obgyn QM Flashcards
what is CI in myasthenia gravis
anticholinergics such as oxybutynin for urge incontinence - if tried bladder training skip straight to botulism toxin injection
PCOS conception advice
Advise the woman to continue having unprotected intercourse and ask to be referred for IVF if she has not become pregnant after 2 years in total
home abortion regimen
The most effective regimen is mifepristone 200mg orally, followed 24–48 hours later by misoprostol 800 micrograms taken by the vaginal, buccal or sublingual route.
1-2- days later !!!
congenital rubella syndrome presentation and diagnosis
This baby has presented with congenital rubella syndrome (CRS). Symptoms of CRS include sensorineural deafness, cataracts or retinopathy, and congenital heart disease. Microcephaly and a “blueberry muffin” rash are also common. CRS occurs when the mother contracts rubella during pregnancy, especially in the first trimester. For babies under 6 months, a blood sample is tested for rubella-specific IgM antibodies. A positive IgM test, along with clinical features, confirms CRS.
IgG and IgM measured if over 6 months
RF for Gestational DM and investigation
Risk factors include family history of diabetes, previous macrosomic baby of >4.5 kg, and a BMI >30.
If a woman has one risk factor, they are offered an oral glucose tolerance at 24-28 weeks.
management for GBS infection at 35 weeks
Intravenous antibiotics (Benzylpenicillin or Vancomycin if penicillin-allergic) during labour or ROM
intrahepatic cholestasis of pregnancy Mx
Emollients and chlorphenamine
anti D prophylaxis administration
There are two ways routine anti-D prophylaxis can be given: a one-dose injection between 28 and 30 weeks of pregnancy or two doses of injections at 28 weeks and 34 weeks of pregnancy.
acute fatty liver of pregnancy presentation and Mx
Acute fatty liver of pregnancy is a rare complication of pregnancy but important to be aware of. It commonly occurs in the third trimester or immediately following delivery and is thought to be more common in nulliparous women as in the case of this patient. A typical patient will present with a few days history of general malaise, anorexia, vomiting, and jaundice. Pain in the right upper quadrant may sometimes be present. Blood results would show marked elevation of liver enzymes, prolonged PT, raised and bilirubin. Low platelets will be seen due to consumptive coagulopathy. Once stabilized, delivery should be performed. Delay in treatment can result in coma and death secondary to hepatic failure. It resolves spontaneously after delivery, which is the definitive treatment
GDM with fasting plasma glucose 7+ mx
According to NICE guidelines, immediate treatment with insulin is offered to patients with gestational diabetes who have a fasting plasma glucose level of 7.0 mmol/litre or above. Advice about changes in diet and exercise should be offered to all women diagnosed with gestational diabetes.
metformin adjunct
A 62 year old presents to the GP complaining of urine ‘leakage’ whenever she coughs or sneezes. She has a past medical history of COPD which is well controlled but does mean she coughs a lot and it is becoming increasingly bothersome. She denies haematuria but does mention urination has been a bit uncomfortable for the past week.
Observations and examination are normal. Urine dipstick shows +1 blood.
What is the most appropriate management?
Patients aged 60 and over with unexplained non-visible haematuria and dysuria or a raised white cell count on a blood tests hould prompt a 2-week wait referral for urological investigation to exclude bladder cancer.
A woman with suspected ectopic pregnancy requiring ultrasound investigation should be promptly referred to an
Early Pregnancy Assessment Unit (EPU) for TVUS
bHCG done after
41 weeks gestation. The birth was a vaginal delivery and other than the presence of green - tinged liquor there were no other complications. At initial assessment the newborn appears to have laboured breathing,
diagnosis?
Meconium aspiration syndrome is the most likely diagnosis. The green tinged liquor suggests that meconium is present and it is likely that this was inhaled by the infant before or during birth. Furthermore, the risk of meconium aspiration syndrome increases after 40 weeks gestation
this is causing the respiratory distress
blood tests in early menopause findings
Raised FSH, Raised LH, Low Oestrogen
During menopause, decreased ovarian oestrogen production reduces hormonal feedback, causing elevated blood levels of FSH and LH.
An immediate oral glucose tolerance test at booking is offered in patients with
previous gestational diabetes
when do you advise someone with missed contraceptive pills to skip the pill free interval
the next pill-free interval is typically only skipped if the missed pills are from the last week of the pack.
Women with an indication for intrapartum antibiotic prophylaxis due to previous neonatal GBS infection who have a penicillin allergy should be
treated with vancomycin instead.
lactational contraception
effective for 6 months, rely on full exclusive breast feeding
contraception is not required for the first how many weeks after delivery
3
vWD 1st line mx
Desmopressin is the first line treatment of Von Willebrand’s disease. The medication works by temporarily increasing FVIII and Von Willebrand factor levels by releasing endothelial stores.
PPD Mx
The patient’s symptoms, including persistent sadness, guilt, difficulty bonding with her baby, and low appetite, strongly suggest postpartum depression (PPD). Sertraline is the preferred SSRI for breastfeeding mothers due to its safety profile, and CBT is an effective therapeutic approach. Combining CBT with an antidepressant like sertraline is often the best approach to managing moderate to severe PPD.
A 44-year-old woman attends her general practitioner troubled by recent heavy periods. She describes her cycle as a regular 40-day cycle, with 7-10 days of bleeding. She has a progestogen-only implant as contraception, and has no past medical history of note.
Her smear tests are up to date, and she has no concerns about sexually transmitted infection.
What is the most appropriate management?
Refer for a transvaginal ultrasound scan
Transvaginal ultrasound scan should be requested for cases of new menorrhagia, looking for underlying causes such as fibroids or polyps. In this age group, fibroids are the most common cause of menorrhagia.
polymorphic eruption of pregnancy presentation and mx
starts on the abdomen, spares the umbilicus, and may spread to the thighs or buttocks. Symptomatic treatment includes emollients, topical corticosteroids, and antihistamines.
A 30-year-old woman attends for her 20-week foetal anomaly scan. The scan notes microcephaly with periventricular calcification, hyperechogenic bowel, splenomegaly and hepatomegaly.
Which of the following is the most appropriate next step in management?
Amniocentesis
These are ultrasound findings common to congenital cytomegalovirus (CMV) infection, which can be tested for using amniocentesis.
A 32-year woman presents to an infertility clinic after being unable to conceive with her partner for the last year. Her menstrual cycle is irregular, lasting anywhere from 28 days to 45 days. Her period usually lasts for 4 days. She doesn’t have any previous children. She also complains that her arms and legs are sometimes weak.
On examination, she has a high BMI and there are several linear purple marks, running in a vertical direction on her abdomen.
What is the most appropriate investigation?
dexamethasone sup test
for cushings
actively vomiting in pregnancy ?
not oral cyclizine as unlikely to be effective
Prochlorperazine 12.mg intramuscular
In cases of pregnancy of unknown location, where ultrasound scan is inconclusive and symptoms are minimal,
monitoring bHCG levels can aid in diagnosis and management.
key finding with onset of HG
symptoms before 16 weeks
Hyperemesis gravidarum is intractable vomiting before 16 weeks of pregnancy leading to the triad of weight loss, dehydration and electrolyte disturbance. Early signs include ketonuria and/or weight loss of up to 5% of overall pre-pregnancy weight. Treatment is usually with electrolyte rehydration therapy and anti-emetics. Admission may be necessary for IV hydration
Pelvic pain that worsens before and during menstruation, along with symptoms of blood in urine and dysuria, may indicate
endometriosis, a condition characterised by the growth of endometrial tissue outside the uterus.
severe pre menstrual syndrome doesn’t want hormones
Fluoxetine is a selective serotonin-reuptake inhibitor (SSRI). NICE recommends the consideration of SSRIs where premenstrual syndrome is severe. These can be taken during the luteal phase of the menstrual cycle (days 15–28).
For women with heavy menstrual bleeding who are planning pregnancy,
tranexamic acid may be an effective option for reducing menstrual blood loss without the need for hormonal therapy.
mefanamic if pain
Heavy menstrual bleeding and an enlarged uterus in a young woman is usually due to
fibroids
what type of hypogonadism in turners
Turner’s syndrome is an example of hypergonadotropic hypogonadism, where the ovaries do not respond to stimulation by LH and FSH.
what day to test progesterone in a woman trying to conceive if A) she has a 28 day cycle, or B) she has a 32 day cycle
In a 28-day cycle, this would make this day 21 progesterone, however as this woman has a 32-day cycle, you must could 7 days back from the last day of the cycle, making the correct time to perform this test on day 25.
what has no indication in speeding up miscarriage
mifepristone
when to use misoprostol in miscarriage
misoprostol, this is used in circumstances where the cervical os is closed and you need to soften it and induce contractions in order to open it up. It is usually therefore indicated for use in incomplete miscarriages or missed miscarriages.
not in inevitable
combined vs quadruple test conditions
The combined test is carried out between 10-14 weeks gestation and tests for Down syndrome, Edward syndrome and Patau syndrome.
quadruple test is just downs
gestational HTN in asthmatic patient Mx
oral nifedipine, not labetalol
folic acid and DM
Women with diabetes are advised to take 5mg folic acid daily instead of 400 micrograms to reduce their increased risk of birth defects such as spina bifida. The most important time to be taking folic acid is pre-conception to 12 weeks gestation, so booking is fairly late in this timeline.
Women with well-controlled type 1 diabetes during pregnancy still carry an increased risk for developing
Women with well-controlled type 1 diabetes during pregnancy still carry an increased risk for developing microvascular complications.
such as retinopathy
menorrhagia initial investigation
FBC
NICE recommend performing a full blood count in all women who present with menorrhagia to rule out iron deficiency anaemia which is a strong indicator of excessive menstrual bleeding.
Urogenital menopausal symptoms, including vaginal dryness and dyspareunia, can be effectively treated with
vaginal moisturisers and lubricants without resorting to systemic hormonal therapy.
placenta adherence classifications
Placenta accreta occurs where adherence of the placenta directly to superficial myometrium but does not penetrate the thickness of the muscle.
Placenta increta occurs where the villi invade into but not through the myometrium
Placenta percreta occurs when the villi invade through the full thickness of the myometrium to the serosa. There is increased risk of uterine rupture and in severe cases the placenta may attach to other abdominal organs such as the bladder or rectum.
alphabetical order
is mirena coil licensed for emergency contraception
no
ovarian torsion ix
TVUS
Untreated chlamydia in pregnancy can lead to complications such as
cervicitis, preterm labour, low birth weight, and an increased risk of neonatal infections.
history will say pain and purulent discharge
A 57 year old woman is seen in general practice with urinary incontinence. She has had minor episodes of incontinence during exercise or on coughing since the birth of her first child 30 years ago. She has managed this with pelvic floor exercises.
Her symptoms have significantly worsened over the last 2 months. She is having trouble getting to the toilet in time and has found herself wetting her bed. She is anxious that she will embarrass herself in public.
What is the most appropriate management, given the likely diagnosis?
Refer for bladder training
While she has had stress incontinence for a long time, her newer symptoms and less manageable symptoms are indicative of urgency incontinence. As urgency incontinence is predominant, first line management is referral to 6 weeks of bladder training, as per NICE guidance.
Asymptomatic bacteriuria in pregnant women ?
nitrofurantoin 7 days
in pregnant women, trimethoprim ought to be avoided as it is a folate antagonist and is thus associated with birth defects if taken during pregnancy.
Asymptomatic bacteriuria in pregnant women should be treated with a 7-day course of nitrofurantoin, amoxicillin, or cefalexin due to the high risk of developing pyelonephritis.
A 55-year-old woman attends her general practitioner with a 1-year history of a lump in her vagina. She also complains of leaking urine when she coughs or sneezes, which has been ongoing for the past eight months. On examination, her abdomen is soft and non-tender. On digital vaginal examination, a small cystocele is felt at the anterior vaginal wall. She can contract her pelvic floor muscles voluntarily. She has no dysuria or increased urinary frequency. Urinalysis is positive for leucocytes but otherwise negative.
What is the most appropriate next step?
Refer the woman for pelvic floor muscle training (PFMT)
Women with stress urinary incontinence should be referred for a trial of at least three months of supervised pelvic floor muscle training (PFMT).
Referral for surgical management may be considered where conservative options have failed.
can you take methotrexate in breastfeeding
no
quetipaine when breastfeeding?
Maternal quetiapine doses of up to 400 mg daily produce extremely low doses in milk, and are generally considered to be safe.
pelvic floor training failed in stress incontiennce next step
surgical options like colposuspension are typically considered when exercises have not been effective, particularly in severe cases or when the patient prefers a more definitive solution.
block in c sec
pudendal
A 26-year-old woman presents to her local antenatal unit with vaginal bleeding and a positive pregnancy test. She is week 7 of pregnancy.
On examination, her uterus is larger than expected for her gestational age.
Which of the following investigation findings is most likely?
Snowstorm appearance on transvaginal ultrasound
The “snowstorm appearance” on transvaginal ultrasound is characteristic of a hydatidiform mole (molar pregnancy), a type of gestational trophoblastic disease. This condition occurs when there is abnormal fertilization leading to the proliferation of trophoblastic tissue, which forms grape-like vesicles. Uterine enlargement and early bleeding are common features, and the ultrasound appearance resembles a cluster of cystic spaces, described as a “snowstorm” pattern.
1st line endo for heavy and painful bleeding
mefanamic acid
tranexamic acid more fibroids
mifepristone and misoprostol order
mifepristone first (foetus is miffed bc it is being aborted)
A 24 year old female presents to her GP because she has missed her period by one month. She has noticed that she has difficulty in sleeping. She has also been complaining of diarrhoea in the past few days.
Which of the following is the best initial investigation?
Pregnancy test
Whilst specific thyroid tests will aid in the diagnosis if her symptoms are secondary to thyroid dysfunction, a pregnancy test in a woman of child-bearing age should be the initial test. In fact, a rare cause of thyrotoxicosis is a molar pregnancy.
COCP post natal
only after 6 weeks, increased VTE risk
A 58-year-old woman presents to her general practitioner with a six-month history of incontinence.
She feels she needs to pass urine more often and cannot make it to the toilet in time. She often feels a burning sensation when voiding.
Her observations are normal, and a urine dipstick is clear.
She has a past medical history of well-controlled hypertension, osteoporosis and hypothyroidism. She has had a previous hysterectomy for menorrhagia. She is not sexually active.
On examination, her abdomen is soft and non-tender. Her vulval skin is pale, and there is a narrowing of the introitus. A single-digit vaginal examination does not reveal any significant pelvic organ prolapse. On coughing, there is a minor leakage of urine.
What is the most appropriate management?
Topical oestrogen therapy for at least 14 days
This postmenopausal woman likely has urge incontinence due to atrophic vulvovaginitis/urethritis caused by oestrogen deficiency. Atrophic vulvovaginitis often results in urinary frequency, urge incontinence and dysuria. Vulval atrophy is evidenced by pallor, and vaginal atrophy is evidenced by the narrowed introitus and inability to insert more than one digit. The treatment of choice is topical oestrogen therapy for at least 14 days. Symptoms can be reassessed at this point.
Primary ovarian failure is characterised by
elevated LH and FSH levels, low oestradiol, and decreased anti-Müllerian hormone, indicating reduced ovarian function.
morning after pill options
levonelle 3 days
ella one (ulipristal acetate within 5 days)
molar pregnancy mx
suction curetage
