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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

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2
Q

with HRT what increases the risk of breast cancer?

A

adding a progesterone

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3
Q

with HRT what increases the risk of thromboembolism?

A

adding a progesterone

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4
Q

women w/ uncomplicated multiple pregnancies should avoid air travel by when?

A

32 weeks

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5
Q

what is the management of endometriosis?

A

first line: NSAIDs and paracetemol

second line: COCP

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6
Q

what are the 3 stages of postpartum thyroiditis?

A

thyrotoxicosis
hypothyroidism
normal thyroid function

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7
Q

what is the management of the thyrotoxicosis phase of post partum thyroiditis?

A

propanolol for symptom management

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8
Q

what is the management of the hypothyroidism phase of post partum thyroiditis?

A

thyroxine

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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

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10
Q

what is the management of urge incontinence?

A

6 weeks of bladder retraining

antimuscarinics (bladder stabilising drugs)

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11
Q

how is pre-eclampsia defined?

A

new onset BP >140/90mmHg after 20 wks AND one of:

proteinurea
organ dysfunction

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12
Q

what is HELLP syndrome?

A

severe form of pre-eclampsia

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13
Q

what is HELLP syndrome classified by?

A

H - haemolysis
E L - elevated liver enzymes
L P - low platelet

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14
Q

what is the management of postpartum depression?

A

sertraline or paroxetine

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15
Q

what is placenta acreta?

A

attachment of the placenta to the myometrium

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16
Q

what is the biggest risk factor for placenta acreta?

A

previous c section

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17
Q

what are the investigations for PCOS?

A

pelvic ultrasound
FSH, LH, TSH
prolactin
testosterone
SHBG

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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

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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

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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

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21
Q

what are the foetal indications for a category 1 c section?

A

foetal hypoxia or persistent foetal bradycardia

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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

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23
Q

what is a category 3 c section?

A

delivery is required but mother and baby are stable

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24
Q

what is a category 4 c section?

A

elective c section

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25
Q

what is intrahepatic cholestasis of pregnancy defined as?

A

abnormal LFTs and intense puritis, usually in the third trimester

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26
Q

what is the management of intrahepatic cholestasis of pregnancy?

A

induce labour at 37-38 wks

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27
Q

what is the antibiotic regime given to all pts w/ preterm pre labour rupture of membranes?

A

10 days oral erythromycin

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28
Q

what is the diagnostic threshold for fasting glucose for gestational diabetes?

A

> 5.6mmol / L

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29
Q

what is the diagnostic threshold for 2 hr glucose for gestational diabetes?

A

> 7.8mmol / L

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30
Q

what is the medical management of an incomplete miscarriage?

A

a single dose of misoprostol

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31
Q

what is the medical management of a missed miscarriage?

A

oral mifepristone then 48 hrs later misoprostol

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32
Q

what is the most common type of ovarian cyst?

A

follicular cyst

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33
Q

what is the cause of physiological ovarian cysts in pregnancy?

A

the corpus luteum

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34
Q

if a semen sample is abnormal when should the test be repeated?

A

3 months later

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35
Q

what is the antibiotic of choice for group b strep prophylaxis?

A

benzylpenicillin

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36
Q

what is placental abruption?

A

separation of a normally situated placenta from the uterine wall

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37
Q

what is the management of placental abruption <36 wks gestation and there are signs of foetal distress?

A

immediate C section

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38
Q

what is the management of placental abruption <36 wks gestation and there are no signs of foetal distress?

A

admit and administer steroids

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39
Q

what is the management of placental abruption >36 wks gestation and there are signs of foetal distress?

A

immediate C section

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40
Q

what is the management of placental abruption >36 wks gestation and there are no signs of foetal distress?

A

deliver vaginally

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41
Q

how should an ectopic pregnancy >35mm in size or B hCH >5,000 be managed?

A

surgically

laparoscopic salpingectomy

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42
Q

how should an ectopic pregnancy <35mm in size of B hCG <5,000 be managed?

A

methotrexate

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43
Q

what is the risk of having intrahepatic cholestasis of pregnancy?

A

stillbirth

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44
Q

what should be given to pregnant women who are at moderate or high risk of pre eclampsia?

A

low dose aspirin

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45
Q

what is the management of moderate PMS?

A

cocp

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46
Q

what is the management of severe PMS?

A

SSRI

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47
Q

what is the antibiotic used in the management of mastitis?

A

flucloxacillin or erythromycin if penicillin allergic

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48
Q

what is the management of cervical cancer in a patient who wishes to preserve fertility?

A

cone biopsy

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49
Q

what is the management of primary dysmenorrhoea?

A

NSAIDs such as mefenamic acid

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50
Q

what are the guidelines for women with a singleton pregnancy
who wish to fly?

A

avoid air travel >37 wks

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51
Q

how does erbs palsy present?

A

adduction and internal rotation of the forearm

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52
Q

what is the first line management of shoulder dystocia?

A

McRobers manoeuvre

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53
Q

what is the diagnosis of post menopausal bleeding until proven otherwise?

A

endometrial cancer

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54
Q

what is the main risk factor for endometrial cancer?

A

excess oestrogen

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55
Q

give 3 things that cause increased oestrogen and therefore increase the risk of endometrial cancer

A

nuliparity
early menarche
late menopause

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56
Q

what is the normal endometrial thickness?

A

<4mm

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57
Q

what is the highly negative predictive value finding of a transvaginal ultrasound for endometrial cancer?

A

endometrial thickness <4mm

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58
Q

what can be used for patients with stress incontinence who have tried pelvic floor exercises and do not want surgery?

A

duloxetine

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59
Q

what is the first line for urge incontinence?

A

bladder stabilising drugs such as oxybutynin

60
Q

what should happen if a woman with known placenta praveia goes into labour?

A

emergency c section

61
Q

progesterones carry an increased risk for which 3 things?

A

breast cancer
venous thromboembolism
cardiovascular disease

62
Q

what is the cut off for anaemia in the first trimester?

A

Hb < 110

63
Q

what is the cut off for anaemia in the second and third trimesters?

A

Hb <105

64
Q

what is the cut off for anaemia post partum?

A

Hb <100

65
Q

how can you confirm ovulation in a pt having difficulty conceiving?

A

check progesterone levels 7 days before next expected period

66
Q

what are uterine fibroids?

A

benign tumours of the smooth muscle of the uterus

67
Q

how do uterine fibroids present?

A

menorrhagia

bulk related symptoms such as bloating and increase urinary symptoms

sub fertility

68
Q

how do bartholins cysts present?

A

painful and soft on examination

69
Q

what is Sheehans syndrome?

A

post partum hypopituitarism

reduction in the function of the pituitary control due to ischaemic necrosis due to hypovolaemic shock

70
Q

how does candida present?

A

painful sex
white cottage cheese discharge
pitching

71
Q

how is umbilical cord prolapse managed?

A

manual elevation of the presenting part

72
Q

combined HRT increases the risk of which cancer?

A

breast cancer

73
Q

apart from downs syndrome, increased nuchal translucency is associated with what?

A

congenital heart defects

74
Q

what is the management of pregnant women with BP >160/110mmHg?

A

admission and treatment with antihypertensive

75
Q

what is the first line treatment of menorrhagia?

A

intrauterine system - mirena

76
Q

what is the management of fasting glucose >7mmol / l in pregnancy?

A

insulin

77
Q

what is a galactocele?

A

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
Q

what are the findings of the combined test in downs syndrome?

A

thickened nuchal translucency
increased HCG
decreased PAPP-A

79
Q

what is the preferred method of smoking cessation in pregnancy women?

A

nicotine replacement therapy

80
Q

what is the gold standard investigation for women w/ suspected endometriosis?

A

laparoscopy

81
Q

why can fibroids grow during pregnancy?

A

because they are sensitive to oestrogen and so with increased oestrogen in pregnancy they grow

82
Q

what is the management of an overweight woman w/ PCOS who is trying to conceive?

A

weight loss

then add metformin

83
Q

what is the correct position for women w/ cord prolapse?

A

on all 4s

84
Q

how often are cervical smears done for women aged 25-49?

A

every 3 years

85
Q

how often are cervical smears done for women aged 50-64?

A

every 5 years

86
Q

what is placenta praevia?

A

when the placenta overlies the lower uterine segment

87
Q

how does placenta praevia present?

A

painless antepartum haemorrhage

88
Q

what size of ectopic pregnancy warrants surgical management?

A

> 35mm

89
Q

what HCG conc warrants surgical management of ectopic pregnancy?

A

> 5000

90
Q

what is the management of hyperemeisis gravidarum in a woman who is unstable / dehydrated?

A

admit for IV saline and potassium

91
Q

what should be done if 2 consecutive cervical smears are inadequate?

A

colposcopy

92
Q

what is the management of women who are exposed to chicken pox in the first 20 wks of pregnancy?

A

zoster immunoglobulin

93
Q

what is the management of women who are exposed to chicken pox after 20 wks gestation?

A

oral acyclovir

94
Q

what is used in the induction of labour when a membrane sweep has already been done and the bishop score is <6?

A

vaginal prostaglandins

95
Q

what is the first line management of hyperemesis gravidarum in a woman who is stable and not dehydrated?

A

antihistamines

96
Q

is lithium safe in breast feeding?

A

no

97
Q

PCOS increases the risk of which cancer?

A

endometrial cancer

98
Q

if insulin is needed in the treatment of gestational diabetes what is used?

A

short acting insulin only

99
Q

in terms of VTE risk which HRT is safest?

A

transfermal HRT

100
Q

what are the 3 types of placenta acreta?

A

placenta acreta
placenta increta
placenta percreta

101
Q

what is placenta acreta?

A

chorionic villi attach to the myometrium

102
Q

what is placenta increta?

A

chorionic villi invade into the myometrium

103
Q

what is placenta percreta?

A

chorionic villi invade through the perimetrium

104
Q

what is the first line for the management of pre eclampsia in women with asthma?

A

nifedipine

105
Q

what is the management of women w/ grade 3/4 placenta praevia?

A

elective c section at 37-38 wks

106
Q

what is adenomyosis?

A

the presence of endometrial tissue w/in the myometrium

107
Q

what makes you more likely to have adenomyosis?

A

multiparty
end of reproductive years

108
Q

how does adenomyosis present?

A

dysmenorrhoea
menorrhagia
enlarged boggy uterus

109
Q

when a baby is breech, external cephalic version can be done up until when?

A

as long as the amniotic sac is in tact

110
Q

what is the treatment of intrahepatic cholestasis of pregnancy?

A

usrodeoxycholic acid

111
Q

are anti epileptic medications safe in pregnancy?

A

yes

112
Q

unopposed oestrogen increases the risk of which cancer?

A

endometrial cancer

113
Q

how is an ectopic pregnancy managed when there is evidence of a foetal heartbeat on ultrasound?

A

surgically

114
Q

what is the management of premature ovarian failure?

A

HRT or combined oral contraceptive pill until 51 years old

115
Q

when can the COCP be started post partum?

A

21 days postpartum

116
Q

when can the POP be started post partum?

A

anytime

117
Q

what is a complete hydatiform mole?

A

when all the genetic material comes from the father

118
Q

what is seen on ultrasound w/ a complete hydatiform mole?

A

snowstorm appearance and no foetal parts present

119
Q

when can levonorgestrel be taken up to?

A

up to 72 hrs following unprotected sex

120
Q

how is levonorgestrel given?

A

as a single 1.5mg dose

121
Q

when can ulipristal be taken up to?

A

up to 120 hrs following unprotected sex

122
Q

how is ulipristal given?

A

as a single 30mg dose

123
Q

what should you do if you miss one COCP?

A

take the missed pill and no emergency contraception needed

124
Q

if breastfeeding, when can the COCP be restarted?

A

> 6 wks

125
Q

what should be done if cervical screening sample is inadequate?

A

test again in 3 months

126
Q

what is the biggest risk factor for cord prolapse?

A

artificial rupture of membranes

127
Q

what are the guidelines regarding methotrexate and conception?

A

methotrexate needs to be stoped at least 6 months before conception in both men and women

128
Q

when can the intrauterine system / device be fitted after childbirth?

A

either within 48 hrs of after 4 wks

129
Q

which condition means ulipristal should be used w/ caution?

A

severe asthma

130
Q

what is stage 2 ovarian cancer?

A

outwith the ovary but confined to the pelvis

131
Q

what is stage 3 ovarian cancer?

A

outwith the pelvis but inside the abdomen

132
Q

what is the first line for infertility in PCOS?

A

clomifine

133
Q

what is the second line for infertility in PCOS?

A

metformin

134
Q

COCP increases the risk of which 2 cancers?

A

breast and cervical

135
Q

COCP is protective for which 2 cancers?

A

ovarian and endometrial

136
Q

a sudden collapse soon after rupture of membranes is suggestive of what?

A

amniotic fluid embolism

137
Q

what can be given to menopausal women suffering from vasomotor symptoms who do not want to try HRT?

A

SSRI such as fluoxetine

138
Q

which method of contraception is assoc w/ delayed return of fertility?

A

depot provera

139
Q

what is the treatment of vaginal vault prolapse?

A

sarcopoplexy

140
Q

when should the combined test for downs syndrome be done?

A

11-14 wks

141
Q

when should be quadruple test for downs syndrome be done?

A

15-20 wks

142
Q

what normally happens to blood pressure during pregnancy?

A

falls in the first half of pregnancy before rising to pre pregnancy levels before term

143
Q

what is the investigation of choice for gestational diabetes?

A

oral glucose tolerance test at 24-28 wks

144
Q

what should be done if 2 COCP pills are missed between days 8-14 of the cycle?

A

nothing as long as the previous 7 days were taken correctly

145
Q

what should be done if 2 COCP pills are missed between days 15-21 of the cycle?

A

omit the pill free interval when starting the next pack

146
Q

what is the management of an incomplete miscarriage?

A

vaginal misoprostol alone

147
Q
A

finals (25 decks)

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