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My 5th year O&G > O&G passmed > Flashcards

O&G passmed Flashcards

1
Q

what should be done in women at high risk of pre-eclampsia?

A

aspirin 75mg od from 12 weeks –> birth

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2
Q

what are the high risk groups for pre-eclapmpia?

A
  • previous HTN in pregnancy
  • autoimmune diseases e.g. SLE
  • chronic kidney disease
  • T1/T2 DM
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3
Q

what is the threshold for a diagnosis of hypertension in pregnancy?

A

systolic >140 mmHg / diastolic >90 mmHg

Or systolic >30 over baseline / diastolic >15 over baseline

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4
Q

what are the 2 types of emergency contraception in the UK?

A
  1. levonorgestrel - (progesterone single dose)

2. ulipristal (progesterone r modulator)

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5
Q

what is HELLP syndrome?

A

haemolysis, ELevated liver enzymes, LP low platelets. It’s a severe form of pre-eclampsia

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6
Q

A 24-year-old woman who is 18 weeks pregnant presents for review Earlier on in the morning she came into contact with a child who has chickenpox. She is unsure if she had the condition herself as a child. What is the most appropriate action?

A

Check varicella antibodies in maternal blood

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7
Q

What are the features of feta varicella syndrome

A

skin scarring, eye defects (micropthalmia), limb hypoplasia, microcephaly, learning disabilities

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8
Q

what is the risk of fetal varicella syndrome following maternal exposure before 20 weeks gestation?

A

1%

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9
Q

When is fetal varicella syndrome a risk?

A

1% risk following maternal exposure in the first 20 weeks, rare between 20-28 and no risk following 28 weeks

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10
Q

what should be the management of a pregnant woman with chickenpox present within 24h of onset of the rash?

A

oral aciclovir

give varicella zoster immunoglobulin (VZIG) as soon as possible - it’s effective 10 days post exposure

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11
Q

what is hypotonia associated with encephalopathy in the newborn period most likely to be caused by?

A

hypoxic ischaemic encephalopathy

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12
Q

Give 4 central causes of hypotonia in a young baby?

A

down’s syndrome,
prader-willi syndrome,
hypothyroidism, cerebral palsy

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13
Q

what type of hypersensitivity reaction is caused by scabes?

A

delayed type IV hypersensitivity reaction

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14
Q

what is the first line treatment for scabes?

A

permethrin (5%)

malathion - 2nd line

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15
Q

What guidance should you give a patient with a diagnosis of scabes?

A

avoid close contact with others until the treatment is finished, launder all bedsheets towels and clothes, everyone in the household/close contact with should get treated,

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16
Q

A 60-year-old lady presents to her GP with persistent abdominal bloating for the last 3 months. She has no other symptoms and examination is normal. She is still concerned as her friend had similar symptoms before being diagnosed with a terminal gynaecological cancer. Which investigation is most appropriate to rule out ovarian cancer to reassure this patient?

A

CA-125

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17
Q

what are the risk factors for endometrial cancer (8 total)

A
  • obesity
  • nulliparity
  • early menarche
  • late menopause
  • unnoposed oestrogen (ie without progesterone)
  • DM
  • tamoxifen
  • PCOS
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18
Q

what should you rule out in someone presenting with post menopausal bleeding

A

endometrial cancer

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19
Q

what is the management forendometrial cancer?

A
  • localised disease treated with a total abdominal hysterectomy with bilateral salpingo-oophorectomy.
  • patients with high risk disease may have post-op radiotherapy as well
  • progesterone therapy sometimes used in old frail women not suitable for surgery
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20
Q

what investigations should you consider if you suspect endometrial cancer?

A
  1. trans-vaginal ultrasound (a normal endometrial thickness of <4mm has a high negative predictive value)
  2. hysteroscopy with an endometrial biopsy
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21
Q

what type of cancer is endometrial cancer?

A

edometrial adenocarcinoma

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22
Q

what’s the test for pregnancy?

A

hCG - human chorionic gonadotrophin, test from the serum (11 days after conception) or the urine (12-14 days after conception). A hormone produced during pregnancy.

differnt types: qualitative hCG test = just if hCG is present or not, and a quantitive hCG aka beta hCG (b-hCG) measures how much hCG is in the blood.

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23
Q

when do hCG levels peak in pregnancy?

A

8-11 weeks of pregnancy

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24
Q

Give causes of secondary amenorrhoea (8)

A
  • pregnancy!
  • hypothalamic (excessive exercise/stress)
  • PCOS
    -hyperprolactinaemia
  • thyrotoxicosis / hypothyroid
  • Asherman’s syndrome
  • Sheehan’s syndrome
    prematue ovarian failure
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25
Q

what investigations should you consider in a patient with amenorrhoea?

A
  1. bHCG
  2. gonadotrophins - to see if its hypothalamus (low levels) or ovarian (high) origin
  3. prolactin (hyperprolactinaemia) 4. TFTs
  4. androgen levels (high in PCOS)
    - oestrodiaol
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26
Q

How far into the pregnancy must it be before pregnancy-induced hypertension can be dianosed?

A

at least 20 weeks

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27
Q

What is the old standard investigation for endometriosis?

A

laparoscopy

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28
Q

what are the clinical features of endometriosis

A
  • chronic pelvic pain
  • dysmenorrhoea (pain often starts days before bleeding)
  • dyspareunia
  • subfertility
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29
Q

What are 4 predisposing fatrs for vaginal candidiasis

A
  1. DM
  2. immunosuppression
  3. pregnancy
  4. drugs - Abx and steroids
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30
Q

cottage cheese discharge is pathognomic for

A

vaginal candidiasis / thrush

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31
Q

what should be the management for cholestasis of pregnancy

A
  • induction of pregnancy at 37 weeks
  • ursodeoxycholic acid
  • vitamin k
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32
Q

what is the triad in meig’s syndrome

A

pleural effusion, ascites and benign ovarian tumour (usually a fibroma)

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33
Q

what is the commonest type of ovarian cyst?

A

follicular cysts (type of physiological cyst)

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34
Q

what is involved in the combined test in the fist trimester of pregnancy?

A

3 markers:
1. USS - to detect nuchal translucency

  1. serum b-hCG
  2. serum pregnancy associated plasma protein (PAPP-A)
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35
Q

when in the pregnancy should the combined test take place?

A

10-14 weeks gestation

36
Q

what happens to PAPP-A and bHCG in Fetal down’s syndrome?

A

PAPP-A decreases and b-hCG is about double in DS.

37
Q

what is the 1st line Tx for menorrhagia when the woman does require contraception/

A

Levonorgestrel releasing IUD

38
Q

what % of infertility is caused by a male factor?

A

30%

39
Q

What levels of serum progesterone (taken 7 days prior to expected next period) should you expect in a woman who is ovulating normally?

A

> 30 nmol/l

40
Q

You receive the results of a 29-year-old female who has recently had a routine cervical smear. Her last smear 4 years ago was reported as normal. The results are reported as moderate dyskaryosis, what is the most appropriate management

A

refer to colcoscopy

41
Q

What is the greatest risk factor for a baby developing group B strep?

A

the mother having a previous baby who has rown group B strep (10x risk)

42
Q

what are the 4 main risk factors for GBS infection?

A
  1. prematurity
  2. prolonged rupture of the membranes
  3. previous sibling GBS infection
  4. maternal pyrexia e.g. secondary to chorioamnionitis
43
Q

What is the most common cause of PID?

A

Chlamydia trachomatis

44
Q

what drug could you offer to women experiencing menorrhagia from fibroids?

A

tranexamic acid

45
Q

what is the mechanism of action of tranexamic acid?

A

antifibrinolytic - acts by binding to plasminogen or plasmin - preventing it from binding to fibrin and degrading it, therefore preserving th framework of fibin’s matrix structure.

46
Q

What proportion of the UK over 15 population are seropositive for VZV igG antibody?

A

90%

47
Q

how long is chickenpox infectious for?

A

2 days before the appearance of the rash, until the lesions have all crusted over.

48
Q

What is considered ‘significant contact’ when thinking about chickenpox exposure.?

A

15 mins in the same room, face to face contact, or contact in the etting of a large open ward.

49
Q

What should be the management if a pregnant woman has had significant exposure to chickenpox, and the serum test shows she is seronegative for VZV IgG

A

Should be offered VZIG (VARICELLA ZOSTER IMMUNOGLOBULIN) as soon as possible, latest 10 days after exposure.

50
Q

What is the time frame that giving VZIG to a non-immune pregnant lady who has had a significant contact with chickenpox?

A

give the VZIG asap, latest is 10 days post exposure

51
Q

What are the maternal risks of varicella in pregnancy?

A

increased morbidity associated with varicella in pregnancy inclusding pneumonia, hepatits and encephalitis

52
Q

What is the management of a pregnant woman who is 19 weeks pregnant who presents to her GP with a 20 hour history of chickenpox rash?

A

prescribe aciclovir

53
Q

What are the TORCH infections?

A

Perinatal infections with similar presentatons of rash and ocular findings:

Toxoplasmosis 
Other (syphilis) 
Rubella 
CMV 
Herpes simplex virus
54
Q

A 27-year-old woman complains of an offensive ‘musty’, frothy, green vaginal discharge. On examination you an erythematous cervix with pinpoint areas of exudation. What is the diagnosis and treatment?

A

Trichomonas vaginalis - can tell from the ‘strawberry cervix’ as well as green frothy discharge. Tx = oral metronidazole

55
Q

A 22-year-old woman presents with a thin, purulent, and mildly odorous vaginal discharge. She also complains of dysuria, intermenstrual bleeding and dyspareunia. A swab shows a Gram negative diplococcus.
What’s the diagnosis and Treatment?

A 
Dx = chlamydia and PID 
Tx = IM ceftriaxone &amp; oral azithromycin (1g oral single dose)
56
Q

what is the common definition of postpartum haemorrhage

A

blood loss of >500 ml (vaginal birth) or >1000ml (Caesarian birth) post delivery

57
Q

what is the general timeframe for secondary postpartum haemorrhage?

A

24h–>12 weeks post delivery

58
Q

what 2 mechanisms normally control uterine bleeding after birth, resulting in haemostasis?

A
  1. contraction of the myometrium –> compresses the blood vessels supplying the placental bed, mechanical haemostasis
  2. local clotting factors: T, platelets, plasminogen activating factor
59
Q

What is the most common cause of PPH?

A

Atony of the uterus –> lack of effective contraction of the uterus after delivery

60
Q

What is the normal foetal heart rate

A

100-160bpm

61
Q

What indicates foetal distress on a cardiotograph?

A

Late deceleration - where the foetal heart rate decelerates but lags the onset of a contraction and doesn’t return to normal until after 30 seconds following the end of the contraction

62
Q

which vitamin can be teratogenic in high doses? - and what should you therefore be careful of?

A

Vitamin A (shouldn’t exceed daily intake of 10,000 IU) - so should be careful of multivitamins (although in the Uk they should be limited to max 6000IU per tablet so 1 per day is acceptable), and should also avoid eating liver which is high in vit A

63
Q

A 20-year-old female presents with a 3 month history of abdominal pain. Abdominal ultrasound shows a 8cm mass in the right ovary. Histopathological analysis reveals Rokitansky’s protuberance. What is the most likely diagnosis?

A

Teratoma (dermoid cyst)

64
Q

What is the Rokitansky protrubence and what does it indicate?

A

The inner lining of every mature cystic teratoma contains single or multiple white shiny masses projecting from the wall toward the center of the cysts. When hair, other dermal appendages, bone and teeth are present, they usually arise from this protuberance. This protuberance is referred to as the Rokitansky protuberance.

65
Q

Wht is the first line treatment for gestational hypertension?

A

oral labetolol

66
Q

how is premature ovarian failure defines?

A

the onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40

67
Q

What investigation would you do if you suspected chlamydia infection?

A

NAAT (nuclear acid amplification test) - cervical swab (high vaginal)

68
Q

what are potential complications of chlamydia infection in women?

A
  • PID
  • endometitis - reactive arthritis
  • ubfertiity
  • increased risk of ectopic pregnancies -
    epididymitis
  • perihepatitis
69
Q

What are the two main long term effects of the menopause

A

increased risk of osteoporosis and ischaemic heart disease

70
Q

what are the common side effects of hormone replacement therapy?

A

nausea, weight gain, fluid retention, breast tenderness

71
Q

A 30-year-old primip presents to the maternity care unit with the following symptoms: severe headache, visual disturbance and pain in the epigastric region. Blood pressure 180/100mmHg and 3+ protein in her urine.

What is the most appropriate treatment

A

Labetalol = first line management of patients with severe HTN

72
Q

what is the pearl index

A

common technique in clinical trials to report the effectiveness of a contraceptive.

73
Q

How long does the injectable contracepton work for?

A

12 weeks

74
Q

how long does the implant last for (etonorgestrel)

A

3 years

75
Q

What is the immediate treatment for a seizure in eclampsia?

A

magnesium sulphate, or if that fails then benzodiazepine

76
Q

what supplement and dose should women take to prevent neural tube defects?

A

folic acid 400micrograms per day

77
Q

How effective is 1.5mg levonorgestrel taken within 72 hours of unprotected sex?

A

82% effective

78
Q

What manoever should you try if there seems to be shoulder dystocia?

A

McRoberts manoevre

79
Q

What is the most appropriate antibiotic to treat uncomplicated Chlamydia infection in a 21-year-old female who is not pregnant?

A

Azithromycin (single dose 1g stat) - better than doxycycline 7 day course due to less compliance

80
Q

What are the 3 major symptoms of myometrial fibroids?

A

menorrhagia, pain (with torsion) and subfertility

81
Q

In amenorrhoea, what do gonadotrophins tell you?

A

If high- indicate an ovarian problem, whereas low levels suggest a hypothalamic cause

82
Q

what are 4 causes of premature ovarian failure?

A
  1. idiopathic
  2. chemotherapy
  3. radiotherapy
  4. autoimmune
83
Q

What are the diagnostic thresholds for gestational diabetes a) fasting glucose b) 2 hour glucose?

A

5.6mmol/l - fasting
7.8mmol/L - 2 h
(remember 5 6 7 8!!)

84
Q

What are 4 types of incontinence?

A
  1. overactive bladder / urge incontinence - due to detrusor overactivity
  2. stress incontinence (leaking small amounts when coughing etc
  3. mixed inocontinence
  4. overflow incontinence (due to bladder outlet obstruction)
85
Q

What is the management of urge incontinence?

A 
bladder retraining (minimum 6 weeks, gradually increase intervals between voiding) 
2. bladder stabilising drugs e.g. antimuscarinics like oxybutynin - but avoid in frail older ladies.
86
Q

What is the management of stress incontinence?

A

pelvic floor muscle training - NICE recommend 8 contractions performed 3X day for a minimum of 3 months
can have surgery if really bad e.g. retropubic mid-urethral tape procedures

My 5th year O&G (3 decks)

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