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4th Year > OBGYN > Flashcards

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

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2
Q

what should you do to levothyroxine dose in pregnancy

A

increase by 30-50%

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3
Q

what drug to treat hyperthryoid in pregnancy

A

PTU (switch from carbimazole three months prior to conception)

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4
Q

what antiepileptic drugs are safe in pregnancy

A

carbamazepine
lamotrigine
levetiracetam

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5
Q

lifestyle advise for pregnancy women with epiliepsy

A

folic acid 5mg until end of 1st trim

shower instead of baths/ shallow baths

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6
Q

what should you do in intrapartum seizure

A

benzodiazepines asap

CTG

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7
Q

what diabetes drugs are safe in pregnancy

A

metformin

insulin

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8
Q

how much folic acid in low risk pregnancy

A

400 micrograms

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9
Q

can you use ACEis in pregnenacy

A

no

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10
Q

can you use warfarin in pregnancy

A

no

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11
Q

how many DS babies will have normal anomaly scan

A

50%

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12
Q

when is anomaly scan done

A

20 weeks

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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

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14
Q

should you give anti D to mothers who have already been sensitised

A

no

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15
Q

when should you give anti D

A

within 72 hours of sensitising event
prophylatically at 28 weeks
(only rhesus -ve mothers)

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16
Q

when is CVS done

A

11-13+6 weeks (2% change of miscarriage)

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17
Q

when is amniocentesis done

A

16 weeks (1% risk)

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18
Q

when is chorionicity determined

A

at booking scan

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19
Q

how do you date pregnancy in 1st tri

A

CRL USS

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20
Q

what happens to umbilical and middle cerebral artery resistance in fetal hypoxia

A

umbilical goes up

MC down

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21
Q

how do you monitor growth in low risk pregnancy

A

symphaseal fundal height (roughly 1cm per week)

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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

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23
Q

what can you give in multiple pregnancies

A

folic acid, iron, low dose aspirin

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24
Q

what is the most dangerous form of breech

A

footling (feet/ one foot first)

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25
Q

what is gravidity

A

number of times pregnant

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26
Q

when should fetal movements start

A

20 weeks

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27
Q

what is parity

A

pregnancy with deliveries >24 weeks

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28
Q

what is EDD

A

9 months + 7 days after last menstrual period

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29
Q

what anti-emetics for hyperemesis

A

1s line: cyclizine, prochlorperazine
2nd line: metaclopramide, odansetron (do not give in 1st trimester as risk of cleft), domperidone
steroids if severe

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30
Q

what other medication should you give in hyperemesis

A

thiamine, folic acid high dose, thromboprophylaxis if dehydrated

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31
Q

what analgesia can you not give in pregnancy

A

NSAIDS- pulmonary hypertension, premature closure of DA and oligohydramnios
avoid morphine if possible

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32
Q

what medication can help colicky, GI pain

A

anti-spasmodic e.g buscopan

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33
Q

what analgesia cannot be given when breastfeeding

A

codeine

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34
Q

what is sulfasalazine

A

a 5-ASA

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35
Q

can you take methotrexate in pregnancy/ when conceiving

A

no needs to be stopped by both partners 6 months prior to conceiving

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36
Q

what drugs to control IBD are NOT safe in pregnancy

A

methotrexate, mycophenalate, ibruprofen

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37
Q

what is the dose for adrenaline in anaphylaxis

A

500 micrograms 1:1000 (10,000 for cardiac arrest)

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38
Q

when can IUD be inserted after birth

A

immediately in SVD

within 48 hours following c section

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39
Q

when can implant be put in after childbirth

A

anytime

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40
Q

what contraception is not recommended in breast feeding

A

oestrogen based (COCP, vaginal ring )

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41
Q

when can you take levonorgestrel after UPSI

A

within 72 hours

if vomiting occurs within 3 hours repeat the dose

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42
Q

when can ulipristal be taken after UPSI

A

up to 5 days

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43
Q

when can a copper IUD be fitted after UPSI

A

up to 5 days or 5 days after predicted day of ovulation

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44
Q

what are the contraindications to the COPC

A

migraine with aura, smoking history and high BMI, uncontrolled hypertension, Hx of stroke/MI, breast feeding, <6 weeks post partum, positive APS antibodies

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45
Q

what contraception causes weight gain

A

depo provera

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46
Q

what is the first line for heavy menstrual periods

A

mirena (then COCP, then long acting progesterone)

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47
Q

what is first line for heavy menstrual periods when trying to conceive

A

tranexamic acid

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48
Q

what do you need to be cautious of with NSAIDs and asthmatics

A

NSAID hypersensitivity

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49
Q

what hypertension meds are safe in pregnancy

A

labetalol, methyldopa, nifedipine

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50
Q

what should you do to lithium in pregnancy

A

keep dose the same, increase monitoring, involve psych

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51
Q

what medication for eclampsia

A

IV magnesium sulphate

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52
Q

what can be used to prevent pre-eclampsia in those with a history of it

A

low dose aspirin from 12 weeks

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53
Q

what are the diagnostic values from GDM

A

fasting >5.6

2hr >7.8 (5-6-7-8)

54
Q

what is infertility

A

failure to conceive despite regular unprotected intercourse over 12 months in the absence of known reproductive pathology. Can be primary or secondary

55
Q

what are the potential comps of PID

A

tubo-ovarian abscess, peritonitis, fits-hughcertis syndrome

chronic pelvic pain, ectopic pregnancy, infertility

56
Q

what is a hydrosalpinx

A

fluid filled dilatation of the fallopian tube

57
Q

what hormone causes ovulation

A

LH surge

58
Q

when is the best day to check for progesterone to see if ovulating

A

mid luteal phase (length of cycle - 7 days ) usually day 21

59
Q

what are the groups of ovulatory disorders

A

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
Q

what is the commonest cause of anovulatory infertility

A

PCOS

61
Q

who do you diagnose PCOS

A

rotterdam criteria:
irregular cycle, hirsutism, acne, subfertility, alopecia, obesity
elevated LH, normal estradiol, low progesterone, raised testosterone
TVUSS PCOS morphology

62
Q

how do you induce ovulation in PCOS

A

1st line
antioestrogens: clomifene citrate, tamoxifen
amromatase inhibitors letrozole

2nd line
clomifene +metformin, gonadotrophin injections

3rd line
ovarian diathermy

63
Q

what can cause male infertility

A

idiopathic
obstruction: vasectomy, infection, congenital absence of VD (CF)
undescended testes, orchitis, torsion/trauma, genetic
hormonal, testicular cancer, chemo

64
Q

treatments for male infertility

A

surgery if obstructed
IUI/ICSI
donor sperm

65
Q

when should a hysterosalpingogram be done

A

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
Q

tx for tubal disease

A

surgery, IVF

67
Q

what common investigations are done for infertility

A

rubella immunity, chlamydia screen, ovulation test (progesterone day 21), semen analysis and tubal patency (HSG if not CI)

68
Q

how is anaemia in fetus screen for

A

middle cerebral artery peak velocity pressure

69
Q

what is a minor haemorrhage

A

<500ml (major 500-1000, massive >1000 and /or signs of shock)

69
Q

what is a minor haemorrhage

A

<500ml (major 500-1000, massive >1000 and /or signs of shock)

70
Q

is speculum exam safe in placenta praevia

A

yes

71
Q

how do you tell the difference betwen placenta praevia and abruption

A

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
Q

what is HCG like in an extopic pregnancy

A

not as high as a normal pregnancy

73
Q

what is the medical management for a miscarriage

A

misoprostol

74
Q

what is the medical management for an ectopic pregnancy

A

methotrexate

75
Q

what is the management for hyperemesis

A 
rehydration, nutrients IV 
cyclizine/ prochloperazine 
2nd line odansetron/ metaclopramide 
steroids if refractory 
thiamine 
randitidine/omeprazole for reflux 
thromboprophylaxis if dehydrated
76
Q

treatment in pregnancy for APS

A

aspiring and fragmin daily injections (LMWH)

77
Q

what is an inevitable miscarriage

A

symptoms + products already passed/ non viable pregnancy/ open cervical os

78
Q

when are miscarriages recurrent

A

> 3

79
Q

what is a threatened misscarriage

A

bleeding +/- pain but viable intrauterine pregnancy, fetal pole >7mm, heartbeat

80
Q

what is a missed misscarriage

A

no symptoms but no viable preg on USS

81
Q

what is an incomplete misscarriage

A

some products passed, some remain

risk of cervical shock- need speculum evacuation with sponge forceos

82
Q

what is a fall of 50% HCG suggestive of

A

misscariage

83
Q

what is snow storm on USS and passing of grape like matter

A

molar preg

84
Q

treatment for molar pregnancy

A

surgery

85
Q

what are the treatment options for stable ectopic/ inevitable/ incomplete misscariage

A

medical
conservative (give 2 weeks, repeat HCG until negative in ectopic pregnancy)
surgical

86
Q

what is typically the management for threatened misscarriage

A

watch and wait

87
Q

what are the molar pregnancy

A

complete: 2 sperm no egg (risk of choriocarcinoma)
partial: 1 egg 2 sperm

88
Q

what is implantation bleeding like

A

normal
10 days after ovulation (when period would have been)
minimal, light brown

89
Q

what are the stages of labour

A

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
Q

when is labour prolonged

A

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
Q

what is active management of 3rd stage of labour

A

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
Q

what is engagement

A

1/5ths of fetal head not palable in abdomen- has gone below ischial spines

93
Q

what are the steps of labour

A

engagement, descent, flexion, internal rotation (transverse to anterior), extension, external rotation (restitution), expulsion

94
Q

what is malpresentation and position

A

mal position: OP, OT

malpresentation: breech, transverse, shoulder, arm, face, brow

95
Q

what are the causes of failure to progress

A

power
passage
passenger

96
Q

what are the signs of obstruction

A

moulding, caput, haematuria, vulval oedema, anuria (obstructive AKI)

97
Q

when can outlet, mid/ low cavity and rotational forceps be used

A

outlet baby visible at pelvic floor
mid/low when 1/5th palpable abdominally
rotational in theatre

98
Q

can caput succedaneum cross suture lines

A

yes, resolves in a few das

99
Q

can cephalohaematoma cross sututre lines

A

no, subperiosteal haemorrhage, associated with jaundice, may take months to resolve

100
Q

what do you need to check for prior to artifical ROM

A

cord prolapse/ vasa praevia

101
Q

methods of induction of labour

A 
stripping membranes 
AROM 
syntocin infusion (post amnitomy) 
prostaglandin pessary (membranes in tact)
mechanical cervical ripening
102
Q

what space is an epidural inserted

A

L3/4

103
Q

what are the normal CTG parameters

A

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
Q

when is a deceleration abnormal

A

always tell someone about them
late (occurs into contraction and takes >20s after contaction finished to return to baseline)
shows fetal hypoxia

105
Q

what is a terminal CTG

A 
terminal bradycardia (<100 for >100 mins) 
terminal deceleration (takes >3 mins to recover)
= emergency c section
106
Q

is decreased variability and fetal tachycardia fine

A

no

107
Q

what should you do when there is a non reassuring CTG

A 
get help 
stop oxytocin 
left lateral position 
fluids 
consider tocolysis
108
Q

what are variable decelerations

A

no relationship to contractions

seen in decreased amniotic fluid/ PROM due to cord compression, change position and increase monitoring

109
Q

what does a sinusoidal pattern mean

A

urgent c section

110
Q

what first line test for PE in pregnancy

A

CXR and then V/Q scan

111
Q

can you use DOACs in breastfeeding

A

no

112
Q

can you use warfarin when breastfeeding

A

yes

113
Q

what is thromboprophylaxis in pregnancy

A

LMWH

114
Q

when can you take emergency contraception

A

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
Q

what is the Ix and Tx for prostatitis

A

MSSU for C+S (+/- FVU NAAT for G/C)

oflaxcin 28 days

116
Q

what is the Ix and Tx for BV

A 
wet mount (clue cells) 
oral met 5 days
117
Q

what is the Ix and Tx for chlaymdia

A

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
Q

what is the Ix and Tx for gonorrhoea

A

(gram -ve intracellular diplococcus)
NAAT tests same as chlamydia, 14 days after exposure
ceftriaxone

119
Q

what is the Ix and Tx for trichomonas vaginalis

A

high vaginal swab for microscopy
is men with recurrent non G/C urethritis or contact empirical tx
oral met 5-7 days

120
Q

what is the Ix and Tx for candida

A

high vaginal swab

oral fluconazole and clotrimazole pessary

121
Q

what might cause non gonococcal urethritis

A

mycoplasma genitalium

trichonomas vaginalis

122
Q

what does HAART consist of

A

3 drugs from 2 different classes

123
Q

what infections are screen for at booking

A

syphillis, hep b, HIV and rubella

124
Q

when in location of placenta screened for

A

anomaly scan

125
Q

what does G 4 para 2 + 2

A

pregnant 4 times
2 deliveries regardless of outcome (past 24 weeks)
+2 carried not to 24 weeks

126
Q

does an overweight women carrying twins need VTE prophylaxis

A

needs aspirin as twins higher risk of PET and IUGR

needs LMWH as overweight (fragmin)

127
Q

what is the first line medical management of uterine atony

A

syntocinon

128
Q

what metabolic disturbance are patients receiving blood transfusions at risk of

A

hypocalcaemia

129
Q

when do you test for gestational diabetes

A

if previous history of RF- aOGTT at booking and 24-28 weeks

130
Q

when should Tx be started in gestational diabetes

A

if fasting <7 but not responding to two weeks of lifetsyles changes
>/=7

131
Q

what are the target levels for gestational diabetes

A

fasting <5.3
1 hr after meals <7.8
2hr <6.4
HBA1C <48

4th Year (7 decks)

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