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MSRA 2023 > OBGYN > Flashcards

OBGYN Flashcards

1
Q

duration until effective contraception
IUD

A

INSTANT

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2
Q

duration until effective contraception POP

A

2days
Levonorgestrelm norethisterone, ethynodiol diacetate , desogetrel

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3
Q

duration until effective contraception IUS

A

7 days

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4
Q

duration until effective contraception COC

A

7 days

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5
Q

duration until effective contraception injection + implant

A

7 days
depo provera- medroxyprogesterone acetate 150mg im every 12-14 wks

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6
Q

What type of contraception Nexplanon + duration until effective contraception achieved

A

IUS + 7days

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7
Q

youngest age for consent- contraception

A

13yrs

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8
Q

Choice of contraception in young pts

A

Progesterone only implant Neplanon

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9
Q

Increase risk/ SE of COCP

A

VTE, increased risk breast and cervical cancer
small risk MI + strokes

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10
Q

What risk decreased using COCP

A

ovarian cancer

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11
Q

which drug decreases efficacy of COCP

A

St John’s Wart
Rifampicin

CYP450 inducers

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12
Q

which contraceptive method in pt with migraine

A

Copper IUD

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13
Q

UKMEC 4 COCP

A

> 35 yrs old + smoking >15 cig
migraine with Aura
Hx VTE/ thombogenic mutation
Hx stroke or IHD
breast feeding <6wks postpartum
uncontrolled HTN
current breast cancer
SLE

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14
Q

when to discontinue COCP before surgery

A

Before maj sugery 4wks
Progestogen only contraceptive may be offered

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15
Q

Emergency Contraception, when to take it

A

(POP) Levonorgestrel within 72hr
Ulipristal within 120hrs
IUD within 5day OR if after 5d-> after 5d likely ovulation date

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16
Q

CI depo provera + SE ass

A

Breast cancer
weight gain

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17
Q

When can you start postpartum contraception

A

after 21d

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18
Q

Which contraception CI postpartum

A

COCP-> if breast feeding <6 wks

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19
Q

Most common ovarian cyst

A

follicular cyst

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20
Q

which cyst aka chocolate cyst

A

endometriotic cyst

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21
Q

most common ovarian cancer

A

serous carcinoma

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22
Q

most common Benign ovarian tumour + what risk it increases

A

Dermoid cyst + increases risk of torsion

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23
Q

most common benign epithelial ovarian tumour

A

serous cystadenoma
The mucinous cystadenoma

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24
Q

HTN in pregnancy

A

HTN after 20GW
SBP >140 or dBP >90 or increase above booking reading of >30SBP, >15 DBP

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25
Q

Mx HTN in pregnancy- 1st and 2nd line

A

po labetalol FIRST line

2nd line: Nifedipine + hydralazine if asthmatic

Aspirin low dose 12-14GW till delivery reduce risk of pre-eclampsia

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26
Q

Definition of pre-clampsia

A
  1. new onset HTN 140/90 after 20GW AND one of

2a. proteinuria 0.3g/24hr= 300mg or protein: creatinine ratio 30mg/mmol

2b. renal insufficiciency Cr >90umol/L, liver, neuro, haematological, uteroplacental dysfunction

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27
Q

When to admit pt with pre-clampsia

A

BP >160/110

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28
Q

Eclampsia

A

preclampsia

  1. BP >140/90 + 2. proteinuria or end stage organ dysfunction
  2. seizure
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29
Q

Mx elcampsia

A
  1. MgSO4
    iv bolus 4g 5-10min follow by infusion 1g/hour
  2. emergency C-section
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30
Q

MgSO4 induced resp depression mx

A

iv Ca-gluconate

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31
Q

most common cause of post-coital bleeding

A

cervical ectropion

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32
Q

which contraceptive method ass with weight gain?

A

depo provera (medroxyprogesterone acetate)

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33
Q

Which HPV strain-> cervical ca

A

HPV 16,18/, 33

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34
Q

Cervical cancer screening age + freq

A

25-49 every 3 yrs
50-64 every 5 yrs
NOT offered >64yrs

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35
Q

(-)hr HPV Cervical ca screening result

A

return to normal recall unless test of cure pathway (CIN)

25-49 3 yrly
50-64 5 yrly

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36
Q

(+) hr HPV Cervical ca screening result

A
  1. CYTOLOGY
  2. CYTOLOGY NORMAL: repeat test 12 months
    • if HPV (-): normal recall 25-49 3 yrly; 50-64 5yrly
    • if HPV (+) + cytology still normal: repeat after 12 months
    • if hrHPV (-) at 24 months- return to normal recall
    • if hrHPV (+)==> colposcopy
  3. CYTOLOGY ABNORMAL: COLPOSCOPY
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37
Q

inadequate sample- cervical ca screening

A

repeat sample w/in 3month

2 inadequate sample==> COLPOSCOPY

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38
Q

CIN mx

A

LLETZ: large loop excision of transformation zone
alternative cryotx

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39
Q

Epidemio endometrial cancer + cervical cancer

A

endometrial: postmenopausal
cervical: 25-29 yrs

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40
Q

Risk factors for endometrial cancer

A

excess oestrogen: nulliparity, early menarche, late menopause, unopposed oestrogen
Metabolic sy: obesity, PCOS, DM
Tamoxifen
Hereditary Non-poliposis CRC

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41
Q

Protective factors for endometrial cancer

A

multiparity, COCP, smoking

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42
Q

Asx uterine fibroid Mx

A

1) asymptomatic NIL mx

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43
Q

Uterine fibroid Mx

A

1) menorrhagia: Levnogetrel IUS, NSAIDS- mefenamic acid, tranexamic acid/ COCP or po/ sc progestogen

2) pre-op: GbRH AG eg. leuprolide- dec size of fibroids

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44
Q

Breast feeding CI abx

A

ciprofloxacin: arthropathy

Tetracycline: bdins to Ca2+ in infants system-> dental staining, enamel hypoplasia, inhibits bone growth, photosensitivitiy

chloramphenicol: grey baby syndrome CV collapse, cyanosis

sulphonamides

Aspirin

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45
Q

Mx vasomotor sx menopause

A

fluoxetine, cialopram, velafaxine

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46
Q

Mode of action: COCP

A

inhibit ovulation

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47
Q

Mode of action:: POP

A

thickens cervical mucous

48
Q

Mode of action: desogestrel-only pill

A

Pri inhibit ovulation
also thickens cervical mucous

48
Q

implantable contraceptive

A

pri: inhibits ovulation
also thickens cervical mucous

49
Q

IUD

A

decreases sperm motility and survival

50
Q

IUS

A

pri prevents endmetrial proliferation

also thickens cervical mucous

51
Q

Mode of action: Levonorgestrel

A

inhibit ovulationu

52
Q

Mode of action: Ulipristal

A

inhibits ovulation

53
Q

IUD Mode of action:

A

pri toxic to pserm and ovum
inhibit implantation

54
Q

Mx of primary & sec dysmenorrhoea

A

Primary: NSAIDS + ibuprofen, if not effective then COCP 2nd line
Secondary: ALL pt with secondary needs to be referred to OBGYN

55
Q

When to check for 1st and 2nd rhesus status red cell autoAb

A

8-12 weeks & 28 weeks

56
Q

When to check for BP, urine dipstick and urine culture for asx bacterium is in preg

A

8-12 weeks

57
Q

When to check hep b and syphilis in pregnancy

A

8-12 weeks

58
Q

Early scan to confirm dates, excl multiple preg

A

10-13 weeks

59
Q

When to check down sy, nuchal scan

A

11-13 weeks

60
Q

When is anomaly scan in pregnancy

A

18-20 weeks

61
Q

When do you give anti-D prophylaxis for rhesus negative pregnancy

A

Week 28 and week 34

62
Q

When do you check presentation & offer cephalon version week 36

A
63
Q

Define obesity in pregnancy and mx

A

BMI >30kg/m2 at 1st antenatal visit

Folic acid 5mg and vit D 10mcg (400units) OD

64
Q

Foetal alcohol syndrome FAS

A

Learning difficulties
Face: smooth philtrum, thin vermilion, small palpebral fissure, epicanthic folds, microcephaly

IUGR & postnatal restricted growth

65
Q

Which scale do you use for depression postnatal

A

Edinburgh postnatal depression scale

66
Q

Induction of labour- which score do you use and the score indication

A

Bishop score: assess whether incision of labour required

<5 unlikely to start without induction.
>-8 cervix ripe or favourable for induction.

<-6 vag PG/ po misoprostal, mech methods balloon catheter can be considered if high risk of hyperstimulation/ prev c-section.

> 6 amniotomy + iv oxytocin infusion

67
Q

Causes of postpartum haemorrhage

A

Trauma, tone, tissues, thrombin

68
Q

Mx of postpartum haemorrhage

A
  1. Mechanical: palpate uterine fungus + rub stimulate contraction, catheterisation prevent bladder distension
  2. Medical: failed mechanical mx. If oxytocin slow iv injection followed by infusion. Ergometrine slow iv.im unless he of HTN, carboprost unless he of asthma, misoprotol suvlingual
  3. Surgical: failed med mx- intra-uterine balloon tampon are 1st line where uterine stony main/ only cause
    B-lynch suture, ligation of uterine arteries/ internal iliac arteries.
69
Q

Secondary postpartum haemorrhage definition and causes

A

24 hours - 6weeks

Causes: due to retained placenta/ endometritis

70
Q

Perineal tears classification

A

1st degree: superficial
2nd: perineal muscle but not involving anal sphincter
3rd: injury to perineum involving anal sphincter complex
4th: injury to EAS+ IAS and rectal mucosa

71
Q

Puerperal pyrexia definition, causes, mx

A

Fever .38 first 14day postpartum

Causes: endometritis, uti, wound infection

Mx: iv abx- clindamycin + gentamicin until a febrile >24hrs

72
Q

Postpartum haemorrhage definition

A

Blood loss .500ml after vaginal delivery

73
Q

Mx of breech position and classification of breech position

A

Complete
Frank: flexed hip, extended knee most common
Footling

Mx: <36GW may turn spontaneously
>36GW- attempt external cephalon version
If still breech- c-section/ vag delivery

74
Q

Folate deficiency in preg mx and when to give folic acid

A

ALL preg F should take folic acid 400mcg unto 12 GW

High risk patient should take 5mg folic acid before conception up to 12 Gw

High risk: either partner NTD or prev affected by NTD. fmhx of NTD. Anti-epileptic, DM, coeliac disease, Thalassaemia. Obese BMI 30kg.m2

75
Q

Vit D replacement in preg

A

ALL preg + breastfeeding patients 10mg Od which is 400units of colecalciferol

76
Q

Exposure of VZV in pregnancy

A

1st step check Antibody for VZ whether vaccinated or not.

  1. If <-20GW with NO immunisation: start VZIg up to 10days after exposure
    >20GW with no immunity: NO VZIg

If rash >-20GW give po aciclovir if <20Gw consider with precaution

77
Q

Meig’s syndrome

A

Benign ovarian tumour ass with pleural effusion and ascites

78
Q

Mx of ovarian cyst

A

Premenopausal: conservative esp if <35years. If small <5cm + simple cyst- repeat US in 8-12 weeks.

It postmenopausal: any cyst regardless of nature and size- referral

79
Q

Risks of ovarian cancer

A

BRCA1 AND BRCA 2
early menarche, late menopause, nulliparity

80
Q

Protective factors of endometrial cancer

A

Multiparty
Smoking
COCP- needs progesterone if on HrT

81
Q

Mx of endometrial cancer especially frail pt

A

Surgery: total abdominal hysterectomy with bilateral saplings-oophrectomy

Frail pt: progrstogen tx

82
Q

Medications used for emergency contraception, timing and mechanism of action

A
  1. Levonogestrel (progesterone): inhibits ovulation and prevention of implantation. Take within 72 hours.
  2. Ulipristal: selective progesterone receptor modulator. Inhibits ovulation. Can take up to 120 hours.cI asthma severe
  3. iUD: most effective. Within 5 days. Inhibits fertilisation or implantation.
83
Q

Side effects of POP and how long does it take to be effective

A

2 days

SE: irregular vag. Bleeding

84
Q

Injectable contraception mech of action, SE and Contraindication

A

Inhibits ovulation, secondary mech inhibit cervical mucous thickening and endometrial thinning.

SE: weight gain, irregular bleeding, increased risk of osteoporosis, not quickly reversed

CI: breast cancer

85
Q

Which contraception can be used in patient with migraine

A

Implantable contraception

86
Q

Mech of action of implantable contraception, advantages, SE, CI

A

Contains etonogestrel inhibits ovulation
High effective, long lasting 3 years, can be used in migraine

No oestrogen therefore can be used in patient with VTE he, migraine

SE: irregular bleeding

CI: IHD, unexpected or suspicious vag bleeding post breast cancer
Current breast cancer

87
Q

Can you used COCP post partum

A

No absolute contraindication if breast feeding <6weeks post partum

88
Q

Which contraceptive methods can be used postpartum

A

Progestogen only pill: can start POP at any time
ISD/IUD: 48 hours or after 4 weeks

89
Q

Definition of premature ovarian insufficiency, lab findings

A

Onset of menopause sx and increased gonadotropins level before age 40 years

Labs: low estradio <100pmol/L with raised FSH and LH.

FSH>40 is/L, high FSH demonstrated x2 samples taken 4-6 weeks apart

90
Q

Contraindications of HRt

A

Current. Post breast cancer
Any oestrogen sensitive cancer
Undo caginal bleeding
Unix endometrial hyperplasia

91
Q

Atrophic vaginitis mx

A

1st line: vaginal lubricants + moisturiser
2nd line if x work then try topical oestrogen cream

92
Q

Congenital rubella syndrome sx esp cardiac abonormalities

A

Sensorineural hearing loss, congenital cataracts, congenital heart disease PDA/ pulmonstenosis, hepatosplenimegaly, cerebral palsy.

Mx: if female patient has no immunity stay away from contact, offer MMR post natally, not offered during pregnancy or attempting to become pregnant

93
Q

Which rheumatoid arthritis drugs are safe to be used during pregnancy

A

Silfasalazine, hydroxychloroquine
Low dose steroid

NSAIDS can be used til 32GW but stopped due to increased risk of early closure of PDA

94
Q

Intrahepatic cholestasis in pregnancy mx

A

Induction of labour 37-38GW
Ursodeoxycholic acid, weekly LFT checkup
Vit K supplementation

95
Q

When to consider surgical mx for ectopic pregnancy

A

Size >35mm
Foetal heart present
Significant pain
HCG >5000U/L

96
Q

Salpingectomy vs salpingotomy im ectopic pregnancy

A

1st line salpingectomy for F with no other risk factors for infertility

Slapingotomy- considered for F with risk factors for infertility eg PID or contrast damage

97
Q

When to consider medical mx for ectopic pregnancy and what do you use

A

Size <35mm, no foetal heart
HCG <100-1500U/L

MTX

98
Q

Dx gestational diabetes and when do you test

A

1st line OGTT.
offered 24-28GW, if prev GDM offer within first trimester if normal repeat test 24-28GW.

Fasting glucose >5.6mmol/l
After 2 hours >7.8mmol/l

99
Q

Mx of gestational DM

A

If fasting glucose doesn’t;t decrease <7mmol/l with life style in 1-2 weeks= add metformin.

If glucose target not met with metformin=> insulin!!!

Plus add aspirin and folic acid 5mg from preconception - 12GW

100
Q

What can you give preg pt can’t tolerate metformin

A

Glibenclamide

101
Q

Mx of hyperemesis in pregnancy 1st and 2nd line

A

1st line: po cyclising, promethazine. Po prochloperazine

2nd line: po odansetron, metoclopramide/ deomperidone

102
Q

Medical mx of miscarriage

A

Vag misoprostol

Prostaglandin- binds to myometrial cells causes strong contraction

103
Q

Definition of menorrhagia

A

Heavy menstrual blood >80ml/ menses

104
Q

Menorrhagia mx

A

If needs no contraception: mefenamic aide 500mg TDS / tranexamic acid 1g TDS

If needs contraception
1st line: IUS
then COCP, depo provers

105
Q

Infertility Ix

A

Semen analysis

Serum progesterone taken 7day prior to next period

If >30nmo/l indicates ovulation
If <16nmol/l repeat if consistently low specialist

16-30nmol/l repeat

106
Q

PCOS infertility mx

A

Weight reduction

Clomifene most effective- hypothalamic oestrogen Receptor mimic w/o activating them interferes with negative FB of oestrogen and inhibits FSH secretion

Metformin esp obese

107
Q

What can you see in combined test for Down syndrome and when do you do it?

A

Offered 11-13

Unchallenged translucency thickened
High hCG
Low pref ass plasma ass protein A PAPP-A

108
Q

Quadruple test what is it
Findings of Edward, down, NTD

A

Offered 15-20
Checks AFP, undone oestriol, hCG, inhibit A

Down: low AFP, UNCON OESTRIOL, high inhibit A & hCG

Edward’s: low AFP, UNCONJ OESTRIOL, HCG, normal inhibit A

NTD:high AFP, NORM UNCONJ OESTRIOL, HCG, INHIBIN A

109
Q

HIV antiretroviral tx for preg pt and for baby

A

ALL preg pt offer antiretroviral regardless whether prev on it or not

Baby:
If mom’s viral load <50 copies/ml then only zidocudine offered otherwise triple ART used for 4-6 weeks

110
Q

Mode of delivery in HIV + pt

A

If viral load <50 copies/mL vagina, recommended

Otherwise C-section. Start zidovudine 4 hours before C-section

111
Q

Breastfeeding in HIV + pt

A

Not recommended!!!

112
Q

Mx of Group B streptococcus in preg

A

Intrapartum ivermectin benzylpenicillin if CI ckindamycin

113
Q

Vaginal candida mx

For F and preg

A

1st line: po fluconazole 150mg single dose

If unable to take oral clotrimazole 500mg intravag pessary

If preg only use local

114
Q

Recurrent vag candidiasis mx and definition

A

> 4 episodes/ year

Induction of po fluconazole for 3 days then maintenance for 6 months

Check BM

115
Q

PID mx

A

Po ofloxacin + metronidazole

Or

Im ceftriaxone + po doxycycline + po metronidazole

MSRA 2023 (22 decks)

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