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PPQ Learning > OB/GYN > Flashcards

OB/GYN Flashcards

1
Q

Drug of choice for medical management of ectopic pregnancy?

A

Methotrexate (HIGHLY terataogenic so single IM dose does job)

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2
Q

Contraindications to methotrexate for ectopic?

A

-Mass>35mm
-Detectable Heartbeat
-Ruptured

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3
Q

Surgical management for ectopic?

A

Laparoscopic salpingectomy

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4
Q

What component of HRT causes breast cancer risk?

A

Progesterone

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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

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6
Q

Medication for hot flushes?

A

Clonidine: Hormonal
Venlafaxine: Non-hormonal

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7
Q

Most common adverse reaction for progesterone-only pill?

A

Irregular vaginal bleeding

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8
Q

What is desogesterol?

A

POP

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9
Q

If a patient has itchy hands and is 31 weeks pregnant?

A

Intrahepatic cholestasis

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10
Q

Treatment of intrahepatic cholestasis?

A

Induction of labour at 37-38 weeks

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11
Q

Gestational diabetes treatment?

A

Fasting glucose 7< = Commence insulin
Fasting glucose 5.6-6.9mmol/L = Commence metformin

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12
Q

1st line treatment of urge incontinence?

A

Bladder retraining

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13
Q

1st line treatment for stress incontinence?

A

Pelvic floor muscle training

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14
Q

Migraine with aura and HRT?

A

NOT contraindicated

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15
Q

If patient has uterus what type of hormonal treatment is required?

A

Combined oestrogen and progesterone

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16
Q

If a patient has not yet reached full menopause (amenorrhoea >1 year) what type of treatment?

A

Cyclical HRT

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17
Q

What is a contraindication for HRT?

A

Undiagnosed vaginal bleeding

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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.

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19
Q

Transdermal oestrogen vs oral?

A

Transdermal:
do not have increased risk of DVT

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20
Q

Chicken pox exposure in pregnancy?

A

Check Antibodies as first step

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21
Q

Gestational HT diagnosis?

A

new onset HT undiagnosed after 20 weeks without signif proteinuria

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22
Q

Treatment of gestational diabetes?

A

Oral nifedipine

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23
Q

Persistent bleeding 6 months, not helped by mefanamic or tranexamic?

A

Endometrial biopsy at hysteroscopy

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24
Q

Definition of puerperal pyrexia?

A

Temp pf >38 degrees in first 14 days following delivery

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25
Q

Causes of puerperal pyrexia?

A

Endometritis
UTI
Wound infections
Mastitis
Venous thromboembolism

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26
Q

Management of puerperal pyrexia?

A

If endometritis is suspected the patient should be sent to hospital for IV ABs
-Clindamycin and gentamicin until afebrile for 24 hours

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27
Q

ABs for suspected puerperal pyrexia?

A

Clindamycin and gentamicin

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28
Q

Most common cause of postmenopausal bleeding?

A

Vaginal atrophy

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29
Q

Bleeding following sexual intercourse in Post-menopausal women?

A

Vaginal atrophy

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30
Q

Investigations for suspected PCOS?

A

-Plevic US
-FSH, LH, Prolactin, TSH
-Testosterone
-SHBG

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31
Q

Pelvic cysts with bead on a string appearance diagnosis?

A

PCOS

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32
Q

Blood test results in PCOS?

A

Raised LH: FSH ratio
Normal/mildly elevated prolactin and testosterone

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33
Q

Rotterdam criteria and what it diagnoses?

A

PCOS
-Hyperandrogenism
-Oligo-/anovulation
-Cystic morphology on USS

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34
Q

2 methods of emergency hormonal contraception medication ?

A

Levonorgestrel
Ulipristal

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35
Q

When can you take levonogestral as emergency contraception?

A

within 72 hours of unprotected intercourse

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36
Q

What is levongestral?

A

A progesterone

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37
Q

Dosing of levonogestral in UNSI?

A

1.5mg
3.0mg if BMI >26 or >70Kg

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38
Q

When can hormonal contraception be started after using levornogestrel as EC?

A

immediately

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39
Q

What s Ulipristal?

A

Selective progesterone receptor modulator (EllaOne)

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40
Q

MOA of Ellaone?

A

Inhibition of ovulation

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41
Q

Use of ulipristal as EC? Timeframes etc?

A

ASAP
No later than 120 hours after intercourse

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42
Q

Dose of elleOne for EC?

A

30mg

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43
Q

EllaOne and contraception methods?

A

May reduce effectiveness
Restart/start with ring, patch or pill 5 days after having ulipristal: until then barrier methods

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44
Q

Who to be cautious of when prescribing EllaOne?

A

ASTHMA patients

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45
Q

Breastfeeding and EC?

A

Wait 7 days post EllaOne
No restrictions with levonorgestrel

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46
Q

Most effective method of EC which should always be offered?

A

IUD

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47
Q

Timeframes with IUD and UPSI?

A

Within 5 days of UPSI

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48
Q

If a patient had UPSI 6 days ago what you gonna do?

A

Offer IUD fitting up to 5 days after likely ovulation date

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49
Q

Increased Nucal translucency (NT)?

A

Down’s Syndrome
Congenital heart defects
Abdominal wall defects

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50
Q

Causes of hyperchogenic bowel?

A

CF
Down’s
Cytomegalovirus

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51
Q

What is folic acid necessary for?

A

Proper closure of neural tube during fetal nervous system development

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52
Q

Causes of folic acid deficiency?

A

Phenytoin
Methotrexate
Pregnancy
Alcohol XS

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53
Q

Criteria for high risk NT defects in woman in pregnancy?

A

-Either partner NTD
-Previous pregnancy affected by NTD
-Fam Hx of NTD
-Antiepileptic drugs
-Coeliac
-Diabetes
-Thalassaemia trait
-OBESITY (BMI: >30)

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54
Q

Most common diagnosis for post-menopausal bleeding?

A

VAGINAL ATROPHY

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55
Q

Ovarian cyst which upon rupture may cause pseudomyoxoma peritonei?

A

Mucinous cystadenoma

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56
Q

Most common type of ovarian epithelial tumour?

A

Serous cystadenoma

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57
Q

Investigation for suspected placenta praevia?

A

Transvaginal US

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58
Q

What is placenta praevia?

A

Placenta wholly or partly in lower uterine segment

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59
Q

Clinical features of PlacePraev?

A

Shock in proportion to visible loss
No pain
Uterus not tender
Lots of things could be normal

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60
Q

What should NOT be done when PPraev suspected?

A

Digital vaginal exam

61
Q

Menorrhagia management first line?

A

MIrena (IUS )

62
Q

Management of HT in pregancy?

A

Oral labetalol
Oral nifedipine and hydralazine (if asthmatic)

63
Q

When would you do continuous CTG monitoring ?

A

-Sus chorioamnionitis or sepsis (38<)
-Severe HT (160/110)
-Oxytocin use
-Presence of signif meconium
-Fresh vaginal bleeding develops in labour

64
Q

Lump or ulcer on labia majora is likely what?

A

Vulval cancer

65
Q

Post-partum haemorrhage management?

A

Intra-uterine ballook tamponade is first line surgical

66
Q

Definition of primary postpartum haemorrhage?

A

> 500ml of blood <24 hours post delivery

67
Q

4 Ts of Primary PPH causes?

A

Tone: (uterine atony)
Trauma: (perineal tear)
Tissue: (retained placenta)
Thrombin: (clotting/bleeding disorder)

68
Q

RFs for primary PPH?

A

Previous PPH
Prolonged labour
Pre-eclampsia
Increased maternal age
Polydraminos
Emergency C section
PlacPraev/accreta
Macrosomia

69
Q

Management of PPH?

A

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
Q

Diagnostic thresholds for gestational diabetes?

A

Fasting glucose: >5.6 mmol/L
2 - hour glucose: > 7.8 mmol/L

71
Q

If fasting plasam glucose is <7 mmol/L what should be trialled with pregnant woman?

A

Diet and exercise

If targets not met in 1-2 weeks the start metformin, if still not met then add insulin (sjort acting)

72
Q

Investigation for preterm prelabour ROM?

A

Speculum examination

73
Q

Bishop score <6 what do you use to induce labour?

A

Vaginal PGE2
Oral misoprostol

74
Q

Oral contraception and gastric sleeve/bypass/duodenal switch?

A

CAN’T HAVE ORAL CONTRACEPTION
-Due to lack of efficacy

75
Q

Treatment of vaginal thrush in non-pregnant women?

A

Oral fluconazole

76
Q

1st stage of labour splits?

A

Latent phase: 0-3cm dilation
Active phase: 3-10cm dilation

77
Q

Snow storm appearance on US?

A

Complete hydatidiform mole

78
Q

Management of ectopic?

A

Salpingectomy

79
Q

Stereotypical PCOS hormone results?
-LSH:FSH ratio
-Testosterone
-SHBG (Sex hormone binding globulin)

A

LSH: FSH = Raised
Testosterone: normal or elevated
SHBG: Normal to low

80
Q

What might reduce the size of uterine fibroids while waiting for surgery?

A

GnRH agaonists
Triptorelin

81
Q

Anti-emetics in pregnancy?

A

PROMETHAZINE: BAE

Metaclop: can be used for 5 days but no more due to EPSEs

82
Q

PCOS diagnostic criteria?

A

-Infrequent or no ovulation
-Clinical or biochemical signs of hyperandrogenism/elevated testosterone
-Polycystic ovaries

83
Q

Medical treatments for postpartum haemorrhage secondary to uterine atony?

A

Oxytocin
Ergometrine
Carboprost
Misoprostol

84
Q

Category 2 C sections should occur within how long of decision?

A

75 minutes

85
Q

Medical management of ectopic frequency?

A

Methotrexate

86
Q

What is HELLP syndrome?

A

Severe pre-eclampsia

87
Q

Features of HELLP?

A

Haemolysis
Elevated liver enzymes
Low platelets

-Presentation: malaise, nausea, vomiting, headache
HT with proteinuria

88
Q

Pregnant woman with BP > 160/110mmHg?

A

Admitted and observed

89
Q

UKMEC 1 means what?

A

No restriction for use of the contraceptive method

90
Q

UKMEC 2?

A

Advantages outweigh disadvantages

91
Q

UKMEC 3?

A

Disadvantages generally outweigh advantages

92
Q

UKMEC 4?

A

Represents an unacceptable health risk

93
Q

UKMEC 4 conditions?

A
  • > 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
Q

UKMEC 3 conditions?

A

-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
Q

Down’s syndrome quadruple test result?

A

-Decreased AFP
-Decreased oestriol
-Increased hCG
-Increased inhibin A

96
Q

PID makes you more likely to have what?

A

Ectopic pregnancy

97
Q

Symptoms of PID?

A

-Lower abdo pain
-Adnexal tenderness
-Cervical motion tenderness

98
Q

Boggy uterus + >30 y/o + dysmenorrhoea + menorrhagia = what?

A

Adenomyosis

99
Q

Routine monitoring for patients with possible DVT on LMWH in pregnancy?

100
Q

Threatened miscarraige?

A

Painless vaginal bleeding before 24 weeks
Cervical os closed

101
Q

Missed miscarraige?

A

Gestational sac which contains dead foetus before 20 weeks with no expulsion symptoms

Light vaginal bleeding/discharge

Cervical os closed

102
Q

Inevitable miscarraige?

A

Heavy bleeding
Cervical os open

103
Q

Pre term labour ROM?

A

Antenatal corticosteroids

104
Q

If fetal movements have not been felt before which week, should you refer

105
Q

Ectopic pregnancy where is the most risky?

106
Q

Magnesium sulfate toxicity symptoms?

A

-Deep tendon reflexes
-Resp depress
-Cardiac arrest

107
Q

1st line treatment for mg sulfate induced resp depression?

A

Calcium gluconate

108
Q

SSRI of choice for breastfeeding women?

A

Sertraloine
Paroxetine

109
Q

Progesterone only pill: most likely side effect?

A

Irregular vaginal bleeding

110
Q

What layers does Obs Dr cut through in a C section?

A

Skin
Superficial fascia
Deep fascia
Anterior rectus sheath
Rectus abdominis muscle
Transversalis fascia
Extraperitoneal connective tissue
Peritoneum
Uterus

111
Q

Severe itching, jaundice, Obstructive LFTs, normal WBC?

A

Cholestasis of pregnancy

112
Q

What reduces risk of pre-eclampsia again?

A

Low dose aspirin (75-150mg)

113
Q

High risk HPV + abnormal cytology? What do you do

A

Colposcopy

114
Q

Mother with previous baby who has neonatal sepsis by Group B strep (GBS). What is most appropriate management?

A

Prescribe intrapartum IV Benzylpenicillin

115
Q

COCP first 21 days following pregnancy?

A

NOPE
-Increased post-partum risk of thromboembolism

116
Q

Turner’s syndrome is what?

A

Gonadal dysgenesis

117
Q

Turner’s syndrome presentation?

A

-Widely spaced nipples
-primary ammenorrhoea
-Raised FSH/LH

118
Q

PCOS patient with oligomennorhoea (2 periods per year) management and why?

A

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
Q

No pain + vaginal bleeding in pergnancy?

A

Placenta praevia

120
Q

Take folate form when til when for pregnancy?

A

3 months prior to pregnancy and 12 weeks gestation

121
Q

Most common cause of puerperal pyrexia

A

Endometritis

122
Q

Management of endometritis?

A

Refer to hospital for IV ABs
Clindamycin and gentamicin until afebrile

123
Q

Meig’s sydnrome is what ?

A

3 features including:
-Benign ovarian tumour
-Ascites
-Pleural effusion

Usually women over 40. Tumour is usually a fibroma.

124
Q

Standard medical management for incomplete miscarraige for cases completed by bleeding risk?

125
Q

What is mifepristone used for?

A

Missed miscarriages
-Pharmacological assistance required to initiate detachment before expulsion

126
Q

Gestational diabetes testing with woman who have a first degree relative with diabetes?

A

Oral Glucose Tolerance Test (OGTT) at 24-28 weeks

127
Q

What happens to BP in pregnancy?

A

Falls in 1st half of pregnancy then rises to pre-pregnancy levels before term

128
Q

Contraception post pregnancy, how soon can you use IUD and IUS?

A

Inserted within 48 hours of childbirth or after 4 weeks

129
Q

Who is a surrogate’s child legal mother?

A

Party giving birth to the child

130
Q

Low lying placenta at 20 weeks management?

A

Rescan at 32 weeks

131
Q

COCP post partum contraindication?

A

<6 weeks post partum COCP is contraindicated

132
Q

PCOS results?

A

Raised LH:FSH ratio
Testosterone normal or high
SHBG normal or low

133
Q

55 y/o with grade 1 endometrial cancer what surgery is indicated?

A

Total hysterectomy + biltarsalpingoophorectomy

Ensure no remaining endometrial tissue

134
Q

Purpose of 11-13 weeks booking scan?

A

Viable intrauterine pregnancy and number of babies

135
Q

What infectious disease are screened for at booking?

A

Hep B
HIV
Syphilis

136
Q

What does 20 week anomoly scan look at?

A

Anatomical development
Placental location
(Screen for placenta praevia)

137
Q

What do multiple pregnancy patients need to take and why?

A

Aspirin
Reduces risk of PET and growth restriction

138
Q

Increased BMI in pregnancy predisposes you to ___ so you should take ____?

A

-DVT
-Frgamin

139
Q

Can you have vaginal delivery post c/s?

A

70% chance of achieving Vaginal delivery

If opting for C/S should be thirty nine weeks gestation

140
Q

What to give someone with PCOS trying to conceive?

A

Clomifene citrate

141
Q

Gold standard for diagnosing endometriosis? What you should do before that?

A

Diagnostic laprasopy

-Pelvic examination + /- USS

142
Q

A D-Dimer is increased/decreased in pregnancy?

143
Q

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?

A

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
Q

Most accurate measurement for predicting intrauterine growth restriction/estimating weight?

A

Abdominal circumferences

145
Q

Trisomy 18 = what?

A

EDWARD’S SYNDROME

Anomaly scan: small for gestational age, multiple structural abnormalities, micrognathia, cleft, clenched hands and abnormal feet, heart defect and omphocele?

146
Q

1st line management for atony?

A

Syntocinon

147
Q

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?

A

Hypocalcaemia + metabolic alkalosis

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