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obs and gynae Flashcards

1
Q

which drugs should be avoided in breastfeeding?

A

antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

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2
Q

what is the most common cause of pph?

A

uterine atony - failure of adequate uterine contractions

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3
Q

what is the gold standard investigation for suspected endometriosis?

A

laparoscopy

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4
Q

examination findings in endometriosis?

A

reduced organ mobility
tender nodularity in posterior vaginal fornix
visible vaginal endometriotic lesions (maybe)

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5
Q

what are the reasons to give 5mg folic acid dose?

A

DOCTor NTD
Diabetes
Obesity >30 bmi
Coeliac
Thalassaemia traits
or
NTD (fhx or previous preg)
also antiepileptic medx

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6
Q

what are the complications of hyperemesis gravidarum?

A

wernicke’s encephalopathy
mallory-weiss tear
central pontine myelinolysis
acute tubular necrosis
fetal: small for gestation age, pre-term birth

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7
Q

what should be given for suspected wernicke’s encephalopathy in hyperemesis?

A

pabrinex (iv vit B and C)

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8
Q

what can be given to manage unscheduled bleeding on nexplanon?

A

3 months COCP

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9
Q

does the POP need to be withheld after taking emergency contraception?

A

no - continue taking POP as normal

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10
Q

how long postpartum can smear testing take place?

A

3 months

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11
Q

what is dribbling incontinence in a patient from an area with limited obstetric services a sign of?

A

vesicovaginal fistula

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12
Q

how long before surgery should the COCP be stopped?

A

STOP(4 letters) the COCP (4 letters) 4 weeks before an OP

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13
Q

when should an OGTT at 24-28wks be done for GDM?

A
  • BMI of 30kg/m2
  • previous macrosomic baby 4.5kg
  • previous GDM
  • 1st degree relative with diabetes
  • family origin with high prevalence of diabetes (south asian, black caribbean and middle eastern)
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14
Q

in which patients should ogtt be done asap after booking?

A

pts with previous GDM

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15
Q

how many weeks should folic acid be taken for?

A

first 12 weeks of pregnancy (maybe beyond)

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16
Q

absolute contraindications for depo?

A

breast cancer (current = ukmec4, past = ukmec3)

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17
Q

what investigations are done in menorrhagia with pelvic pain/intermenstrual bleeding/postcoital bleeding/abnormal exam findings?

A

TVUSS

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18
Q

how long after medical TOP can a urine pregnancy test remain positive?

A

up to 4 weeks post TOP

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19
Q

what is the medical management of miscarriage?

A

vaginal misoprostol

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20
Q

what are the risk factors for hyperemesis?

A
  • multiple pregnancies
  • trophoblastic disease
  • hyperthyroidism
  • nulliparity
  • obesity
    (smoking = decreased incidence)
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21
Q

When switching from an IUD to COCP day 1-5 of cycle what additional contraception is required?

A

no additional contraception is needed if removed day 1-5 of cycle

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22
Q

when switching from IUD to COCP on day 7 onwards of the cycle, what additional contraception is needed?

A

7 days barrier contraception

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23
Q

what is the first line management for overactive bladder/urge incontinence?

A

bladder retraining

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24
Q

what is the first line management for stress incontinence?

A

pelvic floor training
then surgery/duloxetine

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25
Q

what is the first line surgical approach to PPH?

A

intrauterine balloon tamponade (bakri catheter)

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26
Q

what are the mechanical approaches to tx of PPH?

A

rubbing uterine fundus
catheterisation to prevent bladder distension and monitor urine output

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27
Q

what are the medical managements of PPH?

A

IV oxytocin
ergometrine slow IV or IM
carboprost IM (unless asthma)
misoprostol sublingual

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28
Q

what is the management for premature ovarian insufficiency?

A

combined HRT or combined pill

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29
Q

how is DVT/PE treated in pregnancy?

A

LMWH

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30
Q

how is a non-metastasised endometrial adenocarcinoma treated in a 76yo?

A

total abdominal hysterectomy with bilateral salpingo-oopherectomy

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31
Q

important antenatal care points

A

8 - advise + bloods
10 - dating scan
11 - looks like chromosomes - down’s - NUCHAL
16 - check hb
18 - anomaly scan
28 - 1st dose anti d and check hb
34 - 2nd dose anti d
38 and 41 - routine care = bpm urine dip and sfh

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32
Q

what are the 3 features of meig’s syndrome

A

benign ovarian tumour
ascites
pleural effusion

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33
Q

how is thrush managed in pregnancy?

A

clotrimazole pessary (oral antifungals cause cong abnormalities)

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34
Q

what are the features of endometrial hyperplasia?

A

abnormal vaginal bleeding ie IMB/PMB

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35
Q

what is the most common complication of open myomectomy?

A

adhesions

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36
Q

how to remember mechanism of action of antiemetics

A

1,2,3 (CMO)
1. cyclizine - h1 receptors
2. metoclopramide d2 receptor
3. ondansetron 5ht3 receptor

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37
Q

when can the copper IUD be used as emergency contraception?

A

5 days after upsi or ovulation, whichever is latest

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38
Q

how is PCOS diagnosed?

A

2/3
- oligomenorrhoea
- clinical and/or biochemical signs of hyperandrogenism
- pcos on USS, oligomenorrhoea or amenorrhoea, and hirsutism

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39
Q

how is chickenpox treated in pregnancy?

A

> 20wks
-> oral acyclovir if presenting within 24h of rash
nothing if over 24h and no signs of complications
-> VZIG or IV antivirals if pre rash and 7-14 days post exposure

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40
Q

when can COCP be started in breastfeeding mothers postpartum?

A

6 weeks postpartum
reduces breastmilk vol

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41
Q

how often should HIV+ women have smears?

A

annually

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42
Q

which are the preferred forms of contraception for women on anti-epileptics?

A

implant, depo-provera, IUD, IUS
(on lamotrigine - can have POP)

43
Q

causes of oligohydramnios?

A

prom
fetal renal probs
iugr
post term gestation pre-eclampsia

44
Q

how does vasa praevia present?

A

Rupture of membranes followed immediately by vaginal bleeding. Fetal bradycardia is classically seen

45
Q

what is non invasive prenatal testing?

A

analysis of fragments of foetal dna in mother’s circ
high spec and sens, no risk miscarriage

46
Q

how does placenta praevia present?

A

vaginal bleeding
no pain
non tender uterus
lie and presentation may be abnormal

47
Q

what is the management for chickenpox in pregnancy <20wks?

A

VZIG

48
Q

what is first and second line for hyperemesis?

A
  1. antihistamines - cyclizine or promethazine
  2. ondansetron (slight inc risk cleft lip/palate) and metaclopramide (<5d)
49
Q

what is the primary mechanism of action of the implant?

A

inhibits ovulation
(also thickens cervical mucus)

50
Q

what gestation should referral be made to FMU if no fetal movements are felt?

A

24wks

51
Q

timings for cat 1,2,3 sections

A

1 - 30 mins
2 - 75 mins
3 - no specific time limit

52
Q

what is the acute tx for cluster headaches?

A

100% o2 and subcut triptan

53
Q

what is seen on imaging in normal pressure hydrocephalus?

A

ventriculomegaly out of proportion to sulcal enlargement

54
Q

what is the mechanism of action of controlled hyperventilation in raised ICP?

A

reduces blood CO2
-> induces cerebral vasoconstriction

55
Q

what are the features of pituitary apoplexy?

A

sudden onset headache
visual field defects
evidence of pit. insufficiency - eg hypotension
(it is a sudden enlargement of a pituitary tumour 2o to haemorrhage or infarction

56
Q

what medication can be used to reduce the number of relapses in MS?

A

moabs eg natalizumab

57
Q

how soon after ullipristal acetate (ellaone) should regular hormonal contraception be resumed?

A

5 days

58
Q

what extra contraception is needed when switching from POP to COCP?

A

7 days barrier

59
Q

what extra contraception is needed when switching from COCP to POP?

A

2 days barrier

60
Q

which cause of APH presents with painLESS bleeding?

A

placenta praevia (PPP = painless placenta praevia)

61
Q

how does BV present?

A
  • thin, white/grey homogenous discharge
  • clue cells on micro: stippled vaginal epithelial cells
  • vag pH >4.5
  • positive whiff test (KOH) - fishy odour
62
Q

how is BV treated?

A

oral metronidazole

63
Q

how does trichomonas vaginalis present?

A

offensive, yellow/green, frothy discharge
vulvovaginitis
strawberry cervix

64
Q

how is trichomonas vaginalis treated?

A

oral metronidazole

65
Q

how does gonorrhoea present?

A

thin, purulent mildly odorous vaginal discharge
dysuria, IMB, dyspareunia
gram neg diplococcus swab

66
Q

how is gonorrhoea managed?

A

IM ceftriaxone

67
Q

what are the missed pill rules for COCP if only 1 pill is missed?

A

take last pill even if it means taking 2 in one day
no additional contraception needed

68
Q

what are the missed pill rules for COCP if 2 or more pills are missed?

A
  • take last pill, leave any earlier ones
  • use condoms until re-established for 7 days
  • if pills missed wk1 - emergency contraception
  • if pills missed week 2 no need
  • if pills missed week 3 omit pill-free interval
69
Q

what drug reverses respiratory depression caused by magnesium sulphate?

A

calcium gluconate

70
Q

what is the most common type of ovarian pathology associated with Meigs’ syndrome?

A

fibroma

71
Q

what is the most common benign ovarian tumour in women under the age of 25 years?

A

dermoid cyst (teratoma)

72
Q

what is the most common cause of ovarian enlargement in women of a reproductive age

A

follicular cyst

73
Q

how long before POP becomes effective?

A

48h

74
Q

how soon post partum can COCP be prescribed if not breastfeeding?

A

21 days
due to inc risk VTE

75
Q

which medication increases the risk of endometrial hyperplasia?

A

tamoxifen

76
Q

what is used for VTE prophylaxis in pregnant women?

A

(if prev VTE)
- lmwh throughout pregnancy
- until 6wks PP

77
Q

what indicates a need for aspirin during pregnancy? (75-150mg daily from 12wks)

A

≥ 1 high risk factors
≥ 2 moderate factors

78
Q

what are high risk factors for htn in pregnancy?

A

hypertensive disease in a previous pregnancy
chronic kidney disease
autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome
type 1 or type 2 diabetes
chronic hypertension

79
Q

what are moderate risk factors for htn in pregnancy?

A

first pregnancy
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
family history of pre-eclampsia
multiple pregnancy

80
Q

at what CRL would you expect to see cardiac activity?

A

over 7mm

81
Q

what are hepatic adhesions specific for?

A

fitz-hugh-curtis syndrome - complication of PID

82
Q

what medication is used to suppress lactation?

A

cabergoline

83
Q

what is the first line tx for primary dysmenorrhoea?

A

NSAIDs eg mefenamic acid

84
Q

what is an example of a tocolytic?

A

terbutaline

85
Q

important things on CTG

A

VEAL CHOP
Variable decels - cord compression
Early decels - head compression
Accelerations - okay
Late decels - placental insufficiency

86
Q

how does ovarian cancer spread initially?

A

local spread within the pelvis

87
Q

when should women with autoimmune conditions (eg SLE, APS) take aspirin?

A

12wks - term - higher risk of PET

88
Q

what is the advice for pregnant women who havent had MMR vaccine regarding rubella?

A

advise of risks
advise stay away from anyone with rubella

89
Q

what type of insulin is used in GD?

A

short acting only

90
Q

which gynae medication can cause falls in the elderly?

A

oxybutynin

91
Q

what type of contraception can people who have had gastric sleeve/bypass surgery not use?

A

no oral contraception - lack of efficacy

92
Q

what are the indications for admission in hyperemesis?

A

continued n+v with ketonuria and/or wt loss greater than 5% despite tx with oral antiemetics

93
Q

which blood test is used to monitor treatment of DVT treatment?

A

anti-Xa (tx with LMWH)

94
Q

which contraceptives can women on enzyme inducing antiepileptics be on?

A

IUD, IUD, depo

95
Q

which contraceptives can women on lamotrigine be on?

A

POP, implant, depo, IUD, IUS (ie not COCP)

96
Q

what is adenomyosis?

A

endometrial tissue in myometrium
more common in multiparous women towards end of repro years
- dysmenorrhoea
- menorrhagia
- enlarged, boggy uterus
mgt - gnrh agonists, hysterectomy

97
Q

what TFTs would you expect in molar pregnancy?

A

high beta -> stimulates thyroid to produce T4 then T3 -> negative feedback on pituitary causing reduction in TSH

98
Q

what is medical TOP at less than 9 weeks?

A

mifepristone then vaginal prostaglandins 48h later

99
Q

what is medical TOP at less than 13 weeks?

A

surgical dilation and suction of uterine contents

100
Q

what is medical TOP at more than 15 weeks?

A

surgical dilation and evacuation of uterine contents or late medical abortion (induces ‘mini-labour’)

101
Q

which HPV viruses cause cervical cancer?

A

16, 18 and 33

102
Q

what is the surgical management for vaginal vault prolapse (post hysterectomy)?

A

sacrocolpoplexy

103
Q

what secretes hcg?

A

syncytiotrophoblasts

revision (11 decks)

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