preg interval 10+ yrs
FHx or previous Hx
BMI >30
Pre-existing vascular or renal disease
Multiple pregnancy
354
Q

4 causes of primary postpartum haemorrhage

A

4 T’s

  • tone
  • tissue (retained placenta)
  • trauma
  • thrombin (coag abnormalities)
355
Q

Commonest cause of primary postpartum haemorrhage

A

Uterine atony (90% cases)

356
Q

Oxybutynin SE + demographic + alternatives

A

Careful using in ELDERLY due to increase risk of FALLS

- use solifenacin or tolterodine instead

357
Q

Switching from IUD to COCP - additional contra needed?

A

If day 1-5 of menstrual cycle - no barrier needed

If day 6+ - barrier needed for 7 days

358
Q

Management of placenta praevia woman who goes into labour

A

Emergency c-section (due to risk of PPH)

359
Q

Date for second screen for anaemia + atypical RBC alloantibodies

A

28 wks

360
Q

PCOS diagnostic critera

A

If 2/3 of:

  • infrequent/no ovulation (oligomenorrhoea)
  • clinical/biochemical signs of hyperandrogenism or elevated total/free testosterone
  • polycystic ovaries on US or increased ovarian volume
361
Q

Components of the Down syndrome QUADRUPLE test

A

Inhibin A, beta-hCG, alpha-fetoprotein, unconjugated oestriol

362
Q

+ve results of QUADRUPLE test for Down’s

A

High - b-HCG, inhibin A

Low - unconjug oestriol, alpha-fetoprotein

363
Q

When do you do quadruple test instead of combined screening for Down’s

A

POST-14 WKS (comb screening test no longer accurate)

364
Q

Management of asymptomatic newborns at risk of GBS sepsis

A

If 1 minor RF = 24hrs observation

If 2 minor or 1 red flag = empirical BenPen + Gent + full septic screen

365
Q

Red flags for newborn sepsis

A

Suspected/confirmed infx in another baby if multiple preg
Parenteral abx given to mum during labour/24hrs before/after birth
Resp distress >4hrs after birth
Seizures
Need for mechanical ventilation in a term baby
Signs of shock

366
Q

Absolute contraindications for VBAC

A

Vertical (classical) caesarean scars
Previous uterine rupture
Other contraindications to vaginal birth (e.g. placenta praevia)

367
Q

POP with 12hr window

A

Cerazette/Desogestrel

368
Q

Commonest risk post-ToP

A

INFECTION

369
Q

Sudden onset unilateral pelvic pain after intercourse/strenuous activity

A

Ruptured ovarian cyst

370
Q

Treatment of candidiasis when PREGNANT

A

Clotrimazole pessary (flucon contra in preg)

371
Q

Preterm-PROM + triad of pyrexia, tachycardia, fetal tachycardia =

A

CHORIOAMNIONITIS

372
Q

COCP 2 pills missed week 3 =

A

Finish pills in current pack + start new pack immediately (no pill-free interval)

373
Q

Escalation of suspected case of rubella in pregnancy

A

Discuss with local Health Protection Unit (advice on investigations)

374
Q

Hepatic adhesions =

A

Fitz-Hugh-Curtis syndrome (complication of PID)

375
Q

Diabetes drugs contraindicated in pregnancy

A

Gliclazide and liraglutide

376
Q

Name of organism that causes GBS (Gram +ve cocci in chains)

A

Strep agalacticae

377
Q

Examination contraindicated in placenta praevia

A

Digital vaginal exam (risk of haemorrhage)

378
Q

UKMEC of COCP use in breastfeeding postpartum

A

<6 weeks - UKMEC 4 ABSOLUTELY contraindicated

6wks-6mths - UKMEC3

379
Q

If risk of infection in miscarriage - management

A

Medical or surgical (misoprostol or manual vacuum)

380
Q

“Bulky” uterus on palpation

A

Fibroids

381
Q

Investigation of choice for ?ectopic

A

TVUS

382
Q

If pregnant >20wks, management if exposed to chickenpox and not immune

A

Aciclovir or VZIG 7-14days post-exposure (not immediately)

383
Q

Factors not associated with increased risk of miscarriage

A 
Heavy lifting
Bumping tummy
Having sex
Air travel
Being stressed
384
Q

Factors associated with increased risk of miscarriage

A

Increased maternal age
Smoking/alcohol/recreational drugs/caffiene
Obesity
Infx and food poisoning
Health conditions (HTN, thyroid, diabetes)
Medicines (ibuprofen, methotrexate, retinoids)
Unusual shape/structure of womb
Cervical incompetence

385
Q

After vomiting emergency contraception, management

A

<3 hrs - repeat dose

386
Q

Consequences of delivering baby in occiput posterior vs occiput anterior head position

A

Can deliver baby in OP position but labour is likely to be longer and more painful

387
Q

Most successful instrumentation-assisted kind of delivery

A

Kielland’s forceps (requires particular expertise)

388
Q

Management of perimenopausal women struggling with vasomotor symptoms (e.g. hot flushes)

A

Fluoxetine

389
Q

Criteria for surgical management of ectopic pregnancy

A

> 35mm in size

Serum b-hCG >5000

390
Q

Criteria required for instrumental delivery

A

FORCEPS

  • fully dilated cervix
  • OA position, OP possible
  • ruptured membranes
  • cephalic presentation
  • engaged presenting part (head must not be palpable abdominally and below/at ischial spines)
  • pain relief
  • sphincter (bladder) empty (use catheter)

Must also be a clear indication for instrumental delivery

391
Q

Investigations if ?ovarian malignancy

A

CA-125, aFP, beta-hCG + elective cystectomy

392
Q

Wheelchair COCP UKMEC

A

UKMEC 3 (risks outweigh benefits)

393
Q

Investigations for PPROM

A

Speculum exam for fluid in vaginal vault
US for oligohydramnios
Vaginal secretion test for IGFBP-1 or PAMG-1

394
Q

Risk factors for placenta accreta

A

Previous c-section

Placenta praevia

395
Q

Contraceptives which inhibit ovulation as primary MoA

A

COCP
Desogestrel-only pill (not-POP)
Injectable
Implant

396
Q

Contraceptives which thicken cervical mucus as primary MoA

A

Progestogen-only pill

Secondary action of desogestrel-only pill, injectable, implant, and IUS

397
Q

Contraceptives which decrease sperm motility and survival as primary MoA

A

IUD

398
Q

Levonorgestrel + ulipristal MoA

A

Inhibit ovulation

399
Q

Management of mild PMS

A

Lifestyle changes

  • regular exercise
  • small 2-3hrly balanced meals rich in complex carbs
  • stop smoking/alcohol
  • regular sleep etc
400
Q

Cells that secrete HCG

A

First by embryo

Maintained by placental trophoblast (syncytiotrophoblasts)

401
Q

Main function of HCG

A

Prevent disintegration of the corpus luteum

402
Q

Reason for >35mm limit to medical management of ectopic pregnancy

A

Risk of spontaneous rupture (measured by TVUS)

403
Q

Rule for patch UPSI

A

<48hrs after UPSI - change patch + no further precautions
>48hrs - change immediately + barrier for 7 days
Emergency contra if UPSI during extended patch-free period

404
Q

Drug to facilitate delivery + prevent PPH

A

Oxytocin/ergometrine

405
Q

Contraindication for using epidural anaesthesia

A

Coagulopathy

406
Q

Management of all patients with secondary dysmenorrhoea

A

Referral to gynaecology for investigation

407
Q

Reason nulliparity is RF for endometrial cancer

A

Progesterone is protective which body shifts towards during pregnancy

408
Q

Blood glucose targets for gestational diabetes treatment

A

Fasting 5.3
1hr postprandial 7.8
2hr postprandial 6.4

409
Q

Drug for N&V in pregnancy that can’t be used >5 days due to EXTRAPYRAMIDAL side effects

A

Metoclopramide

410
Q

Length of time urine pregnancy test positive for post-ToP

A

4 weeks

411
Q

Next step if patient is yet to have a diagnosis of pre-eclampsia but it is suspected AT MIDWIFE appointment

A

Urgent obstetrics referral

412
Q

Terbutaline drug class

A

Tocolytic

413
Q

Drugs to reduce uterine contractions

A

Tocolytics e.g. terbutaline

414
Q

Antibiotic safe for use in breastfeeding

A

Trimethoprim (think trimester/primip or something)

415
Q

Benign ovarian tumour (usually fibroma) + ascites + pleural effusion

A

Meig’s syndrome

416
Q

Reasons for US monitoring in monochorionic twins

A

16-24wks - monitor for twin-to-twin transfusion syndrome

24+wks - monitor for fetal growth restrictions

417
Q

Management for prophylaxis of Rhesus sensitisation (Rhesus -ve bleeding in pregnancy)

A

1 dose of anti-D immunoglobulin + Kleihauer test (for FMH to calculate additional anti-D Ig)

418
Q

Is there an ovarian cancer screening test?

A

No, no current screening programme for ovarian cancer

419
Q

Risk of metabolic acidosis + Reye’s syndrome in infants if this drug is used in pregnancy

A

Aspirin

420
Q

Drug transmitted in breast milk which can cause renal and thyroid dysfunction

A

Lithium

421
Q

Type of insulin used in treating gestational diabetes

A

SHORT-acting, no longer-acting SC insulin is used in gestational diabetes

422
Q

Triptorelin drug class

A

GnRH agonist

423
Q

Next indicated investigation if late decelerations on CTG

A

Fetal blood sampling (assess for fetal hypoxia + acidosis, >7.2 is normal)

424
Q

Investigation/procedure that increases risk of 2nd trimester miscarriage

A

Large cervical cone biopsy

Y5 Passmed (3 decks)

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