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Obs and gynae > obs > Flashcards

obs Flashcards

1
Q

what Heps are screened for at the booking visit

A

b and c

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2
Q

the booking visit should happen when

A

before youre 10 weeks pregnant

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3
Q

what is the naegele’s rule

A

predicts an estimated due date based on the onset of the womans last menstrual period - add 9 months and 7 days

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4
Q

what is placental praevia

A

when the placenta is low lying in the uterus and covers all or part of the cervix

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5
Q

when is the anomaly scan carried out

A

20 weeks

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6
Q

patua is trisomy

A

13

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7
Q

edwards syndrome is trisomy

A

18

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8
Q

what can be used to give risk of trisomy

A

neuchal thickness

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9
Q

what detects fetal DNA fragments from a sample of blood taken from the mother

A

NIPT

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10
Q

what carries a greater miscarriage rate out fo amniocentesis and CVS

A

CVS

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11
Q

what can be perforomed earlier - amniocentesis or CVS

A

CVS

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12
Q

2nd trimester trisomy screening uses what biochemical markers

A

AFP
hCG
UE3
Inhibin A

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13
Q

what tests is baby is rh positivie

A

cord blood testing

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14
Q

what should be takne if got high risk of pre eclampsia

A

aspirin

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15
Q

abortion is certified under what form

A

HSA1 form

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16
Q

what is clause C of HSA1 form

A

continuing pregnancy would involve greater risk than terminating to effects on mother

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17
Q

what is clause E of HSA1 form

A

substantial risk that baby could suffer from being seriously handicapped

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18
Q

how is mifepristone and misoprstol taken

A

misoporstol is taken 24-48hrs after mifepristone

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19
Q

if there is a VTE risk from abortion what can be used as prophylaxis

A

LMWH

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20
Q

can contraceptions be started soon after abortion

A

yes almost all can. Immediately effective if started within 5 days of abortion

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21
Q

what method is used for the diagnosis and surveillance of a small for gestational age fetus

A

US

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22
Q

if early delivery is indicated what may be offered

A

steriods and or magnesium sulphate

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23
Q

what weight is considered large for gestational age

A

greater than 4.5kg

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24
Q

signs of multiples pregancy

A

high AFP
large for dates uterus
multiple fetal poles

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25
Q

management of polyhydramnios

A

IOL by 40 weeks

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26
Q

if got hypothyroidism and become pregnant what needs to be done

A

levothyroxine needs to be increaseed during pregnancy

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27
Q

when should women with epilepsy start taking folic acid

A

before conception

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28
Q

what can cause cleft lip and palate in babies

A

phenytoin

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29
Q

what is first line for RA in pregnancy as methotrexate is contraindicated

A

Hydroxychloroquine

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30
Q

the symptoms of what often improve during pregnancy

A

RA

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31
Q

what is the screening test of choice for gestational diabetes

A

oral glucose tolerance test

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32
Q

gestational diabetes usually disappers as soon as when

A

the placenta is deliverd

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33
Q

The D antigen is found where

A

on red blood cells

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34
Q

when is anti D given to all rehsus negative mothers

A

at 28 weeks

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35
Q

features of obstetric cholestasis

A

pruritus - often more intense on hands and feet
jaundice

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36
Q

blood show what in obstetric cholestasis

A

abnormal LFTs and raised bile acids

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37
Q

what can be given in obstetric cholestasis

A

ursodeoxycholic acid

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38
Q

how is rubella trasmitted

A

respiratory droplets

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39
Q

lymphadenopathy classicaly post auricular can be seen in

A

rubella

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40
Q

what is the investigation for rubella

A

bloods - as there is a rubella specific antibody

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41
Q

what are the features of congenital rubella syndrome

A

congential deafness, cataracts and heart disease

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42
Q

Koplik spots are white spots inside the mouth that can be seen in

A

measles

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43
Q

what is typically transmitted by unpasteurised dairy products, processed meats and contaminated foods

A

listeria

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44
Q

management of listeria

A

ampicillin and gentamicin

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45
Q

preg woman are to avoid what foods due to listeria

A

unpasteurised milk, soft cheese and smoked seafood

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46
Q

acute toxoplasmosis during pregnancy is treated with

A

spiramycin

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47
Q

what is the triad of congenital toxoplasmosis

A

intracranial calcifiction, hydrocephalus and chorioretinitis

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48
Q

zika virus is spread by what animal

A

mosquito

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49
Q

what is first line for UTI in pregnancy

A

1/2nd trimester - Nitrofurantoin
3rd trimester- Trimethroprim

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50
Q

tense shiny abdomen is a sign of

A

polyhydramnios

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51
Q

what is the management fro majority of women with polyhydramnios

A

none

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52
Q

what is low level of amniotic fluid during pregnancy

A

oligohydramnios

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53
Q

definition of a miscarriage

A

loss of a pregnancy at less than 24 weeks gestation

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54
Q

what is the time that seperates early from late miscarriage

A

13 weeks

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55
Q

what is a missed miscarriage

A

the uterus still contains foetal tissue but the foetus is no longer alive

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56
Q

main presentig symptom of miscarriage is

A

vaginal bleeding

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57
Q

what are surgical management of miscarriages

A

manual vacuum aspiration and electric vacuum aspiration

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58
Q

recurrent miscarriage is defined if have

A

3 or more pregnancy losses

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59
Q

management of recurrent miscarriage in anti phospholipid syndrome

A

low dose aspirin and fragmin injections

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60
Q

abnormal form of pregnancy in which a non viable fertilised egg implants in the uterus or tube

A

molar pregnancy

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61
Q

difference between complete and partial mole

A

complete- occurs when 2 sperm cells fertilise an ovum that contains no genetic material
partial- occurs when 2 sperm cells fertilise a normal ovum

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62
Q

what moles have a higher risk of developing into choriocarcinoma

A

complete moles

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63
Q

what moles then has 3 sets of chromosomes

A

partial

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64
Q

what give the grape like appearnace of molar pregnancy

A

overgrowth of placental tissue with chorionic villi swollen with fluid

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65
Q

symptoms of molar preg

A

hyperemesis, hyperthyroidism and early onset pre-eclampsia

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66
Q

the fundus can be greater than dates on abdo palpitation in

A

molar pregnancy

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67
Q

if b-hCG levels dont fall after evacuation of molar pregnancy then what should you suspect

A

malignant choriocarcinoma

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68
Q

pregnancy should be avoided for how long after a molar pregnancy

A

1 year

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69
Q

light brownish bleeding could be

A

implantation bleeding - timing is about 10 dyas post ovulation and sign pregnancy soon emerge. it is often mistaken for a period

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70
Q

what is a chorion

A

a membrane surrounding the embryo

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71
Q

management of chorionic haematoma

A

usually self limiting and resolve

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72
Q

what hormone during pregnancy is thought to be responsible for nausea and vomiting

A

hCG

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73
Q

what is hyperemesis gavidarum

A

vomiting excessively altering quality of life

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74
Q

where is the most common site for an ectopic pregnancy

A

fallopian tube

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75
Q

shoulder tip pain can be a symptom in

A

ectopic pregnancy

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76
Q

gold standard for ectopic

A

transvaginal US

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77
Q

free fluid in pouch of douglas can suggest

A

ectopic

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78
Q

management of ectopic pregnacy if patient is acutely unwell

A

Laparascopic salpingectomy (removal of tube)

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79
Q

what can be medical management in ectopic if woman is stable , low levels of BhCG and ectopic is small and not ruptured

A

methotrexate

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80
Q

what hormone makes the uterus contract and promotes prostaglandin production

A

estrogen

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81
Q

what hormones initiates and sustains contraction

A

oxytocin

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82
Q

what happens in the first stage of labour

A

mild irregular uterine contraction
and cervix ddilates

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83
Q

what happens in the second stage of labour

A

start with complete dilation of the cervix to delivery of the baby

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84
Q

when is labour considered prolonged

A
  • In nulliparous women it is considered prolonged if it exceeds 3 hours if there is regional analgesia, or 2 hours without
  • In multiparous women it is considered prolonged if it exceeds 2 hours with regional analgesia or 1 hour without
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85
Q

3rd stage of labour

A

delivery of baby to explusion of placenta and fetal membranes

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86
Q

what active management is done in the 3rd stage of labour to lower risk of post partum haemorrhage

A

oxytocic drugs and controlled cord traction

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87
Q

what type of pelvis is the most suitable for childbirth

A

gynaecoid

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88
Q

what is meant by engagement

A

passage of the widest diameter of the presenting part to a level below the plane of pelvic inlet

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89
Q

what is the period of repair and recovery after birth called

A

puerperium

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90
Q

what are false labour - contraction thats aim is to prepare the body for birth and they are irregular and do not increase in frequency or intensity

A

braxton hicks contractions

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91
Q

in labour whats the spacing of contractions

A

evenly spaced and then time between them gets shorter and shorter

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92
Q

what score is used to determine if it is safe to induce labour

A

bishops score

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93
Q

what is a graphic record used to assess progress of labour

A

partogram

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94
Q

what can be administered as part of active management in third stage

A

syntometerine (ergometrine maleate and oxytocin)

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95
Q

epidural associated wit

A

longer second stage of labour

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96
Q

oral opiate analgesia in preg

A

codeine phosphate

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97
Q

most common reason for failure to progress in labour

A

deflexion of the fetal head

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98
Q

what is failure to progress defined as

A

Defined as <2cm dilation in 4 hours in nulliparous women, and <2cm dilation in 4 hours or slowing in progress in multiparous women

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99
Q

these are characteristics of foetal hypoxia:

A

loss of accelerations, repetitive deeper and wider decelerations, rising fetal baseline heart rate, and loss of variability

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100
Q

what does an elective c section mean

A

its planned

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101
Q

what is an operative vaginal delivery

A

use of an instrument to aid delivery of the foetus

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102
Q

instruments used to delivery foetus

A

forceps and ventouse

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103
Q

frank breech is when

A

both legs are up

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104
Q

All women in the UK with an uncomplicated breech pregnancy at term should be offered

A

external cephalic version, provided there are no contraindications

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105
Q

antidepressant of choice in pregnancy

A

sertraline

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106
Q

what antipsychotics have best evidence of being safe in pregnancy

A

olanzapine , quetiapine

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107
Q

why should you avoid lithium in pregnancy

A

its secreted into breast milk

108
Q

what is classed as post partum haemorrhage

A

loss of greater than 500ml of blood within 24hrs

109
Q

4 T’s causes of post partum haemorrhage

A

tone, tissue, trauma and thrombin

110
Q

most common cause of post partum haemorrhage

A

tone - refers to uterine atony

111
Q

what is uterine atony

A

This is where the uterus fails to contract adequately following delivery, due to a lack of tone in the uterine muscle

112
Q

tissue is one of the 4 T’s. what does it refer to

A

retention of placental tissue which prevents the uterus from contracting

113
Q

these are:
bimanual compressor to stimulate uterine contraction, foley catherter to empty bladder, oxytocin, intrauterine balloon tamponade

A

treatment of uterine atony in post partum haemorrhage

114
Q

management for tissue in PPH

A
  • Administer IV oxytocin, manual removal of placenta with regional or general anaesthetic, and prophylactic antibiotics in theatre
  • Start IV oxytocin infusion after removal
115
Q

what is the most common cause of secondary PPH

A

post partum endometritis

116
Q

antibiotic for secondary PPH

A

co-amoxiclav

117
Q

3rd degree perineal tear involves

A

anal sphincter

118
Q

second degree perineal tear involves

A

perineal skin and muscle but not anal sphincter

119
Q

4 degree perineal tear involves

A

anal epithelium/mucosa

120
Q

what perineal tears need management

A

3rd and 4th

121
Q

what can be done to prevent perineal tears

A

episiotomy

122
Q

when is antepartum haemorrhage defined as

A

bleeding from 24weeks gestation before the end of the second stage of labour

123
Q

most common causes of antepartum haemorrhage

A

placental abruption and placenta praaevia

124
Q

what is placental abruption

A

separation of a normally implanted placenta from the wall of the uterus

125
Q

severe continuous abdo pain and woody hard uterus can be

A

placental abruption

126
Q

what is placental praaevia

A

when the placenta lies directly over the internal os

127
Q

what is associates with an increased risk of placental praaevia

A

c section

128
Q

is there pain with placental praaevia

A

no

129
Q

what should you not perform until you exclude placenta praaevia

A

vaginal exam

130
Q

what is placenta accreta

A

when placenta is abnormally adherent to the uterine wall

131
Q

what generally causes no symptoms during pregnancy although may be vaginal bleeding in third trimester

A

placenta accreta

132
Q

severe abdo pain and shoulder tip pain

A

uterine rupture

133
Q

what is vasa praaevia

A

Unprotected fetal vessels traverse the membranes below the presenting part over the internal cervical os

134
Q

clinical feature of vasa praevia

A

sudden dark red bleeding during labour

135
Q

what is given in high risk women to prevent pre eclampsia

A

aspirin

136
Q

what is the only cure for pre eclampsia

A

birth

137
Q

what is eclampsia

A

occurrence of convulsions in a pre- elliptic woman in the absence or neurological or metabolic cause

138
Q

eclampsia is more common in what age group

A

teenagers

139
Q

what kind of seizure is it in eclampsia

A

Tonic clonic

140
Q

what can be given to stop seizure in eclampsia

A

IV mag sulphate

141
Q

when might you roll the patient onto her hands and knees

A

shoulder dystocia

142
Q

McRoberts manoeuvre can be used for

A

shoulder dystocia

143
Q

amniotic fluid embolism is when

A

amniotic fluid enters maternal circulation

144
Q

what is a differential of headache in pregnancy

A

dural venous sinus thrombosis

145
Q

management of dural venous sinus thrombosis

A

LMWH

146
Q

management for PE in pregnant woman

A

LMWH then warfarin from 5th post natal day

147
Q

non engaged presenting part should alert to possibility of

A

cord prolapse

148
Q

management of cord prolapse

A

immediate delivery

149
Q

management for sepsis in pregnancy

A
  • IV co-amoxiclav within the ‘golden hour’ +/- gentamicin depending on severity, + clindamycin if sore throat (GAS)
150
Q

what is chorioamnionitis

A

Inflammation of the amniochorionic (fetal) membranes of the placenta, typically in response to microbial invasion

151
Q

when might you suspect chorioamnionitis

A

if fever greater than 39 degrees during labour

152
Q

what is the most common cause of acute fatty liver of pregnancy

A

long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD)deficiency in the fetus

153
Q

HAART is used to treat HIV and is a combination of how many drugs

A

3

154
Q

emergency hormonal contraception only does what

A

temporarily delay ovulation

155
Q

combined hormonal contraception protects against what cancer

A

ovarian and endometrial

156
Q

risk of depot contraception

A

may decrease peak bone mass

157
Q

weight gain is even more common with what contraception

A

depot

158
Q

contraception if got breast cancer

A

avoid any hormonal contraception and go for the copper coil or barrier methods

159
Q

in cervical or endometrial cancer what contraception should you avoid

A

intrauterine system ie Mirena coil

160
Q

Wilsons disease patients should avoid what contraception

A

copper coil

161
Q

what is the contraception of choice in the epileptic population

A

the injection

162
Q

when does fertility return after childbirth

A

21 days

163
Q

do breastfeeding woman need contraception

A

no if fully breastfeeding and amenorrhoeic

164
Q

what contraception are considered safe in breastfeeding though

A

progesterone only pill and implant

165
Q

when can a copper could or intrauterine system (eg Mirena) not be inserted between

A

48hrs after birth to 4 weeks

166
Q

what drugs do not cross the placenta

A

large molecular weight ones eg heparin

167
Q

when should be having folic acid in pregnancy

A

3 months prior and 3 months of pregnancy

168
Q

is insulin safe in pregnancy

A

yes

169
Q

what diabetic medication is not safe in pregnancy and should be switched to insulin

A

sulfonyureas

170
Q

Blood pressure in pregnancy falls during which trimester

A

2nd

171
Q

can you give warfarin in pregnancy

A

NO

172
Q

roaccuane is highly teratogenic, what is the drug name

A

isotretinoin

173
Q

can you give nsaids in pregnancy

A

generally avoided unless really necessary so give paracetamol for pain

174
Q

scanning what must the patient have a full bladder

A

transabdominal scanning

175
Q

what scanning requires patient to have an empty bladder

A

transvaginal

176
Q

what is a Xray screening procedure

A

Hysterosalpingography

177
Q

example of when Hysterosalpingography made be used

A

For assessment of tubal patency in patients with infertility

178
Q

a child under what age cannot consent to any sexual activity

A

13

179
Q

how much fish should preg woman have

A

2-3 servings per week

180
Q

should woman in the Uk with HIV breast food

A

no

181
Q

how does progesterone affect milk production

A

inhibits milk production

182
Q

can you overfeed a breastfeed baby

A

no

183
Q

what is the first form of milk produces by the mammary glands immediately following delivery of the newborn

A

colostrum

184
Q

what is engorgement

A

painful swelling of the breasts

185
Q

the greater sciatic foramen is separated from the lesser sciatic foramen by the

A

sacrospinous ligament

186
Q

what muscles splits up the greater sciatic foramen

A

piriformis

187
Q

4 things in the lesser sciatic Forman

A

Internal pudendal artery and vein
Pudendal nerve
Obturator interns tendon
Nerve to obturator internus

188
Q

what is divided into superficial and deep pouches

A

perineum

189
Q

perineal muscles are supplied by

A

pudendal nerve

190
Q

what covers the superior aspects of the pelvic organs

A

parietal peritoneum

191
Q

majority of the arteries of the pelvis and perineum arise from what artery

A

internal iliac - exception are gonadal and superior rectal

192
Q

what anastomoses with uterine artery

A

ovarian and vaginal artery

193
Q

drainage into what vein goes to the hepatic portal system

A

superior rectal

194
Q

sacrospinous and sacrotuberous both come from the sacrum and attach where

A

spinous- ischial spine
tuberous- ischial tuberosity

195
Q

the pelvic cavity is more. — in females

A

shallow

196
Q

what muscle maintains faecal continence

A

puborectalis

197
Q

what is the deepest layer of the pelvic floor

A

pelvic diaphragm

198
Q

examples of what deep perineal pouch contains

A

urethra, bulbourethral glands in males, NVB for penis/clitoris

199
Q

what is in between the deep and superficial perineal pouch

A

perineal membrane

200
Q

examples of things the superficial perineal pouch contains

A

female erectile tissue, greater vestibular glands (Bartholin’s glands)

201
Q

muscles in superficial perineal pouch

A

ischiocavernous, bulbospongiosus
superficial transverse perineal

202
Q

in a sacrospinous fixation there is risk of injury to what structures

A

pudendal NVB and sciatic nerve

203
Q

urogenital and reproductive systems arise from

A

mesoderm

204
Q

sexual differentiation occurs from how many weeks

A

7

205
Q

female development occurs in the abscence of what transcription factor

A

SRY

206
Q

Persisitant Mullerian Duct syndrome presents with

A

uterus, vagina and testes

207
Q

what happens in the proliferative phase of menstruation

A

stratum basalts proliferates and this thickens the thickness of the endometrium

208
Q

what happens in the secretory phase of menstruation

A

glands become coiled with a corkscrew appearance and secrete glycogen

209
Q

what happens in the menstrual phase

A

the arterioles in the stratum functionalis undergo constriction, depriving the tissue of blood and causing ischaemia, with restultant tissue breakdown, leakage of blood, and tissue sloughing

210
Q

broad ligament of the uterus extends between

A

uterus and lateral walls and floor of the pelvis

211
Q

walls of the vagina are usually

A

collapsed

212
Q

cervical smear needs to sample what area

A

transformation zone (squamocolumnar junction)

213
Q

where does fertilisation usually occur

A

ampullar

214
Q

apart from gametes what else do the ovaries produce

A

steriods mainly oestrogen and progestogens

215
Q

outer shell of the cortex of the ovary is called the

A

tunica albuginea

216
Q

the tunica albuginea is covered by a layer of cuboidal cells called the

A

germinal epithelium

217
Q

primary follicles are defined by what cells

A

cuboidal granulosa cells

218
Q

theca interna will go on to secrete

A

oestrogen precursors

219
Q

antrum (fluid filled space) enlarge in what follicle

A

secondary

220
Q

the very largest antral follicles are called

A

Graafian follicles

221
Q

follicular stigma on ovary indicating

A

imminent rupture of the follicle

222
Q

if no implantation occurs the follicles will become

A

corpus albicans

223
Q

if implantation occurs, the placenta secretes — which prevents degeneration of the corpus luetum

A

hCG

224
Q

paired ovarian arteries arises directly from where

A

abdominal aorta

225
Q

ovarian veins drain into

A

left- left renal vein
right- IVC

226
Q

lymph from the ovaries drains to

A

PARA-aortic nodes -CLINICALLY RELEVANT IN OVARIAN MALIGNANCY

227
Q

what layer of the vagina is thick during reproductive years due to glycogen accumulation

A

non keratinised stratified squamous epithelium

228
Q

are there glands in the vagina

A

There are no glands in the wall of the vagina, but it is lubricated by mucous from the cervical glands and fluid from the thin walled vessels of the lamina propria

229
Q

to see the position of the uterus how do you palpate the uterus

A

bimanual

230
Q

the cervix is the lowest portion of the

A

uterus

231
Q

cyst in cervix called

A

Nabothian cyst

232
Q

what covers two tubes of erectile vascular tissue (corpora cavernosa)

A

clitoris

233
Q

pain from female repro system, the 2 important spinal cord levels are

A

T11-L2 and S2-S4

234
Q

cervix and below nerve supply

A

pudendal (s2-4)

235
Q

nerve to uterine tubes, uterus, ovaries

A

T11-L2

236
Q

spinal cord becomes caudal equine. at what vertebrae

A

L2

237
Q

spinal anaesthetic can result in what side effect

A

hypotension

238
Q

what can be used as a landmark for the pudendal nerve

A

ischial spine

239
Q

superior epigastric artery and inferior is a continuation of

A

superior- internal thoracic
inferior- external iliac

240
Q

in laparoscopy and in surgery and near the deep inguinal ring need to avoid cutting

A

inferior epigastric artery

241
Q

hysterectomy is removal of the

A

uterus

242
Q

in hysterectomy need to be extremely careful to differentiate

A

ureter and uterine artery

243
Q

what vermiculates when touched

A

ureter - the water!

244
Q

what initiates follicular growth

A

FSH

245
Q

what stimulates further development of follicles

A

LH

246
Q

progesterone is mainly secreted by the

A

corpus luteum

247
Q

what phase comes before ovulation

A

follicular

248
Q

what happens to oestrogen and progesterone to stimulate the release of prostaglandins in the menstrual phase

A

they fall

249
Q

what sloughs off in menstruation

A

entire stratum functionalis

250
Q

normal period blood loss is between

A

5-80mls

251
Q

what has the main impact on cycle length

A

time between menstruation and ovulation

252
Q

hCG signals the corpus luteum to secrete what

A

progesterone

253
Q

what prevents inoculation of corpus luteum

A

hCG

254
Q

when do levels of hCG start to fall

A

12-24 weeks

255
Q

what decreases uterus contractility

A

progesterone

256
Q

if taking iron supplements and become pregnant need to

A

increase supplements

257
Q

what 2 things increase contractility of uterus

A

oestrogen and oxytocin and In turn stimulate prostaglandins

258
Q

what inhibit milk production

A

estrogen and progesterone

259
Q

ductus arteriosus goes to

A

pulmonary trunk

260
Q

ductus venosus goes to

A

liver

261
Q

most common cause of respiratory distress in late preterm and term infants

A

transient tachypnoea

262
Q

babies gut prior to birth is

A

sterile

263
Q

what is currenty used for sec determination and trisomy testing

A

NIPT

264
Q

when can you surgically terminate pregnancy and would be induction thereafter

A

before 13 weeks

265
Q

what is- Used as a first line test for acutely unwell children with a likely monogenetic disorder

A

NGS

266
Q
A

Obs and gynae (3 decks)

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