OB/GYN Flashcards
1
Q
Drug of choice for medical management of ectopic pregnancy?
A
Methotrexate (HIGHLY terataogenic so single IM dose does job)
2
Q
Contraindications to methotrexate for ectopic?
A
-Mass>35mm
-Detectable Heartbeat
-Ruptured
3
Q
Surgical management for ectopic?
A
Laparoscopic salpingectomy
4
Q
What component of HRT causes breast cancer risk?
A
Progesterone
5
Q
How to balance risk of breast cancer and endometrial cancer with HRT?
A
Give estrogen and progestegone because endometrial risk is higher than breast
6
Q
Medication for hot flushes?
A
Clonidine: Hormonal
Venlafaxine: Non-hormonal
7
Q
Most common adverse reaction for progesterone-only pill?
A
Irregular vaginal bleeding
8
Q
What is desogesterol?
A
POP
9
Q
If a patient has itchy hands and is 31 weeks pregnant?
A
Intrahepatic cholestasis
10
Q
Treatment of intrahepatic cholestasis?
A
Induction of labour at 37-38 weeks
11
Q
Gestational diabetes treatment?
A
Fasting glucose 7< = Commence insulin
Fasting glucose 5.6-6.9mmol/L = Commence metformin
12
Q
1st line treatment of urge incontinence?
A
Bladder retraining
13
Q
1st line treatment for stress incontinence?
A
Pelvic floor muscle training
14
Q
Migraine with aura and HRT?
A
NOT contraindicated
15
Q
If patient has uterus what type of hormonal treatment is required?
A
Combined oestrogen and progesterone
16
Q
If a patient has not yet reached full menopause (amenorrhoea >1 year) what type of treatment?
A
Cyclical HRT
17
Q
What is a contraindication for HRT?
A
Undiagnosed vaginal bleeding
18
Q
Patient with coil, what HRT do you use?
A
Oestrogen patch
-Mirena is only form of contraception used as progesterone component in HRT.
19
Q
Transdermal oestrogen vs oral?
A
Transdermal:
do not have increased risk of DVT
20
Q
Chicken pox exposure in pregnancy?
A
Check Antibodies as first step
21
Q
Gestational HT diagnosis?
A
new onset HT undiagnosed after 20 weeks without signif proteinuria
22
Q
Treatment of gestational diabetes?
A
Oral nifedipine
23
Q
Persistent bleeding 6 months, not helped by mefanamic or tranexamic?
A
Endometrial biopsy at hysteroscopy
24
Q
Definition of puerperal pyrexia?
A
Temp pf >38 degrees in first 14 days following delivery
25
Causes of puerperal pyrexia?
Endometritis
UTI
Wound infections
Mastitis
Venous thromboembolism
26
Management of puerperal pyrexia?
If endometritis is suspected the patient should be sent to hospital for IV ABs
-Clindamycin and gentamicin until afebrile for 24 hours
27
ABs for suspected puerperal pyrexia?
Clindamycin and gentamicin
28
Most common cause of postmenopausal bleeding?
Vaginal atrophy
29
Bleeding following sexual intercourse in Post-menopausal women?
Vaginal atrophy
30
Investigations for suspected PCOS?
-Plevic US
-FSH, LH, Prolactin, TSH
-Testosterone
-SHBG
31
Pelvic cysts with bead on a string appearance diagnosis?
PCOS
32
Blood test results in PCOS?
Raised LH: FSH ratio
Normal/mildly elevated prolactin and testosterone
33
Rotterdam criteria and what it diagnoses?
PCOS
-Hyperandrogenism
-Oligo-/anovulation
-Cystic morphology on USS
34
2 methods of emergency hormonal contraception medication ?
Levonorgestrel
Ulipristal
35
When can you take levonogestral as emergency contraception?
within 72 hours of unprotected intercourse
36
What is levongestral?
A progesterone
37
Dosing of levonogestral in UNSI?
1.5mg
3.0mg if BMI >26 or >70Kg
38
When can hormonal contraception be started after using levornogestrel as EC?
immediately
39
What s Ulipristal?
Selective progesterone receptor modulator (EllaOne)
40
MOA of Ellaone?
Inhibition of ovulation
41
Use of ulipristal as EC? Timeframes etc?
ASAP
No later than 120 hours after intercourse
42
Dose of elleOne for EC?
30mg
43
EllaOne and contraception methods?
May reduce effectiveness
Restart/start with ring, patch or pill 5 days after having ulipristal: until then barrier methods
44
Who to be cautious of when prescribing EllaOne?
ASTHMA patients
45
Breastfeeding and EC?
Wait 7 days post EllaOne
No restrictions with levonorgestrel
46
Most effective method of EC which should always be offered?
IUD
47
Timeframes with IUD and UPSI?
Within 5 days of UPSI
48
If a patient had UPSI 6 days ago what you gonna do?
Offer IUD fitting up to 5 days after likely ovulation date
49
Increased Nucal translucency (NT)?
Down's Syndrome
Congenital heart defects
Abdominal wall defects
50
Causes of hyperchogenic bowel?
CF
Down's
Cytomegalovirus
51
What is folic acid necessary for?
Proper closure of neural tube during fetal nervous system development
52
Causes of folic acid deficiency?
Phenytoin
Methotrexate
Pregnancy
Alcohol XS
53
Criteria for high risk NT defects in woman in pregnancy?
-Either partner NTD
-Previous pregnancy affected by NTD
-Fam Hx of NTD
-Antiepileptic drugs
-Coeliac
-Diabetes
-Thalassaemia trait
-OBESITY (BMI: >30)
54
Most common diagnosis for post-menopausal bleeding?
VAGINAL ATROPHY
55
Ovarian cyst which upon rupture may cause pseudomyoxoma peritonei?
Mucinous cystadenoma
56
Most common type of ovarian epithelial tumour?
Serous cystadenoma
57
Investigation for suspected placenta praevia?
Transvaginal US
58
What is placenta praevia?
Placenta wholly or partly in lower uterine segment
59
Clinical features of PlacePraev?
Shock in proportion to visible loss
No pain
Uterus not tender
Lots of things could be normal
60
What should NOT be done when PPraev suspected?
Digital vaginal exam
61
Menorrhagia management first line?
MIrena (IUS )
62
Management of HT in pregancy?
Oral labetalol
Oral nifedipine and hydralazine (if asthmatic)
63
When would you do continuous CTG monitoring ?
-Sus chorioamnionitis or sepsis (38<)
-Severe HT (160/110)
-Oxytocin use
-Presence of signif meconium
-Fresh vaginal bleeding develops in labour
64
Lump or ulcer on labia majora is likely what?
Vulval cancer
65
Post-partum haemorrhage management?
Intra-uterine ballook tamponade is first line surgical
66
Definition of primary postpartum haemorrhage?
>500ml of blood <24 hours post delivery
67
4 Ts of Primary PPH causes?
Tone: (uterine atony)
Trauma: (perineal tear)
Tissue: (retained placenta)
Thrombin: (clotting/bleeding disorder)
68
RFs for primary PPH?
Previous PPH
Prolonged labour
Pre-eclampsia
Increased maternal age
Polydraminos
Emergency C section
PlacPraev/accreta
Macrosomia
69
Management of PPH?
ABC
Palpate uterine fundus to stim contractions
Catheterize to prevent bladder distension
IV oxytocin: slow IV injection then IV infusion
Ergometrine slow IV or IM
Carbopost IM
Misoprostol sublingual
70
Diagnostic thresholds for gestational diabetes?
Fasting glucose: >5.6 mmol/L
2 - hour glucose: > 7.8 mmol/L
71
If fasting plasam glucose is <7 mmol/L what should be trialled with pregnant woman?
Diet and exercise
If targets not met in 1-2 weeks the start metformin, if still not met then add insulin (sjort acting)
72
Investigation for preterm prelabour ROM?
Speculum examination
73
Bishop score <6 what do you use to induce labour?
Vaginal PGE2
Oral misoprostol
74
Oral contraception and gastric sleeve/bypass/duodenal switch?
CAN'T HAVE ORAL CONTRACEPTION
-Due to lack of efficacy
75
Treatment of vaginal thrush in non-pregnant women?
Oral fluconazole
76
1st stage of labour splits?
Latent phase: 0-3cm dilation
Active phase: 3-10cm dilation
77
Snow storm appearance on US?
Complete hydatidiform mole
78
Management of ectopic?
Salpingectomy
79
Stereotypical PCOS hormone results?
-LSH:FSH ratio
-Testosterone
-SHBG (Sex hormone binding globulin)
LSH: FSH = Raised
Testosterone: normal or elevated
SHBG: Normal to low
80
What might reduce the size of uterine fibroids while waiting for surgery?
GnRH agaonists
Triptorelin
81
Anti-emetics in pregnancy?
PROMETHAZINE: BAE
Metaclop: can be used for 5 days but no more due to EPSEs
82
PCOS diagnostic criteria?
-Infrequent or no ovulation
-Clinical or biochemical signs of hyperandrogenism/elevated testosterone
-Polycystic ovaries
83
Medical treatments for postpartum haemorrhage secondary to uterine atony?
Oxytocin
Ergometrine
Carboprost
Misoprostol
84
Category 2 C sections should occur within how long of decision?
75 minutes
85
Medical management of ectopic frequency?
Methotrexate
86
What is HELLP syndrome?
Severe pre-eclampsia
87
Features of HELLP?
Haemolysis
Elevated liver enzymes
Low platelets
-Presentation: malaise, nausea, vomiting, headache
HT with proteinuria
88
Pregnant woman with BP > 160/110mmHg?
Admitted and observed
89
UKMEC 1 means what?
No restriction for use of the contraceptive method
90
UKMEC 2?
Advantages outweigh disadvantages
91
UKMEC 3?
Disadvantages generally outweigh advantages
92
UKMEC 4?
Represents an unacceptable health risk
93
UKMEC 4 conditions?
- >35 years old + smoking more than 15 cigs per day
-Migraine with aura
- Thromboembolic disease history
-Stroke or IHD history
-Breast feeding <6 weeks post-partum
-Uncontrolled HT
-Current breast cancer
-+ve antiphospholipid antibodies
94
UKMEC 3 conditions?
-More than 35 y/o + less than 15 cigs per day
-BMI: >35
-Fam history of thromboembolic disease
-Controlled HT
-Immobility
-Carrier of breast cancer genes
-Current gallbladder disease
95
Down's syndrome quadruple test result?
-Decreased AFP
-Decreased oestriol
-Increased hCG
-Increased inhibin A
96
PID makes you more likely to have what?
Ectopic pregnancy
97
Symptoms of PID?
-Lower abdo pain
-Adnexal tenderness
-Cervical motion tenderness
98
Boggy uterus + >30 y/o + dysmenorrhoea + menorrhagia = what?
Adenomyosis
99
Routine monitoring for patients with possible DVT on LMWH in pregnancy?
Anti-Xa
100
Threatened miscarraige?
Painless vaginal bleeding before 24 weeks
Cervical os closed
101
Missed miscarraige?
Gestational sac which contains dead foetus before 20 weeks with no expulsion symptoms
Light vaginal bleeding/discharge
Cervical os closed
102
Inevitable miscarraige?
Heavy bleeding
Cervical os open
103
Pre term labour ROM?
Antenatal corticosteroids
104
If fetal movements have not been felt before which week, should you refer
24 weeks
105
Ectopic pregnancy where is the most risky?
Isthmus
106
Magnesium sulfate toxicity symptoms?
-Deep tendon reflexes
-Resp depress
-Cardiac arrest
107
1st line treatment for mg sulfate induced resp depression?
Calcium gluconate
108
SSRI of choice for breastfeeding women?
Sertraloine
Paroxetine
109
Progesterone only pill: most likely side effect?
Irregular vaginal bleeding
110
What layers does Obs Dr cut through in a C section?
Skin
Superficial fascia
Deep fascia
Anterior rectus sheath
Rectus abdominis muscle
Transversalis fascia
Extraperitoneal connective tissue
Peritoneum
Uterus
111
Severe itching, jaundice, Obstructive LFTs, normal WBC?
Cholestasis of pregnancy
112
What reduces risk of pre-eclampsia again?
Low dose aspirin (75-150mg)
113
High risk HPV + abnormal cytology? What do you do
Colposcopy
114
Mother with previous baby who has neonatal sepsis by Group B strep (GBS). What is most appropriate management?
Prescribe intrapartum IV Benzylpenicillin
115
COCP first 21 days following pregnancy?
NOPE
-Increased post-partum risk of thromboembolism
116
Turner's syndrome is what?
Gonadal dysgenesis
117
Turner's syndrome presentation?
-Widely spaced nipples
-primary ammenorrhoea
-Raised FSH/LH
118
PCOS patient with oligomennorhoea (2 periods per year) management and why?
Fewer than 4 periods per year can increase endometrial hyperplasia and carcinoma risk
Inducing a withdrawal bleed every 3-4 months or preventing proliferation of endometrium is recommended.
-Cyclical oral progesterone for atleast 12 days a month
-COCP
-Levonorgestrel releasing IUS
119
No pain + vaginal bleeding in pergnancy?
Placenta praevia
120
Take folate form when til when for pregnancy?
3 months prior to pregnancy and 12 weeks gestation
121
Most common cause of puerperal pyrexia
Endometritis
122
Management of endometritis?
Refer to hospital for IV ABs
Clindamycin and gentamicin until afebrile
123
Meig's sydnrome is what ?
3 features including:
-Benign ovarian tumour
-Ascites
-Pleural effusion
Usually women over 40. Tumour is usually a fibroma.
124
Standard medical management for incomplete miscarraige for cases completed by bleeding risk?
Misoprostol
-
125
What is mifepristone used for?
Missed miscarriages
-Pharmacological assistance required to initiate detachment before expulsion
126
Gestational diabetes testing with woman who have a first degree relative with diabetes?
Oral Glucose Tolerance Test (OGTT) at 24-28 weeks
127
What happens to BP in pregnancy?
Falls in 1st half of pregnancy then rises to pre-pregnancy levels before term
128
Contraception post pregnancy, how soon can you use IUD and IUS?
Inserted within 48 hours of childbirth or after 4 weeks
129
Who is a surrogate's child legal mother?
Party giving birth to the child
130
Low lying placenta at 20 weeks management?
Rescan at 32 weeks
131
COCP post partum contraindication?
<6 weeks post partum COCP is contraindicated
132
PCOS results?
Raised LH:FSH ratio
Testosterone normal or high
SHBG normal or low
133
55 y/o with grade 1 endometrial cancer what surgery is indicated?
Total hysterectomy + biltarsalpingoophorectomy
Ensure no remaining endometrial tissue
134
Purpose of 11-13 weeks booking scan?
Viable intrauterine pregnancy and number of babies
135
What infectious disease are screened for at booking?
Hep B
HIV
Syphilis
136
What does 20 week anomoly scan look at?
Anatomical development
Placental location
(Screen for placenta praevia)
137
What do multiple pregnancy patients need to take and why?
Aspirin
Reduces risk of PET and growth restriction
138
Increased BMI in pregnancy predisposes you to ___ so you should take ____?
-DVT
-Frgamin
139
Can you have vaginal delivery post c/s?
70% chance of achieving Vaginal delivery
If opting for C/S should be thirty nine weeks gestation
140
What to give someone with PCOS trying to conceive?
Clomifene citrate
141
Gold standard for diagnosing endometriosis? What you should do before that?
Diagnostic laprasopy
-Pelvic examination + /- USS
142
A D-Dimer is increased/decreased in pregnancy?
Increased
143
A women presents to her midwife with worsening ankle swelling, headache and describes 'bright spots' in her vision. BP 155/105 and urine contains 2+ protein on urinalysis.
Which further laboratory investigations would you choose initially to help ascertain the severity of pre-eclampsia?
Plus what do you want to rule out?
HELLP syndrome (Haemolysis + elevated liver enzymes + low platelets)
FBC, U&Es, LFT's and Urine PCR
Urinary PCR will also help quantify protein in urine
144
Most accurate measurement for predicting intrauterine growth restriction/estimating weight?
Abdominal circumferences
145
Trisomy 18 = what?
EDWARD'S SYNDROME
Anomaly scan: small for gestational age, multiple structural abnormalities, micrognathia, cleft, clenched hands and abnormal feet, heart defect and omphocele?
146
1st line management for atony?
Syntocinon
147
What is the risk here?
A woman undergoes a massive transfusion of both O –ve and cross matched blood products for the management of a major PPH. What biochemical abnormality is she at risk of?
Hypocalcaemia + metabolic alkalosis
148
