OBGYN Flashcards
1
Q
how do you treat a uti and pyelonephritis in pregnancy
A
asymptomatic bacteruria/ acute cystitis= 1st/ 2ndtrim nitrofuratoin, 3rd trim trimethoprim (7 days with culture for test of cure)
pyelo= 7 days co-amox (iv or oral) with culture test of cure
2
Q
what should you do to levothyroxine dose in pregnancy
A
increase by 30-50%
3
Q
what drug to treat hyperthryoid in pregnancy
A
PTU (switch from carbimazole three months prior to conception)
4
Q
what antiepileptic drugs are safe in pregnancy
A
carbamazepine
lamotrigine
levetiracetam
5
Q
lifestyle advise for pregnancy women with epiliepsy
A
folic acid 5mg until end of 1st trim
shower instead of baths/ shallow baths
6
Q
what should you do in intrapartum seizure
A
benzodiazepines asap
CTG
7
Q
what diabetes drugs are safe in pregnancy
A
metformin
insulin
8
Q
how much folic acid in low risk pregnancy
A
400 micrograms
9
Q
can you use ACEis in pregnenacy
A
no
10
Q
can you use warfarin in pregnancy
A
no
11
Q
how many DS babies will have normal anomaly scan
A
50%
12
Q
when is anomaly scan done
A
20 weeks
13
Q
what does downs syndrome screening consist of
A
at booking (11-13 weeks): combined test: USS (NT, raised in DS, normal <3.5), PAPP-A (reduced in DS), aFP (reduced in DS), bHCG (increased in DS)
15-16 weeks quad test: aFP, inhibin (raised), oestriol (lower) and total HCG
NIPT is positive
CVS/amniocentisis to confirm
14
Q
should you give anti D to mothers who have already been sensitised
A
no
15
Q
when should you give anti D
A
within 72 hours of sensitising event
prophylatically at 28 weeks
(only rhesus -ve mothers)
16
Q
when is CVS done
A
11-13+6 weeks (2% change of miscarriage)
17
Q
when is amniocentesis done
A
16 weeks (1% risk)
18
Q
when is chorionicity determined
A
at booking scan
19
Q
how do you date pregnancy in 1st tri
A
CRL USS
20
Q
what happens to umbilical and middle cerebral artery resistance in fetal hypoxia
A
umbilical goes up
MC down
21
Q
how do you monitor growth in low risk pregnancy
A
symphaseal fundal height (roughly 1cm per week)
22
Q
when is a still birth, early and late neonatal death
A
still birth born with no signs of life at 28 weeks
early neonate 7 days
late up to 28 days
23
Q
what can you give in multiple pregnancies
A
folic acid, iron, low dose aspirin
24
Q
what is the most dangerous form of breech
A
footling (feet/ one foot first)
25
what is gravidity
number of times pregnant
26
when should fetal movements start
20 weeks
27
what is parity
pregnancy with deliveries >24 weeks
28
what is EDD
9 months + 7 days after last menstrual period
29
what anti-emetics for hyperemesis
1s line: cyclizine, prochlorperazine
2nd line: metaclopramide, odansetron (do not give in 1st trimester as risk of cleft), domperidone
steroids if severe
30
what other medication should you give in hyperemesis
thiamine, folic acid high dose, thromboprophylaxis if dehydrated
31
what analgesia can you not give in pregnancy
NSAIDS- pulmonary hypertension, premature closure of DA and oligohydramnios
avoid morphine if possible
32
what medication can help colicky, GI pain
anti-spasmodic e.g buscopan
33
what analgesia cannot be given when breastfeeding
codeine
34
what is sulfasalazine
a 5-ASA
35
can you take methotrexate in pregnancy/ when conceiving
no needs to be stopped by both partners 6 months prior to conceiving
36
what drugs to control IBD are NOT safe in pregnancy
methotrexate, mycophenalate, ibruprofen
37
what is the dose for adrenaline in anaphylaxis
500 micrograms 1:1000 (10,000 for cardiac arrest)
38
when can IUD be inserted after birth
immediately in SVD
| within 48 hours following c section
39
when can implant be put in after childbirth
anytime
40
what contraception is not recommended in breast feeding
oestrogen based (COCP, vaginal ring )
41
when can you take levonorgestrel after UPSI
within 72 hours
| if vomiting occurs within 3 hours repeat the dose
42
when can ulipristal be taken after UPSI
up to 5 days
43
when can a copper IUD be fitted after UPSI
up to 5 days or 5 days after predicted day of ovulation
44
what are the contraindications to the COPC
migraine with aura, smoking history and high BMI, uncontrolled hypertension, Hx of stroke/MI, breast feeding, <6 weeks post partum, positive APS antibodies
45
what contraception causes weight gain
depo provera
46
what is the first line for heavy menstrual periods
mirena (then COCP, then long acting progesterone)
47
what is first line for heavy menstrual periods when trying to conceive
tranexamic acid
48
what do you need to be cautious of with NSAIDs and asthmatics
NSAID hypersensitivity
49
what hypertension meds are safe in pregnancy
labetalol, methyldopa, nifedipine
50
what should you do to lithium in pregnancy
keep dose the same, increase monitoring, involve psych
51
what medication for eclampsia
IV magnesium sulphate
52
what can be used to prevent pre-eclampsia in those with a history of it
low dose aspirin from 12 weeks
53
what are the diagnostic values from GDM
fasting >5.6
| 2hr >7.8 (5-6-7-8)
54
what is infertility
failure to conceive despite regular unprotected intercourse over 12 months in the absence of known reproductive pathology. Can be primary or secondary
55
what are the potential comps of PID
tubo-ovarian abscess, peritonitis, fits-hughcertis syndrome
| chronic pelvic pain, ectopic pregnancy, infertility
56
what is a hydrosalpinx
fluid filled dilatation of the fallopian tube
57
what hormone causes ovulation
LH surge
58
when is the best day to check for progesterone to see if ovulating
mid luteal phase (length of cycle - 7 days ) usually day 21
59
what are the groups of ovulatory disorders
group 1- hypothalamic (reduced production of GnRH= low FSH, negative progesterone challenge)
group 2- hypothalamic pituitary- PCOS: normal GnrH, normal oestrogen but anovulatory
group 3- ovarian failure- high gonadotrophins, low eostrogen
60
what is the commonest cause of anovulatory infertility
PCOS
61
who do you diagnose PCOS
rotterdam criteria:
irregular cycle, hirsutism, acne, subfertility, alopecia, obesity
elevated LH, normal estradiol, low progesterone, raised testosterone
TVUSS PCOS morphology
62
how do you induce ovulation in PCOS
1st line
antioestrogens: clomifene citrate, tamoxifen
amromatase inhibitors letrozole
2nd line
clomifene +metformin, gonadotrophin injections
3rd line
ovarian diathermy
63
what can cause male infertility
idiopathic
obstruction: vasectomy, infection, congenital absence of VD (CF)
undescended testes, orchitis, torsion/trauma, genetic
hormonal, testicular cancer, chemo
64
treatments for male infertility
surgery if obstructed
IUI/ICSI
donor sperm
65
when should a hysterosalpingogram be done
to assess for patency when no known risk factors or tubal/ pelvic pathology
if history of PID/ endometriosis/ adhesions (previous surgery, previous ectopic, appendix) or previous abnormal HSG then laparoscopy should be done as can treat
66
tx for tubal disease
surgery, IVF
67
what common investigations are done for infertility
rubella immunity, chlamydia screen, ovulation test (progesterone day 21), semen analysis and tubal patency (HSG if not CI)
68
how is anaemia in fetus screen for
middle cerebral artery peak velocity pressure
69
what is a minor haemorrhage
<500ml (major 500-1000, massive >1000 and /or signs of shock)
69
what is a minor haemorrhage
<500ml (major 500-1000, massive >1000 and /or signs of shock)
70
is speculum exam safe in placenta praevia
yes
71
how do you tell the difference betwen placenta praevia and abruption
praevia: painless, bright red bleeding, symptoms in proportion to amount of visible blood loss, uterus non tender
abruption: painful, tender tense uterus, unwell patient out of proportion to visible blood loss (concealed bleed), fetal distress/ absent heart sounds
72
what is HCG like in an extopic pregnancy
not as high as a normal pregnancy
73
what is the medical management for a miscarriage
misoprostol
74
what is the medical management for an ectopic pregnancy
methotrexate
75
what is the management for hyperemesis
```
rehydration, nutrients IV
cyclizine/ prochloperazine
2nd line odansetron/ metaclopramide
steroids if refractory
thiamine
randitidine/omeprazole for reflux
thromboprophylaxis if dehydrated
```
76
treatment in pregnancy for APS
aspiring and fragmin daily injections (LMWH)
77
what is an inevitable miscarriage
symptoms + products already passed/ non viable pregnancy/ open cervical os
78
when are miscarriages recurrent
>3
79
what is a threatened misscarriage
bleeding +/- pain but viable intrauterine pregnancy, fetal pole >7mm, heartbeat
80
what is a missed misscarriage
no symptoms but no viable preg on USS
81
what is an incomplete misscarriage
some products passed, some remain
| risk of cervical shock- need speculum evacuation with sponge forceos
82
what is a fall of 50% HCG suggestive of
misscariage
83
what is snow storm on USS and passing of grape like matter
molar preg
84
treatment for molar pregnancy
surgery
85
what are the treatment options for stable ectopic/ inevitable/ incomplete misscariage
medical
conservative (give 2 weeks, repeat HCG until negative in ectopic pregnancy)
surgical
86
what is typically the management for threatened misscarriage
watch and wait
87
what are the molar pregnancy
complete: 2 sperm no egg (risk of choriocarcinoma)
partial: 1 egg 2 sperm
88
what is implantation bleeding like
normal
10 days after ovulation (when period would have been)
minimal, light brown
89
what are the stages of labour
1st:
latent: up to 4cm dilatation
active: 4-full
2nd: full to delivery of fetus (passive no involuntary expulsive contractions, active have these/ baby visible)
3rd: from delivery of fetus to delivery of placenta and membranes
90
when is labour prolonged
1st stage <2cm in 4 hours
2nd stage 2hrs nuliparous (3 if epidural) 1hr if multiparous
3rd >30 mins active management, >60 mins physiological management
91
what is active management of 3rd stage of labour
uterotonic drugs as ant shoulder birthed (oxytocin and syntometrine)
bladder catheterisation
controlled traction following signs of separation (uterus rises, contracts and hardens, cord lengthens, gush of blood, placenta/ membranes appear at introitus)
92
what is engagement
1/5ths of fetal head not palable in abdomen- has gone below ischial spines
93
what are the steps of labour
engagement, descent, flexion, internal rotation (transverse to anterior), extension, external rotation (restitution), expulsion
94
what is malpresentation and position
mal position: OP, OT
| malpresentation: breech, transverse, shoulder, arm, face, brow
95
what are the causes of failure to progress
power
passage
passenger
96
what are the signs of obstruction
moulding, caput, haematuria, vulval oedema, anuria (obstructive AKI)
97
when can outlet, mid/ low cavity and rotational forceps be used
outlet baby visible at pelvic floor
mid/low when 1/5th palpable abdominally
rotational in theatre
98
can caput succedaneum cross suture lines
yes, resolves in a few das
99
can cephalohaematoma cross sututre lines
no, subperiosteal haemorrhage, associated with jaundice, may take months to resolve
100
what do you need to check for prior to artifical ROM
cord prolapse/ vasa praevia
101
methods of induction of labour
```
stripping membranes
AROM
syntocin infusion (post amnitomy)
prostaglandin pessary (membranes in tact)
mechanical cervical ripening
```
102
what space is an epidural inserted
L3/4
103
what are the normal CTG parameters
3-5 contractions in 10 mins
HR 110-160
variability 5-25
accelerations >/= 15 beats for >/= 15 seconds, 2 every 15 mins, should occur with contractions
early decelerations (>/=15 drop for ./= 15 seconds_
104
when is a deceleration abnormal
always tell someone about them
late (occurs into contraction and takes >20s after contaction finished to return to baseline)
shows fetal hypoxia
105
what is a terminal CTG
```
terminal bradycardia (<100 for >100 mins)
terminal deceleration (takes >3 mins to recover)
= emergency c section
```
106
is decreased variability and fetal tachycardia fine
no
107
what should you do when there is a non reassuring CTG
```
get help
stop oxytocin
left lateral position
fluids
consider tocolysis
```
108
what are variable decelerations
no relationship to contractions
| seen in decreased amniotic fluid/ PROM due to cord compression, change position and increase monitoring
109
what does a sinusoidal pattern mean
urgent c section
110
what first line test for PE in pregnancy
CXR and then V/Q scan
111
can you use DOACs in breastfeeding
no
112
can you use warfarin when breastfeeding
yes
113
what is thromboprophylaxis in pregnancy
LMWH
114
when can you take emergency contraception
copper coil 5 days aster UPSI or after predicted date of ovulation (length of cycle -14)
levonorgestrel 72 hours (3 days)
ulipristal 120 hrs (5 days)
115
what is the Ix and Tx for prostatitis
MSSU for C+S (+/- FVU NAAT for G/C)
| oflaxcin 28 days
116
what is the Ix and Tx for BV
```
wet mount (clue cells)
oral met 5 days
```
117
what is the Ix and Tx for chlaymdia
NAAT test
FVU, vulvovaginal swab, pharyngeal, rectal,
if symptomatic male urethral swab for microscopy
test 14 days after exposure
Tx doxycycline for 7 days (or azithromycin)
no test of cure unless pregnant or rectal disease
118
what is the Ix and Tx for gonorrhoea
(gram -ve intracellular diplococcus)
NAAT tests same as chlamydia, 14 days after exposure
ceftriaxone
119
what is the Ix and Tx for trichomonas vaginalis
high vaginal swab for microscopy
is men with recurrent non G/C urethritis or contact empirical tx
oral met 5-7 days
120
what is the Ix and Tx for candida
high vaginal swab
| oral fluconazole and clotrimazole pessary
121
what might cause non gonococcal urethritis
mycoplasma genitalium
| trichonomas vaginalis
122
what does HAART consist of
3 drugs from 2 different classes
123
what infections are screen for at booking
syphillis, hep b, HIV and rubella
124
when in location of placenta screened for
anomaly scan
125
what does G 4 para 2 + 2
pregnant 4 times
2 deliveries regardless of outcome (past 24 weeks)
+2 carried not to 24 weeks
126
does an overweight women carrying twins need VTE prophylaxis
needs aspirin as twins higher risk of PET and IUGR
| needs LMWH as overweight (fragmin)
127
what is the first line medical management of uterine atony
syntocinon
128
what metabolic disturbance are patients receiving blood transfusions at risk of
hypocalcaemia
129
when do you test for gestational diabetes
if previous history of RF- aOGTT at booking and 24-28 weeks
130
when should Tx be started in gestational diabetes
if fasting <7 but not responding to two weeks of lifetsyles changes
>/=7
131
what are the target levels for gestational diabetes
fasting <5.3
1 hr after meals <7.8
2hr <6.4
HBA1C <48
