Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Revision > OBG > Flashcards

OBG Flashcards

1
Q

What contraceptives should not be given in women < 20?
Why?
What complications/ side effects ?
Guidance?

A

Depo-provera = IM medroxyprogesterone acetate
= risk of young age osteoporosis

IUS/ Mirena

Both cause bleeding more days than usual initially + vaginal spotting between cycles

Most females amennorhoeic after use for 1 year
= reassure + advise to come if unscheduled bleeding is problematic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What do you if bleeding becomes problematic after IUS Mirena or Depo use?

A

COCP for 3 months (while still on depo)
Or
Mefenamic acid or trance mix acid for 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What method of contraception is safe for under 20s?

A

Nexplanon = etonogestrel implant
COCP
POP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What contraception would you give in a female with learning difficulties?

A

NO PILLS = COCP POP

- may forget to take them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the contraindications of COCP use? (7)

A

Smoking
Obesity
Thromboembolism hx
Learning difficulty
Postpartum- if breastfeeding CI for 6 mo, if not 6 weeks.
Migraine with aura
HTN - even if well controlled (DONT GIVE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are long term methods of contraception?

When should they be avoided?

A

MIRENA + nexplanon

Avoid if woman has intentions to get pregnant within the next 6 months / nears future

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What contraceptive is safe for use while breastfeeding?

A

POPs - given orally

Short term contraception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How long after delivery are contraceptive methods NOT required?

A

21 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is Depo given and how often?

When is it 1st line?

A

IM injection - once every 3 months/12 weeks

1st - SCA and Menorrhagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do you give young, non sexually active women that complain fo menorrhagia?

A

Tranexamic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do you give young, non sexually active women that complains of menorrhagia + dysmenorrhea ?

A

Mefenamic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What do you give young, non sexually active women that complain of irregular menses +/- menorrhagia/ dysmenorrhea ?

A

COCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Complaints of menorrhagia in female with SCD, what do you give?

A

Depo - provera

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Medication for dysmenorrhea

A

Mefenamic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Medication for metrorrhagia?

A

COCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Medication for menorrhagia only?

A

Tranexamic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the 1st line contraceptive method in a sexually active woman with dysmenorrhoea / or fibroids ( do not distort uterine cavity)?

A

Mirena

If contraindicated =
COCP/POP/implants (if no contraindications)

Uterine cavity distorted - implants = Nexplanon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Emergency contraception for a woman that presented within 3 days of the unprotected sex?

A

Levonelle pill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Emergency contraception for a woman that presented within 120 hours/5 days of the unprotected sex?

A

IUD copper
Or
EllaOne pill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What contraception reduces the risk of cervical ca?

A

Condoms

= reduce risk of HPV infections - therefore reduces risk of ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How often should nexplanon be replaced?

A

Every 3 years

= progesterone only subdermal implants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Lower abdominal pain +recent amenorrhoea + vaginal spotting and cervical excitation
Empty uterus on vaginal US
Dx?

A

Ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Management of ectopic pregnancy

- stable

A

B-HCG
If >1400 - laparoscopy
<1400 - wait and observe - repeat vaginal US later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Management of ectopic pregnancy

- unstable (SBP<90)

A

Laparotomy - salpingectomy / salpingostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Pregnant women + hx of CS comes with profuse vaginal bleeding and severe abdominal pain
She is hypotensive and tachycardic
Dx?

A

Uterine rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Painless vaginal bleeding in late weeks of pregnancy
What do you suspect?
What do you do to rule it out

A

Placenta Previa

Do TVUS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Painful vaginal bleeding in late weeks of pregnancy + constant abdominal pain
Tender hard abdomen on examination
What do you suspect?
Investigation?

A

Placenta abruption

Do CTG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

3rd trimester
Tachycardia + fever + history of PROM
offensive vaginal discharge
What do you suspect?

A

Chorioamnionitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Lower abdominal pain + deep dyspareunia, menstrual irregularities and cervical excitation
Diagnosis?

A

PID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

A women > 51 years old comes with dyspareunia + dysuria
She also complaints of hot flushes and night sweats
Dx?
How to you treat it ?

A

Suspect post menopausal syndrome

HRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

2ry amenorrhoea after chemo

What do you suspect?

A

Premature ovarian failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Painless vaginal bleeding + high placenta

Dx?

A

Suspect cervical ectropion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Female >51 yo with postmenopausal vaginal bleeding
What do you suspect ?
What investigations are to be done?

A

Endometrial ca

TVUS - initially to check thickness
If thick (>4 mm)- hysteroscopy + endometrial biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the commonest cause of postmenopausal bleeding ?

A

Atrophic vaginitis
Vulvovaginal atrophy

Always TVUS to r/o endometrial ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Woman of child bearing age + chronic pelvic pain + dysmenorrhea, deep dyspareunia and dyschezia
What do you suspect?
Treatment?

A

Endometriosis
-NSAIDS + paracetamol
- COCP trial
Laparoscopy - definitive treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q 
High fever + lower abdominal pain 
No vaginal discharge
Sexually active, does not use barriers
What investigation should done?
Dx?
A

Pelvic US

Turbo-ovarian abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Sudden unilateral iliac fossa pain + nausea + vomiting
+/- tender mobile mass
Dx?
Tx?

A

Ovarian torsion

Refer her to gybe or urgently take to theatre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

African women with bloating and heavy regular periods
Enlarged uterus
What do you suspect?
Investigation

A

Fibroids

TVUS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Investigation for PCOS

A

Pelvic US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Chronic pelvic pain + worse on standing and during pms
+/- deep dyspareunia
Dx?

A

Pelvic congestion syndrome
It’s non-organic
Laparoscopy would be unremarkable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

1ry amenorrhoea + cyclic pain
Mass in the lower abdomen
Dx?

A

Hematometra

- Accumulation of blood within uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

When should VZIG be given ?

A
  • immunocompromised w/ exposure
  • pregnant w/ exposure and no VZ antibodies*
  • newborns w/ peripartum exposure

*if exposed >2 days before rash appears + immune = reassure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

When should oral acyclovir be given in VZV

A

Pregnant women with chickenpox

Immunocompromised with chickenpox

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Pregnant woman , 2nd trimester + non immune + in contact with chickenpox child 7 days ago
Best management ?

A

VZIG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

When is VZIG effective?

A

If given within 10 days after exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Pregnant woman in contact with chickenpox, develops rash

What do you give?

A

Oral acyclovir w/in 24 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the infective period of chickenpox?

A

2 days before appearance of rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the causes of 1ry postpartum hemorrhage? (4)

A

4 Ts
Tone - uterine atony = most common *
Trauma - lacerations, incisions, uterine rupture
Thrombin - coagulopathy
Tissues - retained products of conception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Management of uterine atony?

A

Uterine massage

Oxytocin - uterotonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How soon after delivery can mirena/IUS be used?

A

Within 48 hours of delivery or

After 4 weeks - for fear of uterine perforation 2-28 days after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What causes shoulder tip pain in ectopic pregnancy?

A

Peritoneal bleeding + peritonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Initial investigation in ectopic?

A

Urine pregnancy
If +ve = TVUS
- if empty uterus =b HCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Management of ruptured uterus

A

Urgent laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Risk factors of uterine rupture (3)

A

Previous CS or uterine surgery **
Excessive oxytocin - uterotonics
Unrecognised obstructed labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

First investigation to be done in suspected placental abruption?
What is the management?

A

CTG
If distressed - urgent CS
If normal - vaginal US to r/o previa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Post menopause sx
Management :
- if uterus
- no uterus

A

Uterus - HRT or transdermal estradiol & progesterone patches
No uterus or IUS in place - oestrogen only HRT

*progesterone given w/ estrogen to protect uterus against endometrial ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Post menopausal smoker - how is HRT given?

A

Transdermal

Oral has higher risk for VTE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are the 2 types of HRT?

A

1- sequential /cyclical
= 1st 12 months of menopause/perimenopause
- oestrogen daily / progesterone cyclically

2- continuous combined HRT
= last menstrual > 12 months
- oestrogen + progesterone taken daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is chorioamnionitis?

A

Inflammation of foetal amnion and chorion membranes - typically due to ascending bacterial vaginal infection when there is ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Major RF for chorioamnionitis

A

PROM

Due to ascending bacterial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Features of chorioamnionitis

A

Hx PROM
Maternal tachy followed by fever
+ foetal tachy
Suprapubic tenderness/ and pain and contractions
Aminiotic fluid - purulent/offensive/foul smelling yellow or brown

*sometimes no fever because tachy occurs before

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Fundal height landmark for 12 weeks

A

Public symphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Fundal height landmark for 20 weeks

A

Umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Fundal height @ 20-36 weeks =

A

GA in weeks +/-2 = ____ cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Fundal height landmark @ 36-40 weeks

A

Xiphoid process of sternum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Cause of large for date uterus (4)

A

Hyatidiform mole
Concealed accidental hemorrhage
Tumours as fibroids/ ovarian cysts
Foetal malformations (hydrocephalus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Cause of small for date uterus

A

Foetal death
IUGR
Pregnancy during amenorrhoea
Malpresentation - transverse lie

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Any female <25 that uses Mirena + develops abdominal pain and irregular menses
Suspect -

A

PID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is a major RF for PID

A

-IUS - mirena
=allleviate symptoms of endometriosis adenomyosis and fibroids

*IU system = mirena IUDevice = copper T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Features of trichomoniasis

A 
trichomonas vaginalis
frothy yellowish- greenish smelly vaginal discharge 
\+ vaginal itching 
On examination - strawberry cervix 
Vaginal pH >4.5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Treatment of trichomoniasis

A

Oral metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Features of bacterial vaginosis

A 
Grey-white fishy, thin discharge 
VERY offensive 
Itching uncommon 
\+ve whiff test - potassium hydroxide 
Vaginal pH >4.5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Whiff test for diagnosis of ?

A

Bacterial vaginosis

Gardnerella vaginalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Treatment of bacterial vaginosis

A

Metronidazole + clindamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is the normal vaginal pH

A

3.8 - 4.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Thick white cottage cheese discharge
Odourless
Vaginal pH 4-4.5
Diagnosis?

A

Vulvovaginal candidiasis

- Candida albicans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Treatment of vaginal candidiasis

A

Local clotrimazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Most common abnormal vaginal discharge in chilbearing age

A

Bacterial vaginosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is Amsel’s criteria?

A

Diagnostic criteria for BV - 3/4 = diagnosis

  • homogenous grey white discharge
  • positive whiff test ( fishy smell when you add koh)
  • clue cells on microscopy
  • vaginal pH > 4.5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Prolonged amenorrhoea in a woman <40
Suspect-
Diagnostic investigation
Treatment

A

Premature ovarian failure
Ix - FSH
FSH > 25 IU/L on 2 occasions 4 weeks apart - diagnostic
T - HRT until 51 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is early menopause?

Investigation

A

Amenorrhoea in 40-45 years old

I - US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Presentation of premature ovarian failure

A

Amenorrhoea / oliguria - commonest presentation
Postmenopausal features
Infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Cause of POF

A

Most common - idiopathic

Can occur after chemo !

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Presentation of atrophic vaginitis

Atrophic vaginitis = vulvovaginal atrophy = genitourinary syndrome (GSM)

A

Urinary = dysuria, frequency, incontinence, etc
+/-
Dyspareunia, vaginal itching/dryness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Cause of atrophic vaginitis

Treatment

A

Oestrogen deficiency after menopause
Treatment = topical oestrogen (intravaginal or cream)

  • if + other menopausal symptoms = HRT or transdermal oestradiol + progesterone patch
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Screening test for colorectal ca

Age it is done + frequency

A

Fecal immunochemical test (FIT)

60-74, every 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Breast cancer screening test

Age it is done + frequency

A

Mammogram

50-70, every 3 years

If high risk - 40-70 years, annually .

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Cervical ca screening test

Age it is done + frequency

A

Pap smear , cervical smear - cytology, HPV
25-49, every 3 years
50-64, every 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Cervical ectropion management

A

***Reassure if there is NO bleeding or pain after sex
If symptoms are bothersome - do cervical smear
= if normal - cryotherapy, diathermy, cautery with silver nitrate

It is not a risk factor for cervical ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is a cervical ectropion

A

Stratified squamous ectocervix is replaced by
I
Columnar epithelium

= happens in high oestrogen states = pregnancy COCP puberty

Asymptomatic , but can have painless vaginal bleed or non purulent watery discharge post-coital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Symptomatic ectropion

Next step?

A

Refer to colposcopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Pre-eclampsia

  • def
  • RF
  • Tx
A

HTN + proteinuria > 0.3g/24 hr
Usually after >20th week gestation

RF - 1st pregnancy , pregnant teens, women >40

Tx - no cure! Except for delivery !
Mild - conservative treatment to allow baby to mature under close monitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Medications given in pre-eclampsia

A

MgSo4 to prevent seizures
Corticosteroids to allow for baby maturation
Labetalol to lower BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Foetal complication of pre-eclampsia

A

Risk of pre-term delivery
Oligohydramnios
Sub -optimal foetal growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Maternal complication of pre-eclampsia

A

Liver + kidney failure
Clotting disorders
HELLP syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What is HELLP syndrome

A

Complication of preeclampsia
Hemolysis - low HB
Elevated Liver enzymes
Low Platelets

Features - epigastric/RUQ pain +- NV =/- dark urine (hemolysis) =/- HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Treatment of HELLP

A

Deliver baby

MgSo4 if seizures develop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Features of AFLP (acute fatty liver of pregnancy)

A

ELLP - raised liver enzymes + low platelets
Low glucose
+- raised ammonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Features of Disseminated intravascular coagulation (DIC) on labs

A

High PT PTT & bleeding time

Low platelets & fibrinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

DIC triggers

A

Sepsis, surgery, major trauma, cancer , complications of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Post menopausal bleeding
Initial test
Diagnostic/ most definitive step
Most likely dx

A

Initial - TVUS
Def - hysteroscopy with endometrial biopsy
Dx - atrophic vaginitis but most worrisome is endometrial ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Risk factors for endometrial ca (7)

A 
Obesity 
Nulliparity
Unopposed oestrogen (oestrogen, no progesterone)
PCOS
Tamoxifen 
Early menarche
Late menopause
DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What can reduce risk of endometrial ca

A

Progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What is antiphospholipid syndrome associated with

What can be done?

A

Recurrent miscarriages

- to avoid = give aspirin + LMWH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Who should you screen for antiphospholipid syndrome

A

Females w/ recurrent abortions ( 3 or more miscarriages) in 1st trimester (<13 weeks HA)
+
1 o more abortions in 2nd trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What does screening for antiphospholipid syndrome include

A

Lupus anticoagulants
Anti-cardio lip in antibodies
Anti-B2 glycoproteins -1 antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Clinical features of endometriosis

A

Chronic pelvic pain
Dysmenorrhoea
Deep dyspareunia

Can have sub fertility, urinary symptoms and dyschezia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Gold standard investigation / most definitive investigation

A

Laparoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Management of endometriosis

A

1st line - NSAID /paracetamol

If it doesn’t help - hormonal treatment
= COCP trial or progesterone 3-6 months before laparoscopy

If fertility is an issue - lap first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Causative organisms of PID

A

Chlamydia trachomatis - most common

Neisseria gonorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Features of PID

A 
Pelvic/ Lower abdominal pain
Fever
 Deep dyspareunia
Cervical excitation
Vaginal/cervical discharge 
Dysuria + menstrual irregularities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Investigation for PID

A

Chlamydia + gonorrhoea screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Common risk factors for PID

A 
<25 years old
IUS
Multiple partners
Previous STIs
Uterine instrumentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Complications of PID

A

Infertility - 10-20 % risk
Turbo-ovarian abscess = if left untreated or not treated properly
Ectopic pregnancy
Chronic pelvic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Lower abdominal pain + tenderness + high fever
No discharge
Suspect?
What investigation to be done?

A

Turbo -ovarian abscess

Pelvic ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Management of PID

A

Outpatient
- oral ofloxacin + oral metronidazole

Inpatient
-IM ceftriaxone + oral doxycycline + oral metronidazole “CDM”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Treatment of cervicitis
Chlamydia
N.gonorrhoea

A

Chlamydia - doxy (1st line) 100 mg bid 7 days
2- or azithromycin 1g PO + 500 mg PO OD for 2 days

Neisseria gonorrohea
- ceftriaxone 1gm IM single dose
Or
Cipro 500mg PO single dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Difference between cervicitis & PID

A

Cervicitis - has vaginal discharge , no ascending infection so no pelvic pain

PID involves adnexa and genital structures - pelvic pain, deep dyspareunia, cervical excitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What are the 5 Ds of endometriosis

A 
Dysmenorrhoea
Dyspareunia 
Dyschezia
Dysuria
Dull chronic pelvic pain
120
Q

When does intermenstrual spotting settle in women on depo

What should you do if it becomes bothersome

A

After a year of use
Depo is given once every 3 months

———
COCP 3 months or mefenamic acid for 5 days

121
Q

Treatment of stress incontinence

A

Caused by weak tone -

  1. Pelvic floor excercise s ( 8 contractions, 3x day for at least 3 mo)
  2. if ^ fails - retro public mid urethral tape = free tension vag tape
  3. Duloxetine
122
Q

Treatment of urge continence

A

Cause = detrusor over activity

Bladder retraining - gradually increase time between voiding for 6 weeks
Meds - antimuscarinin = oxybutynin

123
Q

What does tamoxifen increase the risk of

What is it used for

A

Endometrial cancer

Used for - breast ca tx, prevents bone loss (osteoporosis)

124
Q

What is the most alarming symptom in patients on tamoxifen

A

Vaginal bleeding

125
Q

What can be given with tamoxifen to reduce risk of bone mets

A

Bisphosphonates

126
Q

What is threatened abortion

A

Vaginal bleeding + closed os

Visible foetal heart threatened

127
Q

What is an inevitable abortion

A

Open Os + ongoing bleeding

No way to save it

128
Q

Delayed/ missed abortion is ?

A

Foetus is dead - silently before 20 weeks
OS is closed
There may not be vaginal bleeding

129
Q

Incomplete abortion is

A

On US there are still products of conception

130
Q

What is a complete abortion?

A

On US, the uterus is empty

131
Q

Difference between miscarriage and still-birth

A

<24 weeks - miscarriage

> 24 weeks - abortion

132
Q

When is the foetal heart usually seen?

A

6 weeks

133
Q

What is post-pill amenorrhoea

When should you be concerned - and what is to be done?

A

Amenorrhoea after cessation of COCP - normally for 3-6 months

If it persists >6 months — check FSH (esp if younger than 40)
If FSH > 25 IU/L - suspect POF

134
Q

Abnormal labs in premature ovarian failure

A

FSH, LH - increased

Estradiol - <50 (decreased)

Prolactin - normal

135
Q 
Anemia in pregnancy :
1st trim
2nd trim
3rd trim
Postpartum
A

1 -<11g/dl
2 & 3 - <10.5 g/dl
Postpartum < 10

1= 1-13 weeks (first 3 months)
2= 14-26 weeks (4,5,6)
3= 27-40 weeks (7,8,9)
136
Q

Treatment of postpartum anemia

A

Ferrous sulphate - even if patient is asympromatic

137
Q

Medication to control HTN in preeclampsia

A

Labetalol

If contraindicated *asthma - give nifedipine

138
Q

Management of eclampsia
Regimen + doses
If recurrent

A

Control/prevent seizure - MgSo4
If another fit occurs- give another IV bolus dose

Regimen =

  1. 4g in 100ml .9% NS by infusion pump over 5-10 minutes
  2. 1g/hr maintenance for 24 hrs after last seizure

Recurrent - give further 2g MgSo4 bolus of increase infusion or 1.5-2 /hr

139
Q

Symptoms of MgSo4 overdose

A

Loss of deep tendon reflex
Nausea
Vomiting
Confusion

140
Q

Deep tendon reflexes

A 
biceps C5/6
brachioradialis - C6
triceps - C7  
patella - L4
achilles - S1
141
Q

Treatment of MgSo4 overdose

A

Stop MgSo4
Urgent serum MgSo4
If ongoing seizure - give diazepam
Antidote = ** calcium gluconate**

Deliver baby if seizure has been managed and patient is stable

142
Q

What is turtles sign
Where can it be seen
Management

A

Retraction of the foetal head immediately after it emerges
Shoulder dystocia

= call for help - episiotomy- rotation manoeuvres

143
Q

Management +Manoeuvres in shoulder dystocia

A
  1. Call for help! + discourage pushing
    SD- usually due to imp action of anterior foetal shoulder on maternal pubic symphysis
  2. Mc Roberts - flexion + abduction of maternal hips / thighs towards abdomen
  3. Suprapubic pressure

Episiotomy - for better access of internal manoeuvres
= deliver posterior arm or internal rotation

144
Q

Risk factors for shoulder dystocia (5)

A 
Macrosomia = >4,5kg
Maternal BMI >30
Maternal DM
Hx of prev SD
Prolonged labour
145
Q

Dx of hyperemesis gravidarum

A

Severe/prolonged NV in pregnancy

8-12 weeks gestation (up to 20 weeks)

146
Q

Treatment of hyperemesis gravidarum

What should you look for

A

F>A>S>T - fluids , antiemetics, steroids,thiamine
IVfluids - 1st step - NS.9% if k+ low add 20-40 kcl
Antiemetic - 1.zines , 2. Metoclopramide, ondansetron , 3. Steroids
Thiamine to prevent wernickes

Look for - ketonuria, tachycardia, weight loss, sunken eyes, loss of skin turn or and a prolonged capillary refill

147
Q

What are the possible complications?

A

Wernicke’s encephalopathy
- thiamine added in later management

Mallory Weiss tear due to severe vomiting

148
Q

What recommended vaccines should pregnant women receive

When should they be given?

A

Influenza + pertussis (DPT + influenza given)

B/w 20-32 weeks

149
Q

What vaccines should HIV patients avoid

A

BCG, yellow fever vaccine

If CD4 < 200 avoid MMR as well

150
Q

What are the stages of labour

A

Stage 1 = onset of true labour - full dilation of cervix
2 phases
- latent = 0-3cm dilation usually takes 6 hrs
- active = 3-10 cm dilation - normally 1cm/hr

Stage 2 - full dilation to delivery
Stage 3 - after delivery to delivery of placenta

151
Q

Normal head delivers in what position

A

Occipital-anterior

152
Q

If labour stuck in latent phase i.e 3cm with no further dilation/ poor progress
What should be done?

A 
Amniotomy - if water hasn’t broken
IV oxytocin (syntocinon)
153
Q

Bilateral cystic mass on pelvic US + 1st trimester bleeding
Uterus = large for date + hyperemesis
Suspect?

A

Hyatidiform mole

Bilateral cystic masses = theca lutein cysts

154
Q

Types of gestational trophoblastic disease

A 
1. Hyatidiform mole 
= 2 types -
-complete - b HCG will be extremely high can lead to hyperemesis
- partial 
2. Gestation trophoblastic neoplasia 
= choriocarcinoa, invasive mole 
- this type is malignant and needs chemo
155
Q

Management of molar pregnancy

A

Surgical evacuation - products of conceptions examined to confirm dx

Check HCG every 2 weeks
- no pregnancy allowed until HCH normal ** strict contraception/barrier

156
Q

What does the snowstorm appearance of molar pregnancy represent

A

Hydropic villi and intrauterine hemorrhage

157
Q

What is an advanced complication of sapling it is (PID)

A

Turbo-ovarian abscess

- lower abdominal pain + tenderness + high fever + no discharge

158
Q

Vitamin that reduces risk of having a baby with teratogenic effects (neutral tube defect)

A

Folic acid

159
Q

Dosage of folic acid in pregnancy

A

400 ug/ 0.4mg , once a days for 12 weeks of pregnancy

160
Q

When should 5mg of folic acid be given in pregnancy?

A 
for 12 weeks:
DM
BMI >30
On antiepileptics
Family History of NTD
Previous pregnancy w/ NTD

For whole pregnancy :
Thalassemia or thalassemia trait
Sickle cell disease

161
Q

Initial next step in uterine or tubal perforation

A

US abdomen and pelvis

Can’t wait for a CT

162
Q

Third trimester bleeding (painless) after intercourse
Everything else is normal
Dx?

A

Placenta previa

163
Q

What is Rhesus isoimmunisation

A

Rh -ve mother carrying Rh +ve child
Leak of foetal RBCs - anti-D IgG antibodies in mother
= isoimmunisation
So the mother is sensitised
Next pregnancy - the antibodies can cross placenta and cause
- hemolysis (anemia)
- hydrous fetalis (oedema)

164
Q

Rhesus -ve mother is pregnant
Last pregnancy had Rh +ve baby
What would need to be done?

A

US to assess Middle cerebral artery
= this is to estimate foetal Hb (severity of anemia)

If abnormal - fetacl cord sample to quantify Hb

165
Q

Baby born to Rhesus -ve mother develops severe jaundice soon after birth
She did not receive any IM injections in her previous pregnancy
What is the cause of the jaundice?

A

Rhesus incompatibility

Hemolysis - jaundice

166
Q

How soon should anti D immunoglobulin be given ?

A

ASAP - always within 72 hrs of giving birth

Birth = sensitising event

167
Q

Causes of jaundice in 1st 24 hrs

A

Rh incompatibility
ABO incompatibility
Hereditary spherocytosis
G6PD deficiency

168
Q

When should anti D be give in non sensitised Rh -ve mothers?

A

28 & 34 weeks

169
Q

Anti D should be given ASAP in what situations? (7)

Always within 72 hours

A

Delivery of RH +ve infant = live/stillborn
Any termination of pregnancy
Miscarriage if gestation >12 weeks
Ectopic
Antipartum hemorrhage
Amniocentesis / CVS/ foetal blood sampling
Abdominal trauma

170
Q

What tests should be done for babies born to Rh -ve mothers

A

Cord blood @ delivery
Full blood count
Direct Coombs test
= direct antiglobulin- demonstrates antibodies on RBCs of baby

171
Q

Complications of babies born to Rh -ve mothers (4)

Treatment?

A

Hydrous fetalis
Jaundice, anemia , hepatosplenomegaly
Heart failure
Kernicterus

Tx - transfusion, UV phototherapy

172
Q

Gold standard dx of endometriosis

Treatment

A

Laparoscopy
NSAID/ paracetamol / COCP trial, IUS
Surgical - laparoscopic excision

  • endometriosis - chronic, cyclical pelvic pain + dyspareunia
173
Q

Risk of pregnancy in laparoscopic tubal sterilisation

A

1:200 = 0.5%

174
Q

Contraceptive with lowest failure rate

A

1.Etonogestrel contraceptive implant ** 0.05%**
= implanon,nexplanon

  1. Mirena - levonorgestrel IUS - 0.2$
175
Q

What is a pearl index?

A

No of contraceptive failures/ 100 women

= no. Of total accidental pregnancies
__________________________________
Total months of exposure

176
Q

Failure rate of tubal ligation

A

5%

177
Q

Absolute risk of pregnancy with Mirena

A

None

  • absolute risk does not increase with any contraceptive method

Mirena increases relative risk of ectopic
= 1:20

178
Q

Cervical screening ages + frequency

A

25-49 - every 3 years

50 -64 - every 5 years

Pap smear / cervical smear

179
Q

Borderline or mild dyskaryosis on cervical smear

Management

A

Test original sample for HPV
If + = patient referred for colposcopy
If -ve = goes back to routine recall

180
Q

Inflammatory changes without dyskaryosis seen on Pap smear

Next step?

A

Repeat smear in 6 months

181
Q

Moderate dyskaryosis on Pap smear

Management

A

=CIN II

Refer for urgent colposcopy within 2 weeks

182
Q

Severe dyskaryosis on Pap smear

Next step

A

= CIN III

Urgent colposcopy w/in 2 weeks

183
Q

Suspected invasive cancer on Pap smear

A

Colposcopy w/in 2 weeks

184
Q

Inadequate sample of Pap smear

Next step

A

Repeat smear
- if persistent ( 3 inadequate samples)
= assess by colposcopy

185
Q

Women who have been treated for CIN I/II/II - when should they come back for ‘test of cure’?

A

After 6 months of treatment

186
Q

Cervical smear is Normal
Swabs negative for chlamydia and neisseria
US normal
Cervix appears normal
But patient has abnormal intermenstrual bleeding > 6-8 weeks
Next step?

A

Refer for colposcopy

187
Q

When is termination of pregnancy legal?

A

Before 24th week of gestation
(23 weeks +6 days)

Unless it is life saving or evidence of extreme foetal abnormality
Or risk of serious physical/mental injury to the woman

188
Q

Legal aspects of abortion

What must be done?

A

2 registered medical practitioners must sign legal document
1 is needed in case of emergency

Only a registered medical practitioner can perform an abortion - must be done in NHS hospital or licensed premise

189
Q

Methods of abortion
<9 weeks
<13 weeks
>15 weeks

A
  1. Mifepristone = anti-progestogen (RU486)
    - given + 48 hrs later prostaglandin given to stimulate contractions
  2. Surgical dilation and suction
  3. Surgical dilation and evacuation or later medical abortion (mini labour)
190
Q

Ages of consent that are valid for termination

A

Pregnant females 12-15
- if they understand all aspects of procedure + physical/mental likely to suffer if they don’t receive termination
(Pregnancy should be <24 weeks)

> 16

191
Q

Amenorrhoea and all labs are normal
(LH FSH estradiol prolactin)

Cause?

A

Absent uterus

192
Q

Amennorhoea +
Raised LH & FSH (ratio >2:1)
Normal/raised estradiol

Cause?

A

PCOS

193
Q

Raised FSH on 2 separate occasions + amenoorhoea
Low LH and estradiol

Dx?

A

Premature ovarian failure

194
Q

Amenorrhoea +
Raised FSH LH ; Low estradiol
Possible causes?

A

Turners syndrome
= ovarian failure days genesis - no working ovaries - low oestrogen
Absent ovaries

195
Q

Primary amenorrhoea + LH FSH and oestrogen are normal

What should you suspect ?

A

Absent uterus ( congenitally like in mullerian agenesis)

196
Q

Most important RF in ovarian ca

A

Family history

197
Q

Most important RF in bladder ca

A

Smoking

198
Q

Most important RF in colorectal ca

A

Age > family history

199
Q

Ovarian ca RF (3)

A 
Family history - BRCA1 BRCA2 genes (autosomal dom)
Increased ovulation ( early menarche, late menopause, nulliparity)
Age

Anything that increases ovulation increases the RF and vice verse
Pregnancy and COCP are protective

200
Q

Physiological jaundice vs prolonged

A

Day 2-14 , commonly seen in breast fed babies

Prolonged = > 14 days

201
Q

Tests done in prolonged jaundice

A

Conjugated + unconjugated bilirubin - most imp
=Raised conjugated = could indicate biliary atresia - urgent intervention
Direct anti globulin test - Coombs
Thyroid fn
FBC + blood film , U&Es , LFT

202
Q

Causes of prolonged jaundice (6)

A 
Biliary atresia
Hypothyroidism 
Galactosemia
UTI
Breast milk jaundice
Congenital infections - CMV, toxoplasmosis
203
Q

What should you suspect in a case of heavy and irregular vagina bleeding over the age of > 40?
What do you do ?

A

Endometrial hyperplasia

- TVUS, if endometrium is thick — hysteroscopy + biopsy

204
Q

Endometrial hyperplasia w/o atypia

What is the 1st line of treatment

A

Mirena

-progesterone decreases the thickness caused by excess estrogen

205
Q

Dx of POF

Tx

A

FSH measured x2, 4 weeks apart
If both are raised - POF

Hx of amenorrhea + hot flushes / night sweats in woman <40
Tx - HRT until age 51

206
Q

Types of fibroids - what are their approaches

Which is most common?

A 
Submucosal / Subserosal / Intramural* (Commonest)
Hysteroscopic myomectomy (SM)/ laparoscopic (SS)

SM - into uterine cavity SS - outside uterus IM - within muscle layer

207
Q

Features of fibroid (6)

A 
Fibroid = benign smooth muscle tumour 
-Afro carribean 
Menorrhagia
Bloating 
Asymptomatic/ lower abd pain /cramping 
Urinary sx (frequency)
Subfertility
208
Q

Dx of fibroid

Management

A

TVUS - dx
Management -
Mirena IUS - shrinks fibroid, manages bleeding
= for women that don’t want to get pregnant currently + fibroid is small , uterine cavity not distorted
^ if CI - uterine ablation (but affects fertility )
To save fertility - myomectomy

209
Q

Who should NOT be given the following :

COCP Mirena and Depo-provera

A

Hx of pulmonary embolism

Migraine with aura

210
Q

Hysteroscopic vs abdominal myomectomy

A

Hysteroscopic - for submucosal (project into uterus)

Abdominal - subserosal (project outside uterus)

211
Q

Most successful option for treatment of fibroid

A

Hysterectomy

212
Q

Treatment options fibroid

A

Hysterectomy
Uterine artery embolisation - saves fertility but myomectomy preferred
Endometrial ablation - if fibroids < 3 cm , does not save fertility
= considered if 1 st line treatment CI
GnRH agonist - used before surgery to shrink fibroid and decrease post op bleeding

213
Q

Test used to assess ovulation in female w/ 28 day regular cycle

A

Day 21 progesterone
= mid lateral progesterone level
Progesterone> 30 nmol/l = ovulation

(1 week before expected start of cycle)

** cycle = 28 = 28-7 = day 21
Cycle 32 - 31-7 = day24
Cycle 35 - 35-7 = day 28

214
Q

Safest antihypertensive in pregnancy

A

Labetalol

215
Q

Retained products of conception can lead to

A

Endometriosis (. Uterine infection )

216
Q

Features of endometritis (3)

A

Fever* may not always be present
Foul smelling vaginal discharge + bleed
24hrs - 12 weeks after delivery

217
Q

RFs of endometritis (3)

A

Emergency CS
Prolonged labour
After surgical termination of pregnancy

218
Q

Investigation + Treatment of endometritis

A

I - HVS

T- co-amoxiclav

219
Q

Iceberg tip sign + flat-fluid level on US

Unilocular

A

Dermoid cyst

220
Q

Echo genie tubercle projecting into cyst lumen on US

Dx?

A

Ovarian teratoma

221
Q

Observations after removal of hyatidiform mole

A

BHCG every 2 weeks until normal

No pregnancy should happen until this happens

222
Q

Features of PCOS (6)

A 
LH:FSH >/= 2:1 - both raised
Increased insulin - acanthosis 
Increased androgen - and , hirsute Sam 
Amenorrhoea/ oligomenorrhoea 
Infertility / subfertility 
Obesity
223
Q

Management of PCOS

A

General - weight loss
Menstrual irregularity - COCP , mirena , weight loss
Infertility - weight loss, clomifne citrate (1st line)**+ metformin
Other - laparoscopic drilling

** if main complaint heavy bleeding = mirena or COCP

224
Q

Initial step of management in PCOS

A

Always weight loss

225
Q

Gestational HTN vs pre-eclampsia

A

Preeclampsia - HTN after week 20 + any of the following
Significant proteinuria >.3g/24hr
Protein creatinine ratio > 30 mg/mmol
Albumin creatinine ratio > 8mg/ mmol

226
Q

AFP marker for

A

Liver (HCC)

Teratoma of testicles/ ovaries

227
Q

LDH is a marker for

A

Testicular seminoma

228
Q

CA199 marker for

A

Pancreatic ca

229
Q

CA 15-3 marker for

A

Breast ca

230
Q

CA 125 marker for

A

Ovarian ca

231
Q

CEA marker for

A

Colorectal ca

232
Q

Dyspareunia + dysuria_ frequency in a woman > 51
Also complains of vaginal itching
Tx?

A

Atrophic vaginitis - topical estrogen cream

233
Q

Tender white plaque on vulva
Itchy, especially at night
Treatment ?

A

Lichen sclerosis

Topica steroids + F/U

234
Q

Treatment of vaginal thrush

A

Topical clotrimazole

235
Q

Yellow - greenish offensive discharge + itching
Strawberry cervix
Ph > 4.5
Treatment

A

Trichomoniasis vaginalis

- metronidazole

236
Q

Offensive discharge - no itching
Fishy smell
Ph >4.5
Treatment

A

BV - metronidazole

237
Q

Chronic pelvic pain , worsened by standing and premenstrually
Post coital ache
Dx?

A

Pelvic congestion syndrome

Investigation are unremarkable

238
Q

Treatment of PMS

A

COCP

239
Q

Recurrent miscarriage in 1st trimester
Suspect -
What do you give to prevent further miscarriage

A

Antiphospholipid syndrome

Give LMWH + aspirin

240
Q

PID treatment

A

Outpatient - OM
Oral ofloxacin + oral metronidazole
To
IM ceftriaxone + oral doxy + oral metronidazole

In - CDM
Ceftriaxone + doxy + metronidazole

241
Q

Failed at home treatment of PID

What do you do?

A

Admit

Give IV ceftriaxone + oral doxycycline

242
Q

Features of molar pregnancy (4)

A

Large for date uterus + +ve pregnancy
Hyperemesis
Vaginal bleeding 1st trim
Passage of vehicle through vagina

243
Q

Pain management in pregnant women

A

Paracetamol

Involve consultant if she needs more

244
Q

Most common STI in the UK

A

Chlamydia

245
Q

Treatment o chlamydia cervicitis

A

Doxycycline 100mg BID 7 days

246
Q

Most appropriate investigation of cervicitis

What can happen if it is left untreated

A

Endocervical swab
Vulvovaginal swab

Untreated - sapping it is

247
Q

Missing IUD threads - can’t be seen on speculum

What do you do next?

A

TVUS

If you still can locate it do an abdominal XR

248
Q

ABx that are safe and not safe in pregnancy

A

Macrolides - erythromycin = safe

Trimethoprim - anti folic acid - CI in 1st trimester
= risk of teratogenicity , if used give 5mg folic acid

Nitroufuratoin - CI near term (1 week before + 1 week after delivery)
=risk of neonatal hemolysis

Avoid cipro - risk of arthropathy

249
Q

ABx for UTI that are safe in pregnancy

A

Amoxicillin
Cefalexin
Macrolides

250
Q

P450 enzyme inducers

A

CRAP GPs
- decrease warfarin effec - decrease INR
Can’t be used w/ COCP unless additional contraceptive method used -IUS IUD
Carbamazepine, rifampin, chronic alcohol, phenytoin, griseofulvin, phenobarbital , sulfonylureas

251
Q

P45 enzyme inhibitors

A

Increase effect of warfarin, can be used with COCP
SICK FACES
Sodium valproate, isoniazid, cimetidine, ketoconazole, fluconazole, acute alcohol, chloramphenicol, erythromycin (macrolides), sulfonamides, cipro, omeprazole, metronidazole

252
Q

Treatment of TB in pregnancy

A

RIPE

But avoid streptomycin - harmful to foetus

253
Q

Tx of chlamydial cervicitis in pregnancy

A

Erythromycin

Instead if doxy or azithromycin

254
Q

Cyclical pain + 1ry amenorrhoea

A

Hematometra

  • blood accumulates within uterus
  • imperforate hymen , transverse vaginal septum
255
Q

Secondary PPH

A

12hrs - 12 weeks after delivery

Due to retained placental tissue or endometritis

256
Q

Most common cause of 1ry PPH

A

Uterine atony - 90% of cases

257
Q

Treat of MgSo4 overdoes

A

Stop MgSo4
- get serum level checked
Give diazepam - if ongoing seizure
Calcium gluconate- antidote

258
Q

Gold standard of endometriosis dx?

A

Laparoscopy

259
Q

Preferred laxative in pregnancy

A

Lactulose - osmotic laxative

Ispaghula 1 st line, Lactulose 2nd

260
Q

Constipation management in general

A
  1. Lifestyle - water, diet , excercise
    1st line - senna
    Pregnancy - ILS
    I ispaghula , Lactulose, senna
261
Q

2+ proteinuria in pregnant woman > 20 weeks
Normotensive
What do you do?

A

Urgent referral to 2ry care - same day w/in 24 hrs

262
Q

1+ proteinuria in pregnant woman > 20 weeks
Normotensive
What do you do?

A

Reassess in GP clinic after 1 weeks

263
Q

Gestational HTN

Management

A

New HTN after 20th week w/o significant proteinuria
Mild - 140/99 - 149/99 - observe , no meds
If > 149/99 - oral labetalol 1st line
= nifedipine if CI
If ^ CI = methyldopa

264
Q

Routine bloods at antenatal booking

A

HIV
Hepatitis B
Syphilis screen

FBC, blood group

265
Q

Vaccines recommended in pregnant women

A

Influenza + pertussis

266
Q

Inflammatory changes w/o dyskaryosis

What do you do

A

Repeat smear in 6 months

267
Q

Borderline or mild dyskaryosis

Next step

A

Retest original sample form HPV

If +ve - colposcopy

268
Q

Moderate/sever dyskaryosis

Suspected invasive ca

A

Urgent colposcopy within 2 weeks

269
Q

Inadequate cervical smear sample

A

Repeat smear

If 3 samples in adequate - colposcopy

270
Q

Loading dose of MgSo4 in eclampsia fit

Regimen?

A

4g MgSo4 in 100 ml 0.9% NS - infusion pump over 5-10 mins
^load
Regimen:
1. Loading dose
2. 1g/hr MgSo4 for 24 hrs after last seizure- maintenance
3. Recurrent seizure - further 2g bolus or increase infusion to 1.5-2g/hr

271
Q 
Young non sexually active women :
1.Menorrhagia only
2.Menorrhagia + dysmenorrhoea
3.Metrorrhagia +/- menorrhagia/dysmenorrhoea
Treatment
A
  1. Tranexamic acid
  2. Mefenamic acid
  3. COCP
272
Q

Sexually active female w/ menorrhagia/dysmenorrhoea/ fibroids not distorting uterine cavity
1st line treatment

A

Mirena IUS
If CI/ no long contraception wanted - COCP (if no CI for that)

Uterine cavity distorted - nexplanon (implants)
Sickle cell - Depo

273
Q

post-partum thyroiditis treatment.

A

Manage symptoms
Palpitations and tremors = propanolol

Usually resolves on its own in 1st year after delivery

274
Q

Cervical ectropion bleeds on touch

Next step?

A

Colposcopy

If last smear >3 years ago -order smear

275
Q

What are the antiphospholipid antibodies?

A

Lupus anticoagulants
Anti-cardiolipin antibodies
Anti-B2 glycoproteins 1 antibodies

276
Q

Folic acid dose in DM pregnancy

A

5mg for first 12 weeks

277
Q

Postmenopausal HRT

A

No uterus or IUS in place - oestrogen only HRT
Otherwise combined HRT

If smoker - give transdermally as oral router higher risk of VTE

278
Q

Meigs syndrome

A

Ascites
Pleural effusion
Benign ovarian tumour

279
Q

Early pregnancy w/ no feta, cardiac activity on TVUS

What next ?

A

Measure CRL and gestational sac diameter
CRL <7mm or GSD<25mm - repeat TVUS in 1 week

CRL >/=7mm or GSD >/=25mm -2nd opinion , rescan in 7 days

280
Q

UKMEC categories

A

1- breast feeding after 6 months, varicose veins
2- smoking, BMI >30
3- migraine with aura = absolute CI

1- no restrictions , safe
4- absolute CI

281
Q

Contraceptive method in migraine with aura

A

IU copper device and barrier methods

2. POP, IUS, DMPA

282
Q

Moderate to high risk of developing preeclampsia (11)

What should be given?

A 
Hx of HTN or pre eclampsia 
FHx of pre eclampsia 
Pregnancy >40 yrs
BMI > 35
CKD , chronic HTN , SLE , antiphospholipid syndrome 
Pregnancy interval >10 years
Dm 
Twins, triplet pregnancy

Aspirin 75-150 mg daily from week 12 until delivery

283
Q

Contraception for woman with history of DVT

A

IUCD,

284
Q

Safest contraception

A

IUCD

285
Q

Herpes tx in pregnancy

1st Time

A

1st time -
- 1st + 2nd trim
=oral acyclovir 400 mg TID 5 days
= + from week 36 onwards 400mg TID to reduce neonatal transmission

3rd trim - same as ^ +CS preferred method of delivery

286
Q

Herpes tx in pregnancy - recurrent

A

from week 36 onwards 400mg TID

Risk of neonatal herpes is low even if lesions are present

287
Q

Initial management of single prolonged deceleration

A

Switch to lateral left decubitus position
IV fluids
Prepare for CS as needed

288
Q

Tx UTI in pregnancy

A

Nitrofurantoin unless CI
Cefalexin
Amoxicillin

289
Q

When should serum CA 125 be checked as 1st step

A 
Any woman 50 or over + 1 of the following :
Abdominal distension/ bloating
Loss of appetite or early satiety 
Pelvic or abdominal pain
Increased urinary urgency/frequency

*check CA125 and then do US

290
Q

Lowest failure rate contraception

A

Etonogestrel contraceptive implant 0.05%
Mirena 0.2%
Both better than tubal ligation

291
Q

PCOS, Tried COCPs but develop side effects

Suggested contraception

A

Norethisterone

292
Q 
Missed pill (POP)
What do you advise
A

Take next dose ASAP
Continue taking at usual times
Use condoms if having intercourse for 48 hrs of restart time

293
Q

Missed pill COCP
What do you advise
1 missed
2 or more missed

A

1 missed -
Take next dose ASAP - even if 2 pill a day
Continue taking as usual

2 or more missed -
Take next dose ASAP - even if 2 pill a day
Use condoms or abstain from unprotected sex for 7 days
Emergency contraception if in week 1 ONLY
If missed in week 3 - omit pill free interval

294
Q

Pelvic organ prolapse

  • stage 1
  • stage 2

Management

A

1- prolapse above introitus
2- until level of introitus

Try pelvic floor muscle training - 16 weeks = 1st option for. Symptomatic pelvic organ prolapse

Vaginal pessary as additional treatment

295
Q

Migraine w/ aura in woman on COCPS

Most appropriate action

A

Advise her to switch to POPs

296
Q

Initial investigation for :
-Menorrhagia w/ no other complaints; uterus not palpable on examination

  • menorrhagia + no other complaints ; uterus is palpable on abdominal exam
A

1- FBC

2- pelvic US -= look for submucosal fibroids

297
Q

Normal cervical smear cytology + positive screeen for HPV

What should be done ?

A

Re-screen for HPV in 12 months

If cytology abnormal - refer for colposcopy

Revision (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions