obgyn

Question 1

pregnanct woman uti
when is trimethoprim contraindicated
when is nitrofurantoin contraindicated

Answer 1

1st trimester - nitrofurantoin, cefalexin
2nd trimester - nitrofurantoin, trimethoprim
3rd trimester - trimethoprim, cefalexin

nitro is contraindicated in perinatal period due to risk of haemolytic anaemia

Question 2

anti - htn in preg

Answer 2

1st line; Labetalol - be wary in asthma
be wary in t1dm, because palpitations are their warning system for hypoglycaemia ( also not for Phaeochromocytoma
Not effective for black, afro-Caribbean women)
2nd line: Nifedine MR (very important not to give IR as drop in bp compromise fetal blood flow)Grapefruit juice increases blood levels of medication- so avoid!
3rd line: methyldopa - centrally acting anti htn
increased risk of depression

Question 3

se of labetalol

Answer 3

scalp tingling, headache, weakness, liver damage, gi disturbances, dizziness

Question 4

can we use enalapril in pregnancy and breastfeeding?

Answer 4

not in pregnancy - can cause foetal renal damage

during breastfeeding this is fine

Question 5

when would you use hydralazine in pregn

Answer 5

acute htn

Question 6

signs symptoms preeclampsia

Answer 6

high bp, proteinuria

severe headaches, blurry vision and halos, epigastric pain, oedema, aph, reduced foetal movements, iugr, reduced liquor, hyperreflexia

doppler may show insuff blood

Question 7

herpes in a pregnant woman, whats the significance of it being the first time she has ever had it versus a recurrence?

Answer 7

if first time in 3rd trimester, indication for c-section

if previously had herpes, her antibodies will protect baby

Question 8

pph causes

Answer 8

4 ts
tone - uterine atony
trauma - episiotomy, tears, bleeds
tissue - placenta left behind - infected - late bleeding 
thrombin - vwd, clotting, dic

Question 9

pph define primary and secondary

Answer 9

1o = bleed within 24 hours, 500ml vaginal, 1l section

2o = bleeding after 24 hours post partum, up to 6 wks

Question 10

rx of pph

Answer 10

help abcde

tachycardic? bp?
2 large bore cannulae
bloods - fbc, ue, lft, clotting, gs, xmatch 4 units

fluids- harttmans
pupils concious level
exposure - expose tummy, fundal massage

transexamic acid
ergometrine and oxytocin
carboprost

surgical rx - ex under anaesthetic, remove clots

baloon
brace sutures
last resort - hysterectomy.

Question 11

htn parameters

Answer 11

High BP stage 1 140-159 / or 90-99 (mild)
• High BP stage 2 160-179 or (moderate)
100-109
• Hypertensive Crisis >180 or 110 (severe)

Question 12

preg bp changes

Answer 12

Bloodvolumeincreasesby40-50%inpregnancy
• Cardiacoutputincreasesby50%(HRincreasesby
15bpm)
• BPreducesbetween12-26weeksdueto increased progesterone, which relaxes smooth muscle and causes vasodilation. BP returns to pre pregnancy values around 36 weeks

Question 13

asprin when

Answer 13

ICEguidelines2010
• Commence from 12weeks, until delivery
• 75mgdaily
• One high risk factor, more than one moderate risk factor

Question 14

se of nifedipine

Answer 14

given as brand name for mr - adipine
Side effects:
May inhibit labour/ headaches/ flushing/ dizziness/
palpitations/fluid retention

Question 15

postnatal nifedipine is what

Answer 15

long acting
leave for after
adalat

Question 16

methyldopa contrain

Answer 16

• Not used for:
Severe depressives, methlydopa makes them “dopey and depressive” Not used PN because of risk of PN depression (NICE guidelines stop within 2 days of delivery)
• Side effects:
Depression and tiredness/dry mouth/GI disturbances

Question 17

Pre-eclampsia

Answer 17

Pre-eclampsia is a multi-system disorder.
• Abnormal placentation in early pregnancy causes an exaggerated maternal
response after twenty weeks.
Maternal response includes:
• high levels of circulating pro-inflammatory cytokines
• endothelial dysfunction
• increased capillary permeability
• release of vasoconstrictive substances such as thromboxane A2 (aspirin selectively inhibits this) and endothelin
• a decrease in prostacyclin synthesis

In pregnancies complicated by pre-eclampsia the placenta produces:
increased levels of sFlt-1, endoglin
and
decreased PIGF in the weeks before the onset of PET

Question 18

muscles of pelvic floor

Answer 18

levator ani
puborectalis
coccygyeus

Question 19

cystocoele

Answer 19

prolapse of bladder from upper anterior wall of vagina

Question 20

rectocoele

Answer 20

prolapse of rectum from posterior wall of vagina

Question 21

enterocoele

Answer 21

prolapse of small intestine through pouch of douglas

Question 22

utervaginal prolapse

Answer 22

The degree of uterine descent can also be graded by the Baden-Walker or Beecham classification systems:

1st degree: cervix visible when the perineum is depressed - prolapse is contained within the vagina.
2nd degree: cervix prolapsed through the introitus with the fundus remaining in the pelvis.
3rd degree: procidentia (complete prolapse) - entire uterus is outside the introitus

Question 23

surgery for bladder/urethral prolapse

Answer 23

Anterior colporrhaphy: involves central plication of the fibromuscular layer of the anterior vaginal wall. Mesh reinforcement may also be used. It is performed transvaginally. Intraoperative complications are uncommon but haemorrhage, haematoma and cystotomy may occur.
Colposuspension: performed for urethral sphincter incontinence associated with a cystourethrocele (open or laparoscopic). The paravaginal fascia on either side of the bladder neck and the base of the bladder are approximated to the pelvic side wall by sutures placed through the ipsilateral iliopectineal ligament.

Question 24

List physiological changes during pregnancy

Answer 24

diastolic bp decreases in early-mid preg
gastric stasis
egfr goes up, so serum urea and creatinine come down
increased risk of uti
respiratory symptoms due to hyperventilation
dilutional anaemia
increased thyroid hormone
decreased insulin sensitivity
increased clotting

Question 25

indications for induction

Answer 25

post term
preeclampsia
prom
plus diabetes

Question 26

benefits of breastfeeding

Answer 26

mutual gaze, bonding
sucking promotes uterine contractions, pph
free and clean
colustrum has endorphins (mum)
antibodies
infant mortality reduced

Question 27

have diagnosed pt with HIV now what

Answer 27

Confirm diagnosis
Resistance test to inform therapy
Viral load
CD4 count
Baseline bloods before starting HAART

Education, contact tracing, compliance

contact again in 1-2 days, leaflet

Question 28

AIDS diseases that you may see?

Answer 28

Kaposis sarcoma - herpes virus 8
candiasis
pcp
cytomegalovirus - retinitis
cryptosporaediasis
burkit lymphoma - starry sky bm