obs and Gyn Summary Q's Flashcards
what MUST be offered if appropriate following any antepartum haemorhage?
Anti D (unless mother is known rhesus positive)
cervical CA key facts
HPV (16/18) is main cause
examine with colposcope and acetic acid + biopsies if malig seen
If CIN –> LLETZ
If CA –> chemoradiation
endometrial CA key facts
any post menopausal bleeding is suspicious
must sample ALL of uterine cavity when investigating
ovarian Ca key facts
5 RF’s - nulliparity, early menarche, never used OCP, HRT, fam hx, infertility
3 CFs - abdo dist, weight loss, pain, bladder symp
T - surg and chemo
GYn CA markers
Ca125 AFP BHcG
a newly pregnant woman comes into clinic, what 3 things must you do during this, her first visit.
Educate - smoking and alcohol stop, control any chronic dis
Investigate - rhesus, rubella
Treat - give folate and stop any teratogens
what is used to monitor progress of labour?
partogram
what effects does oxytocin have?
decrease time of 3rd stage, decrease risk PPH // can increase risk MI
contra-indications for giving oxytocin
pre eclampsia, hypertension, renal or liver impairment
methods of induction
membrane sweep, vaginal PGE2, amniotomy and oxytocin
pain relief options in labour?
entonox (NO2 and O2) opiates (diamorphine - not if delivery imminenet) combined spinal nerve block local (episiotomy) GA (severe complications)
when is anti D given during preg and to who?
28/34 weeks, 500Units given to rh -ve mothers and to babies of unknown status
ECV key facts
must be >37 weeks
50% success
can revert
ci = PP, oligohyd, pre-eclampsia
what can meconium stained liquor indicate, and what is management?
fetal distress
- attach CTG, move to consultant ward
- aspirate oropharynx, nasopharynx when delivered
- risk of pneumonitis
fetal distress - what does it indicate, Clinical signs and diag test/outcome
hypoxia leading to acidosis
HR goes up >160 / meconium liquor / reduced CTG variability
take blood sample and if pH low then acidotic = emerg section
when would you perform an emergency c section
poor progress in labour, breech, abruption, prolapse, severe pre-eclampsia
what is the danger of pre-term rupture of membranes?
premature labour, infection (chorioamniotis), fetal mortality
APH defintion, causes and management
blood loss after 24 weeks
PP, Abruption, Vasa praevia
dont vag exam / ABCDE /
PPH causes / management template
4 T’s // resus, investigate, control bleed, replace defecit
main causes of maternal shock
concealed bleed abruption // sepsis / PE
define pre-eclampsia
elevated BP, proteinuria and oedema in pregnancy
major bleed at 20 weeks is known as…?
miscarriage
3 tests for downs
nuchal translucency and free b hcg
CVS/ amnio , bloods???
what is 4 ways of managing labour
- monitoring baby every 2-4 hours - partogram
- maternal monitoring (BP, HR, contractions)
- give oxytocin
- examine VG and Abdo
any mention of severe pre-eclampsia with deranged blood results is known as…
HELLP syndrome
haemolysis
elevated liver enzymes
low platelets
managment of fibroids, both medical and surgical
GnRH analogue or surgical removal (hysterectomy)
3 major CF of menopause and treatment for each
autonomic - flushing etc – clonidene
oestrogen def - atrophic nipples etc – oest
irreg menstral cycles – depends on heavy/light
lady walks in, vag symptoms, what do you do in clinic??
speculum and bimanual + high swab/endocervical swab if approp
DDx of dyspareunia
endometr/PID/STI/cerv ca, scarring
dysmenorrhea causes
endomet/ ?? / ??
PCOS triad + T
cyst on ovaries, menstral irreg, hyperandrogenic
lifstyle is most important, maybe metformin +/- OCP?? clomifene
PID triad , ivestigation and treatment
Pain, Infectious signs, Discharge // vaginal culture // treat with ABx’s
diff swabs for diff diseases?
High vag - TV / Bact vag / candida
endocerv - gon
endocerv scrub - chlamydia
what must be screened for before starting ivf?
HIV, Hep B and C
what is common DDX for endometriosis?
IBS
common CF of endometriosis / I / T
pain (sex, periods, pooing) subfertility
TV-US or gold standard is laparosopy
T/ depends on trying to conceive or not
YES = surg excision / ablation
NO = stop cycles by OCP/IUD
what is endometriosis?
chronic oestrogen dependant condition which results in growth of endometrial tissue, outside of the endometrium.
common sites: ovaries,bladder, rectum
first line treatment for Urge and Stress incontinence?
URGE - bladder retraining#
STRESS - pelvic floor muscle physio
what complication of gonorrhea are possible?
transfer to neonate
eye infection
throat infection
how to treat bact Vag, candida, gonorrhea, chlamydia
BV - metro
candida - clotrimazole
gonor - cefixime
chlamydia - doxy
broad subfertility causes (5)
Male problem - low sperm, erectile dysfunction, motility idiopathic endometriosis tubal blockage no egg - pcos
big super painful lump on vulva
bartholin cyst, woman cant sit down, surgical drainage
diagnostic ovarian CA (4)
Ca125 up, histology, CT/US, ascites
OCP interactions: side effects of the pill
Int - anticonvulsnats,
SE: VTE risk, MI, Breast CA risk
when ??pre-eclampsia what investigations show mothers wellbeing?
HELLP tests!
LFT’s (enzymes)
U+E’s
FBC (platelets)
assessing fetus wellbeing on US, what can be assessed (think acronym)
GLAD
growth
liquor
activity
doppler
DDx for girl with abdo pain, blood PV and no periods?
Treatment for each (3)
PID, ectopic, incomplete miscarriage
abx’s, methotrexate, prostaglandins
incomplete miscarriage / ectopic
misoprostol or vaccum expulsion / methotrexate or surg (laparoscopy/salpingoscopy)
IUGR effects, both peri-natal and in adulthood (3)
Peri - N = hypoglyc / infection / jaundice / hypoxia
Adult = DM2, hypertension, thyroid, corornary artery dis
RF for PPH
PP, multi birth, pre eclamp, prev PPH, energ c sect
woman at 29 weeks with small painless vag bleed =
PP
woman with very low BP at 34 weeks but no bleeding seen in extreme pain =
Abruption
risk factor for premature labour?
smoking, DM, multibirth, aph, polyhydramnios
what is normal fetal head presentation?
OA
What year was term of preg act introduced and what were 4 guidelines?
1967
ok if;
methods of termination?
misoprostol + mifepristone - 15 weeks
increase risk of ectopic?
structural, prev ectopic, endometriosis, AntiPhos syn?, old IUD
Pro’s and Cons of HRT (4 each)
Pro - decrease flushing decrease vag dryness etc decrease osteoporosis improve gen quality of life (sleep etc)
Cons - increase risk endomet CA increase risk breast CA increase risk ovary CA increase risk VTE weight gain
