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Obgyn Flashcards

1
Q

Which ovarian tumour is associated with the development of endometrial hyperplasia?

A

Granulosa cell tumours

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2
Q

Endometrial hyperplasia definition

A

abnormal proliferation of endometrium in excess of normal proliferation of menstrual cycle

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3
Q

features of endometrial hyperplasia

A

abnormal vaginal bleeding eg. intermenstrual

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4
Q

Mx endometrial hyperplasia

A

simple w/o atypia - high dose progestogens, repeat sample 3/4 months (Levonorgestrel IUS)
Atypia - hysterectomy

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5
Q

PPH blood loss

A

> 500mls

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6
Q

4 T’s PPH

A

Tone, Trauma, Tissue, Thrombin

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7
Q

In case of PPH caused by uterine atony, what is most appropriate mx

A

Uterine massage

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8
Q

Continuous CTG monitoring if:

A 
?chorioamniocentesis/sepsis/fever
HTN >160/110
Oxytocin use 
significant meconium
fresh vaginal bleed developing during labour
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9
Q

Chickenpox exposure during pregnancy

A

If unsure/no previous exposure, check varicella Abs

If not immune -> varicella immunoglobulin (<10 days after exposure, any point in preg) <20/40

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10
Q

Primary amenorrhoea in woman with normal secondary sexual characteristics - action?

A

refer to gynae - likely mechanical obstruction

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11
Q

causes primary amenorrhoea

A

Turner’s syndrome
Testicular feminisation
congenital adrenal hyperplasia
congenital malformations of GU tract (imperforate hymen

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12
Q

Primary amenorrhoea definition

A

failure to start menses by 16

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13
Q

Secondary amenorrhoea definition

A

cessation of established, regular menstruation >6/12

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14
Q

causes secondary amenorrhoea

A 
pregnancy
hypothalamic amenorrhoea (stress, excess exercise)
PCOS
hyperprolactinaemia 
premature ovarian failure
Thyrotoxicosis (hypothyroidism) 
Sheehan's
Asherman's (IU adhesions)
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15
Q

Amenorrhoea Ix

A 
bhCG 
gonadotrophins 
prolactin
androgen levels 
oestradiol
TFTs
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16
Q

amenorrhoea with low gonadotrophin levels

A

hypothalamic cause

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17
Q

amenorrhoea with high gonadotrophin levels

A

Ovarian problem (premature ovarian failure)

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18
Q

Can instrumental delivery be used before full dilation of cervix?

A

No

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19
Q

contraindications to prostaglandins and oxytocin

A

Foetal distress

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20
Q

Post menopausal bleeding Ix

A

Transvaginal USS - endometrial thickness
pipelle biopsy - sample endometrium - dx endometrial cancer
hysteroscopy with direct sampling (dilation+curettage)

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21
Q

definitive tx for Bartholin cyst

A

Marsupialisation procedure

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22
Q

Endometrial carcinoma stage 1/2 tx

A

Total abdominal hysterectomy with bilateral salpingo-oophrectomy

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23
Q

hormonal tx for endometrial carcinoma

A

Provera (medroxyprogesterone acetate) - progesterone - slows growth of malignant cells in endometrium

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24
Q

Tx stage 2b endometrial carcinoma

A

Wertheim’s radical hysterectomy (includes removal of lymph nodes)

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25
Endometrial cancer risk factors
``` Post menopausal obesity nulliparity early menarche + late menopause unopposed oestrogen DM Tamoxifen PCOS ```
26
If post menopausal bleeding, what is dx until proven otherwise?
Endometrial cancer
27
What drug must be avoided in breastfeeding
``` Amiodarone (antiarrhythmic) aspirin Abx - ciprofloxacin, tetracycline, chloramphenicol, sulfonamides Li, Benzos Carbimazole MTX sulfonylureas cytotoxic drugs cocp ```
28
risk for women with PCOS undergoing IVF?
Ovarian hyperstimulation syndrome
29
pathophysiology ovarian hyperstimulation syndrome?
multiple luteinized cysts > high levels oestrogen/progesterone + vasoactive Vascular Endometrial Growth Factor > increased membrane permeability > loss fluid intravascular space
30
OHSS mild sx
abdo bloating, pain
31
OHSS moderate sx
+ n/v, USS evidence ascites
32
OHSS severe sx
+ clinical ascites, oliguria, haematocrit>45%, hypoproteinaemia
33
OHSS critical symptoms
+ thromboembolism, ARDS, anuria, tense ascites
34
PID definition
Inflammation and inflammation pelvic organs: uterus, FTs, ovaries, surrounding peritoneum
35
PID causes
``` Ascending infection from endocervix Chlamydia trachomatis - the most common cause Neisseria gonorrhoeae Mycoplasma genitalium Mycoplasma hominis ```
36
PID symptoms
``` lower abdo pain, fever deep dyspareunia dysuria, menstrual irregularities smelly vag/cervical discharge cerevical excitation perihepatitis - RUQ pain ```
37
PID Ix
Screen for chlamydia, gonorrhoea
38
Mx PID
pain relief - paracetamol/ibuprofen Abx - 1 x ceftriaxone IM, doxycycline, metronidazole 14 days ? removal of IUS
39
1st degree tear
within vaginal mucosa
40
2nd degree tear
into subcutaneous tissue
41
3rd degree tear
laceration extends into external anal sphincter
42
4th degree tear
laceration extends through external anal sphincter into rectal mucosa
43
Perineal tears: 3rd degree subset
3a: less than 50% of External Anal Sphincter thickness torn 3b: more than 50% of EAS thickness torn 3c: IAS torn
44
risk factors for perineum tears
``` primigravida large babies precipitant labour shoulder dystocia forceps delivery ```
45
Which questionnaire is used for post-partum mental health?
Edinburgh Post-natal depression scale
46
What score or higher in Edinburgh PND scale indicates depression of varying severity
13
47
If missed POP but less than 3 hours late, what action needed?
Take missed pill now, no further action required
48
If missed POP > 3 hours, what should you do?
take missed pill as soon as possible, if more than 1 pill missed just take 1 pill Take the next pill at the usual time which might mean taking 2 on the same day Continue with rest of pack Condoms given until reestablished 48hours
49
What cyst is sometimes referred to as a chocolate cyst due to it's external appearance?
Endometriotic cyst
50
Commonest ovarian cancer
Serous Carcinoma
51
23yo female with recurrent UTI. USS shows 3cm 'simple cyst' on L ovary. she is asymptomatic. What type of cyst?
Follicular cyst
52
commonest type of ovarian cyst
Follicular cyst
53
What causes follicular cyst?
non-rupture of the dominant follicle or failure of atresia in non-dominant follicle Commonly regress after several menstrual cycles
54
What causes a corpus luteum cyst and how would it commonly present?
In cycle if pregnancy does not occur, CL usually breaks down, if this fails then CL fills with blood/fluid Presents with intraperitoneal bleeding
55
What is a dermoid cyst?
Mature cystic teratoma - lined with epithelial tissue and may contain skin appendages, hair and teeth most common benign ovarian tumour in woman <30 Bilateral in 10-20% Usually asymptomatic. Torsion is more likely than with other ovarian tumours
56
What type of ovarian cyst is a benign germ cell tumour?
Dermoid cyst
57
which ovarian tumours are benign epithelial tumours?
serous cystadenoma | mucinous cystadenoma
58
Serous cystadenoma
commonest benign epithelial tumours | bilateral in 20%
59
mucinous cystadenoma
typically large, may become massive | rupture > pseudomyxoma peritonei
60
First line pharma mx to stop bleeding in PPH
IV syntocinon
61
Other pharma mx of PPH
IV ergometrine | IM carboprost
62
Sx intervention for PPH
First line IU balloon tamponade Then b-lynch suture ligation of uterine arteries/int illiac arteries Finally hysterectomy
63
second screen for anaemia and atypical red cell alloantibodies
28 weeks
64
Nuchal scan when?
11-13+6 weeks
65
Urine culture to detect asymptomatic bacteriuria
8-12 weeks
66
When is the booking visit?
8-12 weeks
67
what does the booking visit entail?
General info - diet, alcohol, smoking, folic acid, vit D, antenatal classes BP, urine dipstick, BMI FBC - blood group, Rh status, RC alloabs, Hbopathies HepB, syphilis, rubella HIV offered to all women urine culture - asx bactiuria
68
When is the early scan to confirm dates/screen for multiple pregnancy?
10-13.6 weeks
69
Which other screening occurs 11-13.6 weeks?
Down's screening, Nuchal scan
70
When does the anomaly scan occur?
18-20.6 weeks
71
When are doses of prophylactic Anti-D given to Rh negative women?
28, 34 weeks
72
What happens at 28/40 antenatal care-wise?
Routine care: BP, urine dipstick, SFH | Second screen for anaemia and atypical red cell alloantibodies. If Hb < 10.5 g/dl consider iron
73
Children under what age are considered unable to consent for sexual intercourse?
13 | If concerned about this, children's services involvement
74
If had unprotected sex, when should STI tests be done?
2 and 12 weeks after
75
Mx women at high risk of pre-eclampsia
from 12 weeks on, take aspirin 75mg OD - birth
76
high risk of pre-eclampsia if:
HTN previous pregnancy CKD AI - SLE/antiphospholipid syndrome 1/2DM
77
Moderate gestational HTN first line tx:
Oral labetolol
78
Cervical screening age ranges in UK
25-64
79
25-49 how often is screening offered (cervical)
3 yearly
80
How often are women recalled for cervical screening in 50-64yos?
5 yearly
81
26yo nulliparous, HTN 155/110 39/40. +++ protein. Mx?
IV labetolol with target diastolic 80-100
82
In pre-eclampsia, what are target BPs?
systolic < 150 | diastolic 80-100
83
women on COCP, with post-coital bleeding, what is common finding:
cervical ectropion
84
Cervical ectropion
ectocervix transformation zone meeting of stratified squamous - coloumnar ep of cervical canal caused by elevated estrogen levels
85
if troublesome cervical ectropion sx, tx?
Ablative tx
86
NICE guidelines on drinking in pregnancy?
0 units. Do not do it
87
If ectopic is located in a certain location there is increased risk of rupture. What is this location?
Isthmus
88
Methotrexate in those planning a pregnancy
Both men and women must stop 6 months before trying
89
What can RA patients take during pregnancy?
sulfasalazine and hydroxychloroquine are considered safe in pregnancy
90
When can NSAIDs be taken up until during pregnancy and what does their use after this increase the likelihood of?
32 weeks | risk early closure of ductus arteriosus
91
Placental abruption
painful vaginal bleeding tense uterus fetal heartbeat absent woman in shock
92
placenta praevia
painless vaginal bleeding
93
When might you feel a woody hard uterus? Why?
Placental abruption | retroplacental blood tracks into the myometrium
94
Mx placental abruption
delivery when woman stable
95
What is there an increased risk of in placental abruption?
PPH
96
How will intrahepatic cholestasis of pregnancy present?
Pruritis | No rash
97
What will the bloods findings be of IHC of pregnancy be?
raised bilirubin
98
Mx of IHC of pregnancy?
ursodeoxycholic acid LFTs weekly deliver at 37/40 - induce
99
Cx of IHC of preg?
stillbirth increased risk
100
``` abdominal pain nausea & vomiting headache jaundice hypoglycaemia ``` are sx of?
Acute fatty liver of pregnancy
101
When does AFLP present?
3rd trimester-post birth
102
what are the investigation findings for AFLP?
ALT>500
103
Mx AFLP
supportive, definitive - delivery
104
which conditions may be exacerbated by AFLP during pregnancy?
Gilbert's, Dubin-Johnson
105
HEELP
Haemolysis Elevated Liver Enzymes Low Platelets
106
what is the effect of pre-eclampsia on reflexes?
Brisk tendon reflexes
107
Which device is most effective form of emergency contraception and is not affected by BMI?
Copper IUD
108
28yo Indian woman, 18/40, increasing SOB, chest pain, coughing clear sputum. Apyrexial, 140/80. 130bpm. Sats 94% 15L O2. Mid diastolic murmur, bibasal creps. Mild pedal oedema. Suddenly deteriorates - respiratory arrest. CXR - whiteout both lungs
Mitral valve stenosis (commonest cardiac abnormality of pregnant women) (related to rheumatic heart disease - developing countries)
109
What are the complication risks of someone with Mitral valve stenosis in pregnancy?
AF | Rapid decompensation
110
Tx mitral valve stenosis pregnancy?
Balloon valvuloplasty
111
28yo, 30/40, sudden onset chest pain associated with LOC. 170/90, sats 15L o2 93%, 120bpm, apyrexial. Early diastolic murmur, occasional bibasal creptitations and mild peal oedema. ECG - ST elevation in leads II, III and aVF.
Aortic dissection
112
When is aortic dissection likely to present in pregnancy?
3rd trimester
113
What are CT disorders (Marfan's, Ehlers-Danlos) associated with in pregnancy (cardiac)?
Aortic dissection
114
Common presenting features of aortic dissection in pregnancy?
Tearing chest pain, transient syncope
115
How to repair aortic dissection in <28/40
aortic repair with fetus kept in utero
116
Repair aortic dissection 28-32/40?
depends on fetal condition
117
Repair aortic dissection >32/40?
Primary cessarian section, with aortic repair at same operation
118
28yo, 18/40 pregnant, sudden onset chest pain. 150/70. 92% 15L o2. 130bpm. No murmurs and chest is clear. Signs of thrombophlebitis in L Leg
Pulmonary Embolism
119
How does PE classically present in pregnancy?
chest pain, hypoxia, clear chest on auscultation
120
How to confirm PE in pregnancy?
``` half dose scintigraphy - vent/perfusion CT chest (underlying lung disease) ```
121
Treatment of PE in pregnancy?
LMWH throughout pregnancy and 4-6 weeks post partum
122
Can you give warfarin in pregnancy?
No - contraindicated
123
8/40, abdo pain and vaginal bleeding. Tender RIF and suprapubic region. Speculum examination - open cervical os. USS confirms IU pregnancy.
Miscarriage
124
Ectopic risk factors
damage to tubes - salpingitis/surgery previous ectopic IVF endometriosis
125
typical history of ectopic
6-8/40 lower abdo pain, constant, may be unilateral vaginal bleeding after
126
where else might pain be referred to in ectopic?
shoulder tip | also pain on defectation/urination
127
painless vaginal bleeding before 24/40 | os closed
threatened miscarriage
128
gestational sac with dead fetus pre 20/40 no expulsion yet light vaginal bleeding/discharge
missed (delayed) miscarriage
129
blighted ovum/anembryonic pregnancy: definition
gestational sac >25mm no embryonic/fetal part can be seen
130
os is open | heavy bleeding with clots and pain
inevitable miscarriage
131
not all products of conception have been expelled
incomplete miscarriage - medical mx
132
pain over the pubic symphysis which radiates to groins and medial aspects of thighs waddling gait
Symphysis pubis dysfunction | - ligament laxity increases in response to hormonal changes of pregnancy
133
Pre-eclampsia / HELLp syndrome abdo pain
typically in RUQ / epigastric
134
uterine rupture - when does it occur? risk of it occuring? presents?
normally during labour, also 3rd tri previous CS maternal shock, abdo pain, PV bleeding
135
where does appendicitis pain present during each trimester of pregnancy?
1 - RLQ 2 - umbilicus 3 - RUQ
136
what is a UTI during pregnancy associated with?
pre-term delivery and IUGR
137
What are some UKMEC4 risks (unacceptable) for COCP?
``` >35yo, >15 fags/day migraine with aura Hx thromboembolic disease/thrombogenic mutation Hx stroke/IHD breast-feeding<6/52 postpartum uncontrolled HTN current Breast cancer major surgery - prolonged immoblisiation ```
138
Some UKMEC3 (disadvantages outweigh the advantages) COCP?
``` >35, <15fags/day BMI>35 FHx thromboembolic disease 1st degree <45yo controlled HTN immobility BRCA1/2 carrier current gallbladder disease ```
139
which type of contraception associated with weight gain?
depo-provera injection
140
Placenta praevia is associated with low lying placenta - true/false?
True
141
What increased likelihood of low-lying placenta?
previous CS multiparity presentation of bleeding/no pain
142
How is placenta praevia diagnosed and graded?
USS - transvaginal | colour flow doppler
143
What should not be done before exluding placenta praevia?
Digital examination - could cause placenta to bleed
144
If low lying placenta on 16-20/40 scan, what is mx?
rescan at 34/40 limit activity/intercourse only IF they bleed if present at 34/40 and grade 1/2 rescan every 2 weeks
145
If high presenting part/ abnormal lie at 37/40?
CS
146
If placenta praevia with bleeding - mx?
Admit treat shock cross-match blood final USS 37/40
147
If final USS (placenta praevia) at 37/40 shows grades 3/4 - mx?
CS 37-38/40
148
If grade 1 placenta praevia - delivery method?
can be vaginal
149
28-yo g1p0 in labour for 11hrs; progressed through first stage without any issues. Midwife noted CTG abnormalities, able to palpate the umbilical cord. She immediately calls the obstetric registrar > checks CTG, variable decelerations. What is initial definitive mx for the cause of these decelerations?
place hand into vagina to elevate the presenting part
150
guidelines for mx cord prolapse
elevate presenting part - manually/filling bladder | Tocolysis - Terbutaline to prep for CS
151
define cord prolapse
umbilical cord descending ahead of the presenting part of fetus
152
risk factors cord prolapse
``` prematurity multiparity polyhydramnios twin pregnancy cephalopelvic disproportion abnormal presentations - breech/transverse lie placenta praevia long umbilical cord high fetal station ```
153
when do most cord prolapses occur?
ARM
154
During tocolysis and prep for CS, what position is mother encouraged to take?
All 4s
155
What are false labour pains common in 2/3 trimester known as?
Braxton-Hicks contractions
156
maternal cx post-term labour
increases need of forceps/CS | increases labour induction rates
157
neonatal cx post-term labour
reduced placental perfusion | oligohydramnios
158
what should be done with woman 41/40
induce | give her choice of expectant mx
159
uterine tenderness and brown foul smelling vaginal discharge along with fever, tachycardia in pregnant woman:
chorioamnionitis
160
if pregnant woman with dysuria, what should be an important differential?
Pyelonephritis
161
what is chorioamnionitis?
result of ascending bacterial infection into amniotic fluid/membranes/placenta
162
what is big risk with chorioamnionitis?
Prolonged premature ROM
163
Tx: chorioamnionitis?
prompt delivery of fetus, ?via CS | IV Abx
164
mastitis mx: no infection
continue breast feeding, simple analgesia, warm compress, send culture
165
mastitis mx: infection
continue breastfeeding +PO flucloxacillin
166
trimethoprim use in pregnancy: ok?
Not in first trimester!! | Folate antagonist
167
What terminology is used to describe the head in relation to the ischial spine?
Station
168
Heb B vaccine schedule in babies with high risk of developing HepB (mum has it)
If mum is surface antigen positive - 1st dose HepB vaccine + 0.5ml HBIG within 12 hours of birth Further vaccination 1-2/12 Further vaccination 6/12
169
can HepB be transmitted via breast feeding?
no
170
what is vasa praevia?
fetal blood vessels cross/run near the os vessels rupture when membranes rupture >frank bleeding
171
classic triad of vasa praevia?
ROM followed by painless bleeding followed by fetal bradycardia
172
McRobert's manouvre - used for?
Shoulder dystocia
173
What position must woman be in for McRobert's manouvre?
suppine, hips flexed and abducted fully
174
continuous dribbling incontinence after prolonged labour in area of world with poor obstetrics care?
Vesicovaginal fistulae | from bldder to vagina
175
if large unilateral ovarian cyst in woman who wants to have children, what is next step of ix?
serum ca125, aFP, bHCG + elective cystectomy
176
tearing pain and haemodynamic compromise in woman of child bearing age:
Ectopic pregnancy
177
RUQ pain in PID cause?
perihepatic inflammation - Fitz Hugh Curtis Syndrome
178
mid cycle pain that subsides within 24-48hours - sharp onset, little systemic disturbance
Mittelschmerz
179
endometriosis
growth of ectopic endometrial tissue outside of the uterine cavity
180
clinical features of endometriosis?
``` chronic pelvic pain dysmenorrhoea - pain day before bleed deep dyspareunia subfertility urinary sx frozen pelvis ```
181
Endometriosis Ix:
Laparoscopy is gold standard
182
Mx: endometriosis
NSAID/paracetamol is 1st line sx relief COCP/medroxyprogesterone acetate GnRH analogues
183
whirlpool sign in gynae:
ruptured ovarian cyst
184
USS ovarian rupture:
whirlpool sign enlarged ovary in midline with free pelvic fluid no ovarian venous flow/reversed diastolic flow
185
when invite women who have been treated for CIN1/2/3 back for repeat cervical screening?
6 months time - test of cure
186
if CIN1, what mx?
Test for HPV - if positive colposcopy if -ve - return to routine call if positive again after 1 yr - smear again in 12/12
187
wheelchair user requests contraception - what is CI?
COCP - immobility -> clots
188
most effective form of contaception (excluding abstinence)?
Contracpetive implant (Nexplanon)
189
How long does nexplanon implant take to work?
7 days
190
how long does implant last?
3 years
191
does implant contain estrogen?
no
192
how long can missed pill be taken if miss desorgestrel?
prog only. 12 hour window
193
if patient on enzyme inducing drug, what contraception method should be used?
Cu IUD commonly (no hormones)
194
in terms of contraception, how many years amenorrhoea for woman <50?
2 years
195
in terms of contraception, how many years amenorrhoea for woman 50
1 year
196
if past / current hx breast cancer - contracpetive?
Cu IUD
197
COCP MOA:
inhibits ovulation
198
Implant MOA (etonogestrel):
inhibits ovulation | All progestogen-only methods of contraception are safe to use as contraception alongside sequential HRT.
199
Cu IUD MOA:
decreases sperm motility and survival
200
multiparity multiple pregnancy embryos are more likely to implant on a lower segment scar from previous caesarean section risk factors for:
placenta praevia
201
what is Bishop's score used for?
predict whether induction of labour will be required
202
under which Bishop's score predicts that labour is unlikely to start without induction?
5 or less
203
What tx given to woman with Bishop score <5 to induce labour and what does it do?
Prostaglandin E2 PV to ripen cervix
204
when in pregnancy can women develop any of the pregnancy related causes of HTN?
after 20 weeks until 6 weeks postpartum
205
after what dates should delivery be offered to a woman with pre-eclampsia?
34 weeks
206
mx moderate-severe depression in post-natal period (with no hx severe depression): first line tx:
CBT
207
when are ADs used in mx of PND and which type first?
after CBT not engaged with | SSRIs
208
can woman taking SSRIs breastfeed?
on sertraline/paroxetine ok to | not fluoxetine
209
what is lochia?
bleeding that presents in the first two weeks following birth red blood>dark brown blood>stops
210
Mx:lochia
reassure, discharge | if vol increased/smells bad/won't stop seek help
211
how long might lochia last after birth?
6 weeks
212
In woman 32/40 PROM, how mx:
admit for >48hours, Abx (erythromycin), steroids (neonatal RDS)
213
when should deliver in woman who has PROMed
34 weeks
214
In woman with severe asthma, how manage her pre-eclampsia?
Nifedipine first line
215
most frequent cause of severe early-onset (< 7 days) infection in newborn infants.
Group B septicaemia
216
GBS in pregnancy mx:
IV benpen IP
217
cord prolapse mx:
1. tocolytics 2. correct to avoid compression 3. patient on all 4s 4. cord should not be pushed back into uterus 5. immediate CS
218
what can you do first in mx of cord prolapse?
push presenting part of fetus back into uterus to avoid compression
219
hyperemesis gravidarum dx criteria triad:
5% pre-pregnancy weight loss dehydration electrolyte imbalance
220
Rh sensitising events in pregnancy:
- Ectopic pregnancy - Evacuation of retained products of conception and molar pregnancy - Vaginal bleeding < 12 weeks, only if painful, heavy or persistent - Vaginal bleeding > 12 weeks - Chorionic villus sampling and amniocentesis - Antepartum haemorrhage - Abdominal trauma - External cephalic version - Intra-uterine death - Post-delivery (if baby is RhD-positive)
221
which test determines proportion of fetal RBCs present?
Kleinhauer test
222
what may an affected Rh+ve fetus show:
``` oedematous (hydrops fetalis, as liver devoted to RBC production albumin falls) jaundice, anaemia, hepatosplenomegaly heart failure kernicterus treatment: transfusions, UV phototherapy ```
223
Reduced urea, reduced creatinine, increased urinary protein loss
normal lab findings in pregnancy!
224
what can be used to classify the severity of nausea and vomiting in pregnancy?
The Pregnancy-Unique Quantification of Emesis (PUQE) score
225
hyperemesis gravidarum: mx
1. antihistamines (promethazine, Cyclizine). 2. ondansetron and metoclopramide 3. ginger and P6 (wrist) acupressure: little evidence 4. admission for IV hydration (severe)
226
hyperemesis gravidarum cx:
``` Wernicke's encephalopathy Mallory-Weiss tear central pontine myelinolysis acute tubular necrosis fetal: small for gestational age, pre-term birth ```
227
when may hyperemesis gravidarum persist until?
20 weeks
228
what is related to hyperemesis gravidarum?
bHCG levels
229
how often is the depot provera (medroxyprogesterone acetate) injecton given
every 12 weeks
230
urinary incontinence: urge incontinence: first line tx
bladder retraining
231
urinary incontinence: stress incontinence: first line tx
pelvic floor training | 2nd: duloxetine
232
In woman who has PROMed at 30/40, what should be given to her to prevent neonatal RDS?
Dexamethasone - steroid
233
sudden onset unilateral pelvic pain precipitated by intercourse or strenuous activity
ruptured ovarian cyst
234
women who have recently stopped breastfeeding and is due to occlusion of a lactiferous duct:
galactocele | no mx needed
235
67-year-old woman presents with a heavy, dragging sensation in the suprapubic region. She also has frequency and urgency.
urogenital prolapse
236
where is cervical excitation seen?
PID | ectopic pregancy
237
mx shoulder dystocia labour:
``` request senior help McRobert's manouvere apply suprapubic pressure episiotomy - internal manouveres (Wood's screw/ grasping posterior arm) Symphisiotomy Zavanelli manouvere (incl CS) ```
238
menorrhagia first line tx:
IUS mirena | lasts 5yrs
239
menorrhagia : mx
IUS COCP Depot provera (progestogens)
240
dysmenorrhoea if do not need contraception mx:
transamic acid / NSAIDS (mefanamic acid) first line
241
eclampsia: first line tx
Mg sulfate | to both stop and prevent seizures
242
35yof, trouble conceiving 8/12. periods have been heavier past year. Now unmanageable, episodes of flooding. abdomen snt, but you palpate a supra-pubic mass.
Fibroids
243
menorrhagia, subfertility and an abdominal mass in this patient points towards uterus can feel bulky
fibroids
244
first line fibroids tx:
``` IUS tranexamoc acid COCP nsaids progestogens sx - myomectomy, hysteroscopic ablation, UA embolisation ```
245
measurement of the symphysis-fundal height in centimetres should???
closely match the gestational weeks from 20 weeks onwards within 1/2cm
246
when is serum AFP raised?
in fetal abdominal wall defects eg. omphalocele | nerual tube defects
247
when is serum AFP low?
Down's syndrome, maternal DM, Edwards syndrome maternal obesity
248
33-year-old woman is investigated for infertility. Laparoscopy is essentially normal. Hysterosalpingography shows blocked fallopian tubes bilaterally. Dx:
PID
249
classic ABC features of irritable bowel syndrome
ABdo pain bloating change in bowel habit
250
26-year-old women develops sudden onset right iliac fossa pains whilst playing netball. She is nauseated and has vomited twice. On examination she is tender in the right iliac fossa.
Ovarian torsion
251
primary PPH definition:
>500mls blood loss within 24 hours of birth of baby
252
risk factors for primary PPH:
``` previous PPH prolonged labour pre-eclampsia increased maternal age polyhydramnios emergency Caesarean section placenta praevia, placenta accreta macrosomia ritodrine (a beta-2 adrenergic receptor agonist used for tocolysis) ```
253
mx PPH
ABC including two peripheral cannulae, 14 gauge (bimanual uterine compression) IV syntocinon (oxytocin) 10u or IV ergometrine 500mcg IM carboprost Sx: IU balloon tamponade is 1. for when uterine atony others: B-Lynch suture, ligation of the uterine arteries/internal iliac arteries if severe, uncontrolled haemorrhage -hysterectomy
254
secondary PPH until?
12 weeks
255
when is first HPV vaccine given and to who and what ages?
12-13yo m+f
256
which strains of HPV does vaccine protect vs?
16, 18
257
Oliohydramnios causes?
``` PROM fetal renal problems e.g. renal agenesis IUGR post-term gestation pre-eclampsia ```
258
oligohydramnios definition?
<500ml at 32-36 weeks and an amniotic fluid index (AFI) < 5th percentile.
259
is it legal to reinfibulate a woman with type 3 FGM after vaginal delivery?
no
260
FGM type 1:
clitoridectomy
261
FGM type 2:
Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision)
262
FGM type 3:
Narrowing of the vaginal orifice with creation of a covering seal, with or without excision of the clitoris (infibulation)
263
FGM type 4:
All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization
264
what normally happens to BP during pregnancy?
falls in first half and then rises to pre-pregnancy levels before term
265
what secretes HCG?
synchtiotrophoblasts
266
what maintains the production of progesterone by the corpus luteum in early pregnancy?
HCG levels secreted by the synchtiotrophoblasts
267
small (<35mm) unruptured ectopic pregnancy with no visible heartbeat, a serum B-hCG level of <1500 IU/L, no intrauterine pregnancy and no pain, then first line treatment should be:
Methotrexate | medical management
268
when should laparoscopic salpingectomy (or salpingotomy where there is risk of infertility) in ectopic?
ectopic is larger than 35mm, is causing severe pain or if the B-hCG level is >1500
269
medical mx miscarriage?
misoprostol | if expectant mx for >14/7
270
if fetal breech at 34/40, what is mx?
wait til 36 weeks then offer external cephalic version
271
heavy menstrual bleeding: initial ix:
FBC
272
diagnosis of postpartum thyroiditis is based upon:
clinical manifestation and TFTs alone | (normal TSH, high T4) - propranolol
273
premature ovarian failure (POM) is defined as:
cessation of menses for 1 year before the age of 40. It can, however, be preceded by irregular menstrual cycles. Common symptoms include hot flushes, vaginal dryness, vaginal atrophy, sleep disturbance, and irritability.
274
hyperemesis gravidarum associations:
``` multiple pregnancies trophoblastic disease hyperthyroidism nulliparity obesity ```
275
if woman already treated for pre-eclampsia and comes in 37+1 with papilloedema and HTN, mx?
IV Mg Sulfate + plan immediate delivery
276
18-yof discharge. New sexual partner, not using barrier protection. Thick cottage-cheese like discharge is visualised. She reports no other symptoms of note. What is the most likely diagnosis?
Candida albicans
277
'cottage cheese', non-offensive discharge vulvitis: dyspareunia, dysuria itch vulval erythema, fissuring, satellite lesions may be seen
candida albicans
278
mx: candida albicans?
local - clotrimazole pessary (clotrimazole 500mg PV stat) | oral - itraconazole 200mg PO bd for 1 day/fluconazole 150mg PO stat
279
Causes of an increased nuchal translucency include:
Down's syndrome congenital heart defects abdominal wall defects
280
Causes of hyperechogenic bowel:
cystic fibrosis Down's syndrome cytomegalovirus infection
281
urge incontinence: bladder training unsuccessful - what is next tx?
Tolterodine - antimuscarinic
282
monochorionic twins: ultrasound monitoring performed between 16 and 24 weeks gestation aims to detect?
twin-twin transfusion syndrome
283
Cocaine abuse, pre-eclampsia and HELLP syndrome are known causes of?
placental abruption
284
what window of time is the Nexplanon inplant effective as immediate contraception if administered?
1-5 days
285
Ix: after USS for endometrial ca:
hysteroscopy with endometrial biopsy
286
What will transvaginal USS show for endometrial thickening if needs further ix:
>4mm thickness- | high negative predicted value
287
why should oxybutinin not be used in elderly population?
risk of falls
288
what must happen re: all cases of FGM in UK?
reported to police
289
what are CIs of Cu IUD?
pregnancy and PID
290
how many days before day 1 does ovulation always occur?
14 days
291
when can the mid-luteal progesterone levels best be measured?
7 days before day 1 (21 days)
292
what bishop's score indicates labour will likely start spontaneously?
>9
293
definitions anaemia in pregnancy: each trimester
first trimester Hb less than 110 g/l second/third trimester Hb less than 105 g/l postpartum Hb less than 100 g/l
294
Pregnant patients with type 1 diabetes should monitor their blood glucose:
daily fasting, pre-meal, 1hour post meal, bedtime
295
how long does active mx of 3rd stage of labour last?
<30 mins
296
what is theactive mx of 3rd stage of labour?
Uterotonic drugs - oxytocin clamping and cutting of cord, >1 min after delivery <5 mins Controlled cord traction after signs of placental separation
297
when should ergometrine not be used?
HTN
298
when should Mg treatment be stopped in eclampsia?
either 24 hours after delivery or 24 hours after last seizure
299
when is the deadline for attempting external cephalic version?
rupture of amniotic sac
300
expectant management of an ectopic pregnancy can only be performed for:
1) An unruptured embryo 2) <30mm in size 3) Have no heartbeat 4) Be asymptomatic 5) Have a B-hCG level of <200IU/L and declining
301
when should ca125 be ix:
``` 50 years old +: abdominal distension or 'bloating' early satiety or loss of appetite pelvic or abdominal pain increased urinary urgency and/or frequency ```
302
The definition of menorrhagia has changed
to reflect the woman's subjective experience rather than mls blood loss
303
incontinence (urinary) Ix:
bladder diaries should be completed for a minimum of 3 days vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles ('Kegel' exercises) urine dipstick and culture urodynamic studies
304
The requirements for instrumental delivery can be easily remembered by the mnemonic FORCEPS
Fully dilated cervix OA position preferably OP delivery is possible with Keillands forceps and ventouse. Ruptured Membranes Cephalic presentation Engaged presenting part i.e. head at or below ischial spines the head must not be palpable abdominally Pain relief Sphincter (bladder) empty this will usually require catheterization
305
Late decelerations and foetal bradycardia on cardiotocography (CTG) is a worrying sign and would justify??
emergency CS
306
A high voiding detrusor pressure with a low peak flow rate on urodynamic testing:
bladder outlet obstruction | overflow incontinence
307
what is used as pre-eclampsia prophylaxis during early pregnancy>
low dose aspirin
308
do we have ovarian screening in UK>
no
309
when is action required re: contraceptive patch (if patient doesn't replace patch)
above 48 hours emergency contraception if required barrier protect for 7 days
310
what type of contraception is the EVRA patch?
Combined
311
how does contraceptive patch work?
for first 3 weeks wear patch everyday, change patch weekly | remove for week 4 - withdraw bleed
312
what is the riskiest, but rare form of breech presentation?
footling at delivery
313
A transvaginal ultrasound demonstrating a crown-rump length greater than 7mm with no cardiac activity
diagnostic of miscarriage - confirmed
314
what effect will mirena have on periods?
initially irregular then followed by light menses or amenorrhoea
315
when in cycle can Cu ID be inserted?
anytime
316
risk for endometrial hyperplasia (drugs)
tamoxifen
317
cervical screening in HIV patients:
cervical cytology annually
318
what is measured in the combined test for Down's?
nuchal translucency + bhCG + PAPPA
319
triple test for Down's?
AFP, unconjugated oestriol, hCG
320
quadruple test for Down's?
AFP, unconjugated oestriol, hCG, inhibin A
321
which cancers are increased risk in COCP use:
breast and cervical | protects against ovarian, endometrial
322
Infertility in PCOS: Tx
Clomifene>metformin
323
mild dyskaryosis and negative HPV smear: when should she next be screened if 29yo
3 years
324
if untreated GBS in pregnancy, and baby delivered, what is MX:
observe for 24 hours as risk of sepsis
325
HNPCC/Lynch syndrome is a strong risk factor for?
endometrial cancer
326
Women should be prescribed cyclical combined HRT if
LMP<1yr ago
327
Women should be prescribed continuous combined HRT if
taken cyclical combined for at least 1 year or it has been at least 1 year since their LMP or it has been at least 2 years since their LMP, if they had premature menopause (menopause below the age of 40)
328
Most common type of ovarian pathology associated with Meigs' syndrome:
fibroma
329
what is Meig's syndrome?
benign ovarian tumour (usually fibroma) associated with ascites and pleural effusion
330
Most common benign ovarian tumour in women under the age of 25 years
dermoid cyst
331
The most common cause of ovarian enlargement in women of a reproductive age:
follicular cyst
332
34-year-old woman presents to her GP for contraception advice three weeks after the delivery of her second child. She is currently breastfeeding. She has a body mass index of 28 kg/m^2. Her husband has a vasectomy booked for three months time:
POP
333
atrophic vaginitis tx:
topical oestrogen | lubricants and moisturisers
334
TOP medical mx:
mifepristone + prostaglandins
335
TOP <9 weeks
medical mx - mifepristone and prostaglandins
336
TOP <13 weeks
Surgical dilation + suction of uterine contents
337
TOP >15 weeks:
surgical dilation + evacuation of uterine contents | or late medical abortion (mini-labour induced)
338
where is Nexplanon implantation implanted?
subdermal, non-dominant arm
339
medication of choice in suppressing lactation when breastfeeding cessation is indicated??
cabergoline
340
most common identifiable cause of postcoital bleeding
cervical ectropion
341
placenta accreta:
attachment of the placenta to the myometrium, due to a defective decidua basalis. As the placenta does not properly separate during labour there is a risk of post-partum haemorrhage.
342
Risk factors for placenta accreta:
previous CS | Placenta praevia
343
if delayed placental delivery in placenta accreta and major blood loss, definitive mx:
hysterectomy
344
if mildly elevated BP, but no proteinuria or any other sx >20 weeks pregnancy, description of case?
gestational HTN
345
ca125 measure for:
ovarian ca
346
open myomectomy. Which of the following is a common complication following this operation?
ahdesions
347
history of sudden collapse occurring soon after a rupture of membranes is suggestive of
amniotic fluid embolism
348
if pt refuses hormonal tx for menopausal vasomotor sx, what can be prescribed?
SSRI
349
contraceptive vaginal ring - what hormone(s)?
combined - oestrogen and progesterone
350
are noacs ok in pregnancy?
no - must be swpped onto LMWH
351
woman refusing screening as she is lesbian - advice?
cervical screening as normal
352
thin, white homogenous discharge clue cells on microscopy: stippled vaginal epithelial cells vaginal pH > 4.5 positive whiff test (addition of potassium hydroxide results in fishy odour)
bacterial vaginosis
353
tx: bacterial vaginosis;
Oral metronidazole
354
offensive 'musty', frothy, green vaginal discharge. On examination you an erythematous cervix with pinpoint areas of exudation.
Trichomonas vaginalis
355
Strawberry cervix - which infection?
Trichomonas vaginalis
356
trichomonas vaginalis tx:
oral metronidazole
357
thin, purulent, and mildly odorous vaginal discharge. She also complains of dysuria, intermenstrual bleeding and dyspareunia. A swab shows a Gram-negative diplococcus.
gonorrhoea
358
gonorrhoea tx:
IM ceftriaxone+PO azithromycin
359
sudden intense pain | free fluid in the pelvis - USS - Dx:
ruptured enometrioma
360
MOA of metformin in PCOS?
increases peripheral insulin sensitivity so affects the HPA axis
361
women with preterm-PROM with a triad of maternal pyrexia, maternal tachycardia, and fetal tachycardia
chorioamnionitis
362
Epilepsy + pregnancy =
5mg Folic acid starting when planning preg | also in obese pregnant women first 12 weeks
363
first line ix for ?endometrial ca
TVUSS
364
if lochia > 6weeks - ix??
USS
365
painless vaginal bleeding, excessive morning sickness and shortness of breath. Routine examination of the patient's abdomen reveals a uterus which extends up to the umbilicus. Ultrasound revealed a solid collection of echoes with numerous small anechoic spaces.??
hydatiform mole
366
CF: hydatifrom mole
painless vaginal bleeding in early pregnancy and a uterus which is large for dates. Hyperemesis gravidarum severe thyrotoxicosis
367
USS : hydatifrom mole
solid collection of echoes with numerous small anechoic spaces which resembles a bunch of grapes (also known as 'snow-storm' appearance).
368
Fibroid dx. waiting for myomectomy surgery, what drug given while awaiting sx?
GnRH analogue
369
37yof 15/40 abdo pain. Gradually, progressively worse 3/7. n/v. 38.4ºC, 116/82 mmHg, 104bpm. The uterus is palpable just above the umbilicus and a fetal heart beat is heard via hand-held Doppler. cervix is closed, no blood. PMH: menorrhagia due to uterine fibroids. This is her first pregnancy. What is the most likely diagnosis?
fibroid degeneration (red degeneration) pain, fever, vom
370
``` anaemic 20 weeks gestation. Hb 104 MCV 104 blood film shows hypersegmented NPs explain: ```
macrocytic anaemia. The blood films suggests that the cause of the macrocytosis is a megaloblastic anaemia -> folate or b12 deficiency
371
COCP: If 2 pills missed in week 3,:
finish the pills in the current pack then start new pack immediately ommiting the pill-free interval
372
microgynon ??
COCP
373
cancer commonly ulcerated and can present on the labium majora.?
vulval carcinoma
374
cancer tend to be white or plaque like?
Vulval intraepithelial neoplasia
375
risk factors for vulval ca;
Human papilloma virus (HPV) infection Vulval intraepithelial neoplasia (VIN) Immunosuppression Lichen sclerosus
376
ovarian mass in post-menopausal woman - mx?
any maass - refer to gynae - needs ix
377
late decells seen on CTG - mx?
fetal blood sampling | urgent delivery if fetal acidosis
378
couples should have regular sexual intercourse for a period of ? before referring ?
12/12
379
commonest risk in TOP?
infection (10%) - prophylactic Abx
380
if called for smear during pregnancy - what is advice??
advise to go for smear >12/52 post-partum
381
if previous smear abnormal and woman becomes pregnant - mx?
seek specialist advice | smear could be done mid-trimester
382
which criteria for PCOS:
Rotterdam
383
risk for pre-eclampsia: | moderate
``` FHX Primigrav age 40 years or older pregnancy interval of more than 10 years body mass index (BMI) of 35 kg/m² or more at first visit multiple pregnancy ```
384
tx: moderate pre-eclampsia risk?
aspirin from 12 weeeks
385
possible cause oligohydramnios?
``` premature rupture of membranes fetal renal problems e.g. renal agenesis intrauterine growth restriction post-term gestation pre-eclampsia ```
386
39 weeks pregnant comes to see you complaining of itching down below. She has thick white discharge.
thrush | Tx - clotrimazole pessary
387
only definitive tx adenomyosis:
hysterectomy
388
adenomyosis:
presence of endometrial tissue in the myometrium
389
features: adenomyosis:
dysmenorrhoea menorrhagia enlarged, boggy uterus
390
Mx: adenomyosis:
GnRH agonist | hysterectomy
391
emergency contraception:
copper coil), an oral progesterone-only contraceptive (levonorgestrel) or a selective progesterone receptor modulator (ulipristal acetate) could be offered
392
atypical endometrial hyperplasia. She is post-menopausal and otherwise fit and well. What is the ideal management of this condition?
total hysterectomy with bilateral salpingo-oophrectomy
393
first-line treatment for magnesium sulphate induced respiratory depression?
Calcium gluconate
394
commonest site of ectopic?
Ampulla of FTs
395
most important aetiological factor for causing cervical cancer?
HPV 16, 18
396
contraception: time til effective: IUS mirena, COCP, implant, injection:
7 days if not taken on first day of cycle
397
time til POP effective as contraception if not day 1 cycle:
2 days
398
time til IUD effective contraception if not day 1 cycle:
instantaneous
399
blooking bloods: rubella undetected: advice??
advise to stay away from anyone who has rubella and advise of risks of rubella pregnancy
400
``` sensorineural deafness congenital cataracts congenital heart disease (e.g. patent ductus arteriosus) growth retardation hepatosplenomegaly purpuric skin lesions 'salt and pepper' chorioretinitis microphthalmia cerebral palsy ```
congenital rubella syndrome
401
can women have MMR during pregnancy?
no
402
what is criteria for medical management of fibroid?
<3cm | not distorting uterine cavity
403
long term complications of vaginal hysterectomy with antero-posterior repair:
enterocele and vaginal vault prolapse
404
Bladder still palpable after urination, think
retention with urinary overflow
405
raised FSH, LH levels | low oestrodiol levels
premature ovarian failure
406
Woodscrew Manoeuvre? | shoulder dystocia
put your hand into the vagina and rotate the fetus 180 degrees
407
best way to dx adenomyosis:
MRI pelvis
408
emergency contraception. Last night the condom split. She does not use regular contraception and is on day 20 of a 28 day cycle. You discuss the intrauterine device but she declines. which option?
Levonorgestrel stat dose 1.5mg
409
why should cooked liver be avoided in pregnancy?
high amounts of vit A - teratogen
410
mx: breech delivery, fully dilated:
CS
411
what test to confirm early menopause?
FSH - raised
412
POP+Abx - any extra precautions?
no - continue as usual
413
24yof to GP 8/7 giving birth. Persistent pink vaginal discharge, 'smelly'. 90bpm, 38.2ºC diffuse suprapubic tenderness. Uterus feels generally tender. Urine dipstick shows blood ++. What is the most appropriate management?
Admit to hospital - IV Abx clindamycin and gentamicin until afebrile for greater than 24 hours puerperal pyrexia secondary to endometritis
414
puerperal pyrexia:
temp > 38 in first 14/7 post-delivery
415
puerperal pyrexia causes:
``` endometritis: most common cause urinary tract infection wound infections (perineal tears + caesarean section) mastitis venous thromboembolism ```
416
30yof 34/40 UTI - GBS, what mx going forward:
IP IV Benpen
417
to prevent spina bifida, what dose of folic acid should be taken throughout the first 12 weeks pregnancy?
400mcg daily
418
risk factors for spina bifida in baby:
``` parental NTD FHx NTD prev pregnancy NTD AEDS, coeliac, DM, thalassaemia obesity ```
419
23F, G2P1, 37/40 - fainting and has severe abdominal pain. BP 92/58 and HR 132. Cold and her fundal height is 37 cm; cervical os is closed and no vaginal bleeding. dx?
placental abruption | rf = cocaine
420
which AED is recommended for pregnancy?
Lamotrigine
421
17 year old girl presents with a history of amenorrhoea, having never started her period. On further questioning she has developed secondary sexual characteristics, such as growth of breast tissue and pubic hair. She also complains of pelvic pain and some bloating. Which of the following is likely to be the cause?
imperforate hymen
422
if woman has 2 inadequate smears in a row - mx??
refer to colposcopy
423
25yof ED. Severe abdo pain. Started suddenly 3 hrs ago. She has not had periods for 7wks, currently sexually active. Hx PID 5yrs ago. Abdo ex: generalised guarding and signs of peritonism. An urgent USS showed free fluid in the pouch of Douglas, empty uterine cavity. Urine βhCG was positive. Suddenly became very ill. BP 85/50 mmHg, HR 122/min, RR 20/min, O2 sats 94%. likely dx:
ruptured ectopic pregnncy
424
Mx of sudden deterioration in ?ruptured ectopic?
urgent laparotomy
425
HIV pregnancy - advice re breastfeeding?
do not do it
426
Mx of a HIV pregnancy?
anti-retroviral tx throughout vaginal delivery if viral load < 50copies/ml 36/40 CS if viral load higher zidovudine infusion 4hrs pre CS if VL<50, zidovudine PO to neonate/4-6wks if higher VL, ART 4-6wks
427
woman with IUS first 6/12 - commonest sfx:
irregular bleeding
428
UTI in breastfeeding woman: which Abx safe?
trimethoprim
429
CTG: terminal bradycardia:
fetal HR<100 for >10mins
430
CTG: terminal deccelerations: what does this mean?
fetal HR drops and does not recover >3mins
431
If see pre-terminal CTG findings - mx?
emergency CS
432
clinical features of hypertension, vomiting and abdominal pain support the diagnosis of which obstetric condition?
HELLP
433
? case of rubella in pregnancy - who should you contact?
local health protection unit
434
Assuming the Pearl Index of the combined oral contraceptive pill is 0.2, how will you explain the failure rate of this form of contraception if used correctly?
For every 1000 women on this contraception for 1 year, 2 will become pregnant
435
what results would the testing for downs show?
``` thickened nuchal translucency high bHCG low oestrodiol low PAPPA low AFP ```
436
5th day post partum. ED. husband noticed abrupt change in behaviour. Confused and restless. MSE: describes racing thoughts, low mood and suicidal ideation. Pressurised speech is also evident. What is the most likely diagnosis?
puerperal psychosis
437
differentiating between puerperal psychosis and post natal depression in terms of onset?
puerperal psychosis is first 3 weeks | PND is 1 months after - 3 months
438
need for contraception after the menopause: | over 50:
12 months LMP
439
need for contraception in menopaise: | Under 50
24 months LMP
440
how long after partum can women get pregnant
21 days
441
what happens to urine pregnancy test after TOP?
can remain positive for up to 4 weeks post-TOP
442
if pregnancy test positive after 4 weeks since TOP, what does this indicate?
incomplete abortion or | persistent trophoblast
443
if woman with hyperemesis gravidarum presents 12/40, severe with diplopia and ataxia - what is wrong and what needed for mx?
``` wernicke's encephalopathy IV pabrinex (vit b and c) ```
444
28-year-old woman presents because she has not had a period for the past 9 months. She also describes fluid leaking from her nipples.
prolactinoma
445
26-year-old woman presents 3 months after giving birth to her first child. During labour she had a large post-partum haemorrage. She did not breastfeed but has not had a period since.
sheehan's
446
25-year-old woman presents 5 months after having dilation and curettage for a miscarriage. Since this procedure she has not had a period. A pregnancy test is negative. Hysteroscopy is performed which reveals the diagnosis.
asherman's
447
best test to confirm ovulation?
progesterone
448
PCOS criteria (3)
oligomenorrhoea hyperandrogenism (high T) polycystic ovaries on USS or increased ov volume
449
how many criteria need fulfilling for PCOS dx:
2/3
450
risk factors for cervical cancer:
``` HPV smoking HIV early first intercourse, many partners high parity lower social status cocp ```
451
mechanism of HPV causing cervical cancer?
HPV 16 & 18 produces the oncogenes E6 and E7 genes respectively E6 inhibits the p53 tumour suppressor gene E7 inhibits RB suppressor gene
452
missed 1 cocp - action?
take 2 following day - no further action
453
34-year-old woman from Zimbabwe presents with continuous dribbling incontinence after having her 2nd child. Apart from prolonged labour the woman denies any complications related to her pregnancies. She is normally fit and well.
vesicovaginal fistulae | Ix - urinary dye studies
454
56-year-old lady reports incontinence mainly when walking the dog. A bladder diary is inconclusive. Ix?
urodynamic studies
455
what condition is CI of epidural analgesia in labour?
coagulopathy
456
which oral hypoglycaemic drug during breastfeeding is safe?
metformin
457
what is fetal fibronectin (ffn)?
protein releasaed from the gestational sac
458
what does high Ffn indicate?
increased likelyhood of early labour
459
step-wise mx DM in pregnancy?
metformin + insulin glibenclamide (if can't tolerate metformin)
460
if at 25/40, high FFP, what is mx?
admit for 2xdoses IM steroids, monitor BMs closely adjust insulin pump accordingly
461
if woman presents with baby blues, mx?
reassure, explain
462
methods of contraception is most associated with delayed return to fertility?
depo-provera
463
molar preg 8 weeks after her last menstrual period. She complains of severe nausea, vomiting and vaginal spotting. - bloods (bhcg, tsh, thyroxine)??
high bhcg, low tsh high thyroxine
464
For women taking phenytoin,carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine: UKMEC 3:
POP, COCP
465
amenorrhoea, abdominal pain and vaginal bleeding in combination with shoulder tip pain suggesting peritoneal bleeding - dx?
ruptured ectopic
466
miscarriage with evidence of infection or increased risk of haemorrhage - mx:
surgical mx | expectant inappropriate
467
23-year-old woman complains of anorexia, vomiting, fever and abdominal pain. The pain was initially periumbilical but is now worse in the lower abdomen.
appendicitis
468
28-year-old woman complains of a two year history of bad period pains which are not controlled by NSAIDs or the combined contraceptive pill. She also reports significant pains during intercourse.
endometriosis | pelvic pain, dysmenorrhoea, dyspareunia and subfertility
469
31-year-old woman complains of intermittent pain in the left iliac fossa for the past 3 months. The pain is often worse during intercourse. She also reports urinary frequency and feeling bloated. There is no dysuria or change in her menstrual bleeding
ovarian cyst
470
25-year-old woman is to have an elective laparoscopic cholecystectomy in 8 weeks time. She takes no medications other than the combined oral contraceptive pill. What should be done with regards to her pill and her upcoming surgery?
stop pill 4 weeks before and restart 2 weeks after VTE risk
471
COCP: If 2 pills are missed in week 1,
emergency contraception if she had unprotected sex during the pill-free interval or week 1 and then take 2 pills today then back to normal
472
common cause of menorrhagia and abdominal pain in a menstruating female?
fibroids (leiomyoma)
473
woman mentions to her midwife that she has been previously diagnosed with immune thrombocytopenic purpura (ITP). Which procedure carries the greatest risk of haemorrhage in the newborn?
prolonged ventouse delivery
474
14-year-old daughter. She is concerned as her daughter has not yet started her periods although suffers cyclical pain.
imperforate hymen
475
19-yo GP 14 weeks into her second pregnancy. Her pregnancy has been progressing normally so far, including a normal dating scan at 10 weeks. She visited 24 hours ago due to excessive nausea and vomiting and was started on oral cyclizine 50mg TDS. However, she is still unable to tolerate any oral intake, including fluids. Her urine dip is positive for ketones. What is the most appropriate next step?
admit for iv fluids if wt loss or ketonuria admit
476
fetal head: optimum position?
OA
477
when will women experience earlier urge to push - oa or op head?
OP head
478
first line non-hormonal tx for menorrhagia?
tranexamic acid
479
cholestatic picture of liver function tests (LFTs) :
high ALP and GGT, with a lesser rise in ALT
480
hepatic picture would be expected on LFTs, with a rise in ALT/AST greater than that of ALP, a raised white cell count and potential clotting abnormalities in which condition?
acute fatty liver of pregnancy
481
vomiting, dry skin, tiredness and raised B-hCG may point towards
molar pregnancy
482
classic finding on US in molar pregnancy:
Large for dates uterus
483
only effective treatment for large fibroids causing problems with fertility is??
myomectomy if woman wants to conceive
484
levonorgestrel: how long can wait for emergency contraception:
72 hours (96 but decreases over time)
485
ulipristal acitate: how long can wait for emergency contraception:
120 hours | CI in asthma
486
ov ca stage 1:
confined to ovary
487
ov ca stage 2:
outside ovary but in pelvis
488
ov ca stage 3:
outside pelvis but in abdo
489
ov ca stage 4:
distant metastasis
490
Ix: jaundice of pregnancy?
LFTs
491
first line tx: dysmenorrhoea
NSAIDs
492
which gene predisposes to ovarian cancer (especially if hx in 1 degree relatives)
BRCA1
493
signs during a cardiac examination would not be considered normal and prompt referral for further evaluation?
pulmonary oedema
494
in women above 50, which contraception should be stopped?
depo-provera
495
layers of abdomen to get to fetus in CS:
``` Superficial fascia Deep fascia Anterior rectus sheath Rectus abdominis muscle (not cut, rather pushed laterally following incision of the linea alba) Transversalis fascia Extraperitoneal connective tissue Peritoneum Uterus ```
496
15-year-old girl reports heavy menstrual bleeding since menarche when she was 14. When she was younger, she frequently suffered from heavy nosebleeds. What is the most important next step after normal examination and ultrasound? Ix?
coagulation screen
497
moderate dyskaryosis:
urgent referral for colposcopy 2ww
498
after 24 weeks how much should fundal height grow per week?
1cm
499
when is combined test for downs done?
11-13.6 weeks
500
if women present later than 14 weeks which downs antenatal tests should be done and when?
triple/quadruple tests - between 15-20 weeks
501
when is CVS (downs) done in pregnancy?
11-14 weeks | <15 weeks
502
when is amniocentesis testing done in pregnancy?
15-20 weeks | >15 weeks
503
infertility investigations if looking for tubal patency?
hysterosalpingogram laparoscopy check BMI
504
lifestyle mx infertility:
sex, stress, sleep, weight
505
lab investigations for infertility:
progesterone 21/28 LH, FSH semen analysis - if abnormal repeat 3/12
506
how to measure gestational age in first trimester?
crown-rump length
507
twin-twin transfusion more likely in which type of twins?
monozygotic, monochorionic, diamniotic
508
placenta increta?
invasion of the myometrial wall (80%) - no further than the wall
509
Herpes viral labia infection in pregnancy mx:
CS before term
510
tx for white penile discharge:
PO azithromycin
511
PCOS: mx:
weight loss first line!
512
Normal birth weight:
2.5-4kg at term
513
oligohydramnios definition:
AFI < 5 cm at term or below 5th percentile for gest age
514
polyhydramnios definition:
defined sonographically as a total amniotic fluid volume >2 L, a single vertical pocket ≥10 cm, or an AFI >20 cm at term or >95th percentile for gestational age.
515
Small for dates / gestational age: definition:
birth weight < 10th centile | severe < 3rd centile
516
how is fetal small for dates measured?
Estimated fetal weight/abdo circumferance<10th centile
517
IUGR definition:
pathological restricted genetic growth potential leading to oligohydramnios
518
risk factors for IUGR:
``` age>40 smoking prev SGA mat/pat SGA prev stillbirth cocaine use vigorous exercise in preg DM/HTN heavy bleeding low PAPPA ```
519
ix: IUGR?
USS - ratio of head circumferance:abdo circumferance Also anatomical USS infection screen
520
if HC:AC symmetrical on USS - what does this indicate?
constitutional small baby
521
If HC:AC asymmetrical on USS - what does this suggest?
placental insufficiency ->renal failure -> oligohydramnios | Due to 'brain-sparing' effect
522
Mx: IUGR:
Uterine artery doppler - absent/reverse end-diastolic flow -> CS Middle cerebral artery doppler - abnormal - induce by 37/40 Normal findings - induce at 37/40
523
pre-eclampsia: treat above what BP?
160/110 | severe over 170/110
524
Large for dates/LGA:
weight, length, SFH or head circumferance >90th centile
525
causes of Large for dates baby:
``` obesity polyhydramnios DM infection - cmv previous LGA babies genetic abnormalities/syndromes ```
526
cx LGA baby:
``` hypoglycaemia polycythaemia birth defects - shoulder dystocia malpresentation lung problems meconium aspiration PPH perinatal asphyxia low APGAR ```
527
Ix: LGA?
Uterine ex USS UA doppler TORCH screen
528
failure to progress in labour:
<2cm dilation in 4 hours | arrested descent or protracted
529
failure to progress in labour causes:
unborn baby can't fit through mum's pelvis baby not in right position weak contractions/too far apart (Power passage passenger)
530
treatment for failure to progress in labour?
ARM Oxytocin instrumental C-S
531
in failure to progress - factors that make you consider mode of delivery?
fetal distress | maternal risk
532
effacement:
cervical ripening/thinness - NOT SAME AS DILATED
533
what does meconium stained liqor indicate:
fetal distress (also increased risk of aspiration)
534
malpresentation Ix:
USS | uterine examination
535
if face or brow presentation - Mx?
CS
536
Bishops score - what are you examining and where?
``` vaginal exam: effacement position consistency dilation ```
537
commonest cause of recurrent miscarriage in first trimester?
antiphospholipid syndrome
538
absolute contraindication for vaginal delivery following previous cesarean section?
vertical (classical) CS scar
539
mx for vaginal vault prolapse?
sacrocolpopexy
540
27 year-old lady is day 1 post emergency caesarean section for failure to progress in the first stage. She has been complaining of pain and heavy vaginal bleeding since delivery and in the morning was noted to have heavy, offensive lochia and a boggy poorly contracted uterus above the umbilicus.
retained products - examine under anaesthesia
541
ovarian torsion can show what on USS?
whirlpool sign
542
Intrahepatic cholestasis of pregnancy planning?
induction of labour at 37/40
543
At which week should you refer to an obstetrician for lack of fetal movements??
24/40
544
cervical ca FIGO stage 1a mx?
cone biopsy with follow up if they wish to maintain fertility hysterectomy +/- LN clearance option but infertile
545
HRT most likely to cause breast cancer?
Combined HRT | adding a progestogen increases breast cancer risk
546
Chickenpox exposure in pregnancy > 20 weeks (if not immune):
antivirals or VZIG should be given within 7-14/7 post-exposure
547
If after 28/40 weeks, if a woman reports reduced fetal movements and no heart is detected with handheld Doppler- next step?
USS scan
548
patients with secondary dysmenorrhoea?
refer all to gynae | pelvic inflammatory disease, endometriosis, adenomyosis, and fibroids
549
Cervical cancer screening: if smear inadequate then?
repeat within 3/12
550
When investigating suspected PPROM, if there is no fluid in the posterior vaginal vault on speculum exam then?
USS for oligohydramnios
551
Management of placental abruption when the fetus is alive, <36 weeks and not showing signs of distress?
admit and give steroids
552
PCOS ix: gHs?
normogonadotropic normoestrogenic anovulation
553
CI for depo-provera injectable prog only pill?
current breast cancer
554
If at the time of diagnosis of gestational diabetes, the fasting glucose level is >= 7 mmol/l immediate?
insulin +/- metformin should be started can also dx GDM if 2h glucose >7.7
555
Pregnant women ≥ 20 weeks who develop chickenpox are generally treated how if present in <24h OF rash?
oral aciclovir
556
Premenstrual syndrome: mx?
new generation COCP - drospirenone containing COCP continuous or SSRI either continuously or during luteal phase
557
For transgender males, testosterone therapy does not provide protection against pregnancy - mx?
copper IUD | - CI in menorrhagia
558
ix of choice first line in ?ectopic?
transvaginal uss
559
A 34-year-old woman presents to the GP asking about contraception. She is 4 weeks post-partum. When is lactational amenorrhoea a reliable form of contraception?
amenorrhoeic, baby <6/12, breastfeeding exclusively
560
If a breastfed baby loses > 10% of birth weight in the first week of life then?
refer to midwife-led breastfeeding clinic
561
The recurrence rate of postnatal psychosis is?
25-50%
562
Women who have a positive pregnancy test and either abdominal, pelvic or cervical motion tenderness should
refer immediately to early pregnancy assessment unit
563
HRT with lowest VTE risk?
transdermal
564
If a patient vomits within 3 hours of taking the levonorgestrel>
take a second dose
565
For patients assigned male at birth treated with oestradiol, GNRH analogs, finasteride or cyproterone, contraception mx?
barrier - cannot be 100% sure
566
from down's combined screening - which 2 syndromes give similar results?
Edward's (tri 18) and Patau's (tri 13) | PAPPA tends to be lower than downs
567
emergency contraception if it is inserted within 5 days of UPSI, or up to 5 days after the likely ovulation date.???
copper IUD
568
A 32-year-old female requests emergency contraception. She had unprotected sexual intercourse 28 hours ago and is not using any regular contraception. She has a diagnosis of obesity, severe asthma and uterine fibroids with distortion of the uterine cavity. mx?
levonorgestrel - double dose | double dose if BMI>26 / wt>70kg
569
if abnormal exam findings, pelvic pain, intermenstrual or postcoital bleeding- ix?
TVUSS
570
safest contraception in BRCA carrier?
copper IUD
571
48F perimenopausal symptoms. Apart from suffering from migraines with aura, she does not have any relevant medical history. She has a family history of deep vein thrombosis (DVT). The patient's last menstrual periods are irregular, the last one being 3 months ago. She is not currently on any contraception. tx?
topical combined cyclical HRT
572
A 49-year-old patient presents with hot flushes and mood swings. She has no previous medical history or family history. She has been amenorrheic since her Mirena (levonorgestrel) coil was placed 2 years ago. She would like to consider HRT with the least side effects. tx?
oestrogen patch
573
Pregnant women who are < 6 weeks gestation and present with vaginal bleeding and no pain - mx?
expectantly retake preg test in 7 days - if negative = miscarriage if + or continued sx -> EPAU
574
If two pills are missed, between days 8-14 of the cycle,??
no emergency contraception required as long as 7 pills previously taken correctly 7 days of additional precaution
575
28F hirsutism affecting her face, upper arms and chest. It is affecting her self-esteem and she is keen on further treatment for this symptom. She also has irregular menstrual cycles which vary between 19 and 45 days in length. She has no other medical problems and does not smoke. She has a BMI of 29 kg/m2 and blood pressure of 136/88 mmHg. Her HbA1c is normal. She does not wish to get pregnant at this time. rx?
COCP
576
A 35-year-old woman has irregular periods, acne and hirsutism. She has also been trying to conceive with her partner for 6 months but has been unsuccessful. A pelvic ultrasound scan has confirmed the presence of polycystic ovaries. She has tried losing weight and her current BMI is 28 kg/m2. Her HbA1c is normal. mx?
refer to fertility services
577
Maria, a 33-year-old woman, attends the infertility clinic after failing to conceive naturally for the last 18 months. Investigations have diagnosed her with polycystic ovarian syndrome (PCOS) and she would like to discuss initial options for managing her infertility. tx?
letrozole first line to stimulate ovulation
578
Increased risk of placental abruption is associated with>
age, multiparity, maternal trauma

3a (7 decks)

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