obs and gynae Flashcards
1
Q
what is the definition of premature ovarian failure?
A
the cessation of menses for 1 year before the age of 40
2
Q
with HRT what increases the risk of breast cancer?
A
adding a progesterone
3
Q
with HRT what increases the risk of thromboembolism?
A
adding a progesterone
4
Q
women w/ uncomplicated multiple pregnancies should avoid air travel by when?
A
32 weeks
5
Q
what is the management of endometriosis?
A
first line: NSAIDs and paracetemol
second line: COCP
6
Q
what are the 3 stages of postpartum thyroiditis?
A
thyrotoxicosis
hypothyroidism
normal thyroid function
7
Q
what is the management of the thyrotoxicosis phase of post partum thyroiditis?
A
propanolol for symptom management
8
Q
what is the management of the hypothyroidism phase of post partum thyroiditis?
A
thyroxine
9
Q
what advise needs to be given to women trying to conceive who are on anti-epileptics?
A
take 5mg folic acid daily from before conception to 12 wks of pregnancy
10
Q
what is the management of urge incontinence?
A
6 weeks of bladder retraining
antimuscarinics (bladder stabilising drugs)
11
Q
how is pre-eclampsia defined?
A
new onset BP >140/90mmHg after 20 wks AND one of:
proteinurea
organ dysfunction
12
Q
what is HELLP syndrome?
A
severe form of pre-eclampsia
13
Q
what is HELLP syndrome classified by?
A
H - haemolysis
E L - elevated liver enzymes
L P - low platelet
14
Q
what is the management of postpartum depression?
A
sertraline or paroxetine
15
Q
what is placenta acreta?
A
attachment of the placenta to the myometrium
16
Q
what is the biggest risk factor for placenta acreta?
A
previous c section
17
Q
what are the investigations for PCOS?
A
pelvic ultrasound
FSH, LH, TSH
prolactin
testosterone
SHBG
18
Q
what is the criteria for diagnosing PCOS?
A
2 of the following 3;
infrequent or no ovulation
clinical or biochemical signs of hyperandrogegism
polycystic ovaries on US
19
Q
what is the definition of polycystic ovaries on ultrasound?
A
the presence of >12 follicles (measuring 2-9mm in diameter) and / or increased ovary volume >10 cm3
20
Q
what is the time frame for a category 1 c section?
A
the baby should be delivered w/in 30 mins of making the decision
21
Q
what are the foetal indications for a category 1 c section?
A
foetal hypoxia or persistent foetal bradycardia
22
Q
what is the time frame for a category 2 c section?
A
the baby should be delivered w/in 75 mins of making the decision
23
Q
what is a category 3 c section?
A
delivery is required but mother and baby are stable
24
Q
what is a category 4 c section?
A
elective c section
25
what is intrahepatic cholestasis of pregnancy defined as?
abnormal LFTs and intense puritis, usually in the third trimester
26
what is the management of intrahepatic cholestasis of pregnancy?
induce labour at 37-38 wks
27
what is the antibiotic regime given to all pts w/ preterm pre labour rupture of membranes?
10 days oral erythromycin
28
what is the diagnostic threshold for fasting glucose for gestational diabetes?
>5.6mmol / L
29
what is the diagnostic threshold for 2 hr glucose for gestational diabetes?
>7.8mmol / L
30
what is the medical management of an incomplete miscarriage?
a single dose of misoprostol
31
what is the medical management of a missed miscarriage?
oral mifepristone then 48 hrs later misoprostol
32
what is the most common type of ovarian cyst?
follicular cyst
33
what is the cause of physiological ovarian cysts in pregnancy?
the corpus luteum
34
if a semen sample is abnormal when should the test be repeated?
3 months later
35
what is the antibiotic of choice for group b strep prophylaxis?
benzylpenicillin
36
what is placental abruption?
separation of a normally situated placenta from the uterine wall
37
what is the management of placental abruption <36 wks gestation and there are signs of foetal distress?
immediate C section
38
what is the management of placental abruption <36 wks gestation and there are no signs of foetal distress?
admit and administer steroids
39
what is the management of placental abruption >36 wks gestation and there are signs of foetal distress?
immediate C section
40
what is the management of placental abruption >36 wks gestation and there are no signs of foetal distress?
deliver vaginally
41
how should an ectopic pregnancy >35mm in size or B hCH >5,000 be managed?
surgically
laparoscopic salpingectomy
42
how should an ectopic pregnancy <35mm in size of B hCG <5,000 be managed?
methotrexate
43
what is the risk of having intrahepatic cholestasis of pregnancy?
stillbirth
44
what should be given to pregnant women who are at moderate or high risk of pre eclampsia?
low dose aspirin
45
what is the management of moderate PMS?
cocp
46
what is the management of severe PMS?
SSRI
47
what is the antibiotic used in the management of mastitis?
flucloxacillin or erythromycin if penicillin allergic
48
what is the management of cervical cancer in a patient who wishes to preserve fertility?
cone biopsy
49
what is the management of primary dysmenorrhoea?
NSAIDs such as mefenamic acid
50
what are the guidelines for women with a singleton pregnancy
who wish to fly?
avoid air travel >37 wks
51
how does erbs palsy present?
adduction and internal rotation of the forearm
52
what is the first line management of shoulder dystocia?
McRobers manoeuvre
53
what is the diagnosis of post menopausal bleeding until proven otherwise?
endometrial cancer
54
what is the main risk factor for endometrial cancer?
excess oestrogen
55
give 3 things that cause increased oestrogen and therefore increase the risk of endometrial cancer
nuliparity
early menarche
late menopause
56
what is the normal endometrial thickness?
<4mm
57
what is the highly negative predictive value finding of a transvaginal ultrasound for endometrial cancer?
endometrial thickness <4mm
58
what can be used for patients with stress incontinence who have tried pelvic floor exercises and do not want surgery?
duloxetine
59
what is the first line for urge incontinence?
bladder stabilising drugs such as oxybutynin
60
what should happen if a woman with known placenta praveia goes into labour?
emergency c section
61
progesterones carry an increased risk for which 3 things?
breast cancer
venous thromboembolism
cardiovascular disease
62
what is the cut off for anaemia in the first trimester?
Hb < 110
63
what is the cut off for anaemia in the second and third trimesters?
Hb <105
64
what is the cut off for anaemia post partum?
Hb <100
65
how can you confirm ovulation in a pt having difficulty conceiving?
check progesterone levels 7 days before next expected period
66
what are uterine fibroids?
benign tumours of the smooth muscle of the uterus
67
how do uterine fibroids present?
menorrhagia
bulk related symptoms such as bloating and increase urinary symptoms
sub fertility
68
how do bartholins cysts present?
painful and soft on examination
69
what is Sheehans syndrome?
post partum hypopituitarism
reduction in the function of the pituitary control due to ischaemic necrosis due to hypovolaemic shock
70
how does candida present?
painful sex
white cottage cheese discharge
pitching
71
how is umbilical cord prolapse managed?
manual elevation of the presenting part
72
combined HRT increases the risk of which cancer?
breast cancer
73
apart from downs syndrome, increased nuchal translucency is associated with what?
congenital heart defects
74
what is the management of pregnant women with BP >160/110mmHg?
admission and treatment with antihypertensive
75
what is the first line treatment of menorrhagia?
intrauterine system - mirena
76
what is the management of fasting glucose >7mmol / l in pregnancy?
insulin
77
what is a galactocele?
a cystic lesion in the breast that is typically in women who have recently stopped breast feeding and is caused by a buildup of milk
78
what are the findings of the combined test in downs syndrome?
thickened nuchal translucency
increased HCG
decreased PAPP-A
79
what is the preferred method of smoking cessation in pregnancy women?
nicotine replacement therapy
80
what is the gold standard investigation for women w/ suspected endometriosis?
laparoscopy
81
why can fibroids grow during pregnancy?
because they are sensitive to oestrogen and so with increased oestrogen in pregnancy they grow
82
what is the management of an overweight woman w/ PCOS who is trying to conceive?
weight loss
then add metformin
83
what is the correct position for women w/ cord prolapse?
on all 4s
84
how often are cervical smears done for women aged 25-49?
every 3 years
85
how often are cervical smears done for women aged 50-64?
every 5 years
86
what is placenta praevia?
when the placenta overlies the lower uterine segment
87
how does placenta praevia present?
painless antepartum haemorrhage
88
what size of ectopic pregnancy warrants surgical management?
>35mm
89
what HCG conc warrants surgical management of ectopic pregnancy?
>5000
90
what is the management of hyperemeisis gravidarum in a woman who is unstable / dehydrated?
admit for IV saline and potassium
91
what should be done if 2 consecutive cervical smears are inadequate?
colposcopy
92
what is the management of women who are exposed to chicken pox in the first 20 wks of pregnancy?
zoster immunoglobulin
93
what is the management of women who are exposed to chicken pox after 20 wks gestation?
oral acyclovir
94
what is used in the induction of labour when a membrane sweep has already been done and the bishop score is <6?
vaginal prostaglandins
95
what is the first line management of hyperemesis gravidarum in a woman who is stable and not dehydrated?
antihistamines
96
is lithium safe in breast feeding?
no
97
PCOS increases the risk of which cancer?
endometrial cancer
98
if insulin is needed in the treatment of gestational diabetes what is used?
short acting insulin only
99
in terms of VTE risk which HRT is safest?
transfermal HRT
100
what are the 3 types of placenta acreta?
placenta acreta
placenta increta
placenta percreta
101
what is placenta acreta?
chorionic villi attach to the myometrium
102
what is placenta increta?
chorionic villi invade into the myometrium
103
what is placenta percreta?
chorionic villi invade through the perimetrium
104
what is the first line for the management of pre eclampsia in women with asthma?
nifedipine
105
what is the management of women w/ grade 3/4 placenta praevia?
elective c section at 37-38 wks
106
what is adenomyosis?
the presence of endometrial tissue w/in the myometrium
107
what makes you more likely to have adenomyosis?
multiparty
end of reproductive years
108
how does adenomyosis present?
dysmenorrhoea
menorrhagia
enlarged boggy uterus
109
when a baby is breech, external cephalic version can be done up until when?
as long as the amniotic sac is in tact
110
what is the treatment of intrahepatic cholestasis of pregnancy?
usrodeoxycholic acid
111
are anti epileptic medications safe in pregnancy?
yes
112
unopposed oestrogen increases the risk of which cancer?
endometrial cancer
113
how is an ectopic pregnancy managed when there is evidence of a foetal heartbeat on ultrasound?
surgically
114
what is the management of premature ovarian failure?
HRT or combined oral contraceptive pill until 51 years old
115
when can the COCP be started post partum?
21 days postpartum
116
when can the POP be started post partum?
anytime
117
what is a complete hydatiform mole?
when all the genetic material comes from the father
118
what is seen on ultrasound w/ a complete hydatiform mole?
snowstorm appearance and no foetal parts present
119
when can levonorgestrel be taken up to?
up to 72 hrs following unprotected sex
120
how is levonorgestrel given?
as a single 1.5mg dose
121
when can ulipristal be taken up to?
up to 120 hrs following unprotected sex
122
how is ulipristal given?
as a single 30mg dose
123
what should you do if you miss one COCP?
take the missed pill and no emergency contraception needed
124
if breastfeeding, when can the COCP be restarted?
> 6 wks
125
what should be done if cervical screening sample is inadequate?
test again in 3 months
126
what is the biggest risk factor for cord prolapse?
artificial rupture of membranes
127
what are the guidelines regarding methotrexate and conception?
methotrexate needs to be stoped at least 6 months before conception in both men and women
128
when can the intrauterine system / device be fitted after childbirth?
either within 48 hrs of after 4 wks
129
which condition means ulipristal should be used w/ caution?
severe asthma
130
what is stage 2 ovarian cancer?
outwith the ovary but confined to the pelvis
131
what is stage 3 ovarian cancer?
outwith the pelvis but inside the abdomen
132
what is the first line for infertility in PCOS?
clomifine
133
what is the second line for infertility in PCOS?
metformin
134
COCP increases the risk of which 2 cancers?
breast and cervical
135
COCP is protective for which 2 cancers?
ovarian and endometrial
136
a sudden collapse soon after rupture of membranes is suggestive of what?
amniotic fluid embolism
137
what can be given to menopausal women suffering from vasomotor symptoms who do not want to try HRT?
SSRI such as fluoxetine
138
which method of contraception is assoc w/ delayed return of fertility?
depot provera
139
what is the treatment of vaginal vault prolapse?
sarcopoplexy
140
when should the combined test for downs syndrome be done?
11-14 wks
141
when should be quadruple test for downs syndrome be done?
15-20 wks
142
what normally happens to blood pressure during pregnancy?
falls in the first half of pregnancy before rising to pre pregnancy levels before term
143
what is the investigation of choice for gestational diabetes?
oral glucose tolerance test at 24-28 wks
144
what should be done if 2 COCP pills are missed between days 8-14 of the cycle?
nothing as long as the previous 7 days were taken correctly
145
what should be done if 2 COCP pills are missed between days 15-21 of the cycle?
omit the pill free interval when starting the next pack
146
what is the management of an incomplete miscarriage?
vaginal misoprostol alone
147
