OBGYN III 👘 Flashcards
Screening for BRCA patients
6 monthly ovarian US and CA125. And annual MRI of breast. Consider prophylactic removal at 40
Ovulatory bleed first line Mx
COCP
Who gets DEXA scan
Above 65
Who gets HRT in menopausal
Less than 60 and has symptoms of flushing, vag atrophy, mood issues
E vs E AND P for menopause
E only if no uterus
Is liver disease a CI for HRT
Yes,
First and second line medical therapy for endometriosis
COCP and GnRH ag/Levo IUD
Severe recurrent endometriosis, and patient doesn’t want more kids
Can do hysterectomy
Patient has the endometrial hyperplasia…. Bye did the biopsy, just plain hyperplasia, no atypia
Just do progesterone. Then after 6mo reassess, doing biopsy. If not improvement, then send to oncology
What is Yasmin
Drospirenone + ethinyl estradiol (Yaz; Yasmin)
Tx for premenstrual disorder
SSRI if severe
Dx of premenstrual syndrome
Clinical. Get patient to take a diary and make the connection
Endometrial stripe size limit
> 4mm. Don’t forget to apply this
Cyst rupture but not unstable or severe
Reassure and observe
Why ovarian tumour causes precocious puberty in woman
Granulosa
<45 with AUB. Failed COCP. Do what
Biopsy
Endometrial ablations and salpingograms allowed in unknown cause of AUB
No…. Could spread potential cancer
In pregnancy why do we see an increased risk of non-compliance to medications
Women are often scared the medications cause harm to the baby, so decrease them
What affect does neuraxial epidural anaesthesia do to 2nd stage
Increase is it
Main cause of protracted active phase of labour
Catholic pelvic disproportion
Is a platelet range of 100 to 150 okay in pregnancy
Yes
Bleeding when rupture of membranes, and fetal heart tones go. Blood pressures are all okay
Vasa previa
If postpartum (few days postpartum) you have a little bit of red vaginal discharge. Patient is stable. Do we have to worry
Normal lochia rubra
After salpingectomy for ectopic pregnancy, what injection shall I give
RhoGAM
If I have ectopic pregnancy and do salpingectomy, do I need methotrexate
No
Obvs gravidity is number of preg. What is parity
Number of live births beyond 20 weeks
Foods to avoid in preg
Fish with mercury, moderate caffeine only, undercooked meat and fish. Delicaneyby
We give folate, calcium, iron to patients!. But what extra for vegans
D and B12
Obvs give IV penciclin for GBS prophlx. If allergy? Or if risk of anaphylaxis
Ceph
Clinda or vanco resp
When to do the A test in preg
10-14 weeks. So do PAPPA and HCG and nuchal trans. Then do the quad screen not long after
When to do the gest DM screen if no risk factors
End of second trim or beginning of third
Obvs in first visit we test lots of infx. In high risks, what do we check again at end
Chlamydia gonorrhea hiv syphilis
High AFP can be seen on NTD or abdominal wall defect. Where else?
Twins, incorrect dating, fetal death, placental A
When does all the aneuploidy stuff start
10 weeks onward
SE if amniocentesis
PROM, chorioamn, hemorrhage
10-12 weeks gest, or 15-20 weeks gest. Which is CVS and which amnio
That ordet t
Mercury affect of fetus
Cerebral atrophy. Microcephalic etc
Safest testracine in preg
Doxy
Feta warfarin syndrome
Nasal hypo, stippled bone epiphysis, and more
Vit A tox to preg
Thymic agenesis, CV defect, craniofascial issue, CL/CP etc
Infant from HIV mum…. Her titre was less than 1000, do I give Tx?
Yes.
CMV vs Rubella cong infx?
Rubella: Blueberry muffin, cataracts, PDA, hearing loss
CMV: perivent calcification. Petechia rash.
Methylene TDF reductase def
Same as saying homocysteinuria
If spont abortion early (<12 weeks) likely what cause
Chromosomal
If spont abortion later (12-20weeks) likely what cause
Coag, C insuff.
How to prevent spont abortion in APLS
LMWH and aspirin
Spontaneous abortion order
, threatened, inevitable, incomplete, complete, missed.
All os closed and POC still there, but bleeding. Then Os opens but POC kept. Then POC half gone. Then POS gone and Os closed
Spontaneous abortion. Incomplete, or inevitable. If <12 weeks or after
Manual aspiration. Or DandC if after
Stillbirth Mx
If < or > 24 weeks
DandE
Induce labour
Autopsy to see cause
If sus spont abortion. See no fetal pole, no cardiac activity on US… do what?
HCG
Medical abortion:
If < or > 10 weeks gest
Misoprostol and mifepristone
DandC with vaccum aspiration
Complications of abortion
Retained POC (causing DIC of endometritis or septic abortion)
Way to remember Os open and spont abortion
If begins with I…. Then it’s open Os (inevitable and incomplete)
First invx in hyperemesis G
Usually US to check for twins or molar or chorio
Main step approach to Tx for hyperemesis G
Diet, anti H, metaclo, ondansteorn
Reasons for doing early GTC I’m first trim
Fat mum, PCOS, previous macrosomic, previous test of insulin resistance (HbA1c above 5.7), previous gest DM, first degree relative with DM, CVD.
Reasons to do early GTC in preg (first trim)
Fat mum, PCOS, previous macrosomic, previous test of insulin resistance (HbA1c above 5.7), previous gest DM, first degree relative with DM, CVD.
Greater than 8, invegstiagte. In terms of Gest DM
If HBAC1 large that 8 in preg… check for congetsinal issues
What is considered macrosomic
> 4000g. If EFW is above 4500 do C-section
Gestational DM. In labour what do we do
Infuse insulin and dextrose to keep steady glucose
We all know chronic HTN is Dx before 20 weeks. How else can we Dx retrospectively
If persists >3mo post partum
List all the elements that make preeclampsia severe
TCP, Cr high, LFT *2 high, pulmonary edema, Neuro issues and headache unresponsive to meds, eye issues
General Mx on delivery for:
Preeclampsia not severe
Severe features
Eclampsia
37
34
Immediate
Some preeclampsia stuff to Mx
37 weeks
Far from terms (before 34)
Severe features
If Mg tox
24 hr postpartum
Deliver
Expectant, with BP control, Mg drip,
Same as above
Calcium gluconate
Continue seizure prophlx
Patient with preeclampsia has headache and RUQ pain. Is this severe
Yes severe features
RF for preeclampsia
Renal disease (SLE DM), nulliparoty and twin, fam Hx, HTN, extremes of age. Molar preg
If eclampsia seizure recurs, give what
Diazepam
Do you need routine monitoring of Mg levels when giving Mg in eclampsia/preeclampsia with severe features
No
Intrahep cholestasis vs AFLP quick facts
Pruritus, like pain mild elevated LFT. Best to measure bile acids (sens and spec). Give Urso and deliver at 36
RUQ pain, low glucose, jaundiced, only 200-300 LFT. TCP and DIC
Deliver!
Does ectopic preg cause vag spotting
Yes
Risk factors for molar preg
Extreme age, folate def or carotene def
Stable abruption can be Mxd expectantly. What about more severe
Bag deliver if mother and fetus ok
C sec if not
Risk factors for acreta
Low lying placenta, downs, prior Sx to endemtrium
Baby with EFW of >5000, or 4500 with DM
C-SECTION
Main thing to rule out at first in Oligohydramnios
ROM
Does all women get RhoGAM
Only Rh neg women with positive or unknown man. Then if baby positive for Rh, give after birth. Not for all!
when do we actually do fetal movement assessment and NST in preg
For pregnancies at high risk of fetal demise… around 30 weeks can start
What is a reactive stress test?
2 accel over 20 mins.
Causes for non reactive stress test
Less than 32 week, sleeping (wake up with vibration), CNS issue, narcotic mum. Do follow up with CST or BPPP
When not to do contraction stress test
If risk of premature/Previa/ Hx of urge time Sx
What is a positive CST
Worry some (unlike NST). Deliver. Is when late decals usually
What are the abnormal umbilical artery dipole findings
Decrease, absent, reverse end diastolic flow. High velocity diastolic flow is good
BPP
Test the Baby MAN
Tone, Breathing, movement, amniotic FI, Non stress
When do we use umbilical Doppler velocity
If sus FGR
When do we use umbilical Doppler velocity
FGFR
List of CI to breast feed
HIV in US, Tb unTx, varicella, herpes on boob. Chemo, radioTx, cocaine PCP, cannabis. TETRACYCLINE CHLORAMPHENICOL m, galactosemia
Mx for those not wanting to breastfeed
Supportive bra, avoid nipple stun, apply ice and NSAID.
If no improvement in breast mastitis in 48 hours… do what
US to see if abcess
Breastfeeding and get painful tender lump…. No fever or chills. No leuko
Localised plugged duct
Breast engorment Mx
Frequent breast feed, or suppress lactation if not feeding. Warm compress before and cold between feed.
