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Clinical > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

1
Q

What dose folic acid should be taken during pregnancy and when should it be taken?

A

400 micrograms, 5 mg for those more at risk for neural tube defects (e.g., diabetics).
2 months prior to conception until 12 weeks post conception.

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2
Q

At what point do you investigate couples for infertility? What is the first line investigation?

A

After 12 months of regular, unprotected sex without successful conception.
Mid-luteal phase progesterone and semen analysis.

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3
Q

What is ovarian hyperstimulation syndrome?

A

Complication of IVF, exaggerated response to excessive hormones.
Ovaries swell and become painful causing abdo pain, you also get systemic symptoms such as nausea, vomiting, diarrhoea, and bloating.

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4
Q

How would you confirm a pregnancy <5 weeks? Can you get an USS?

A

Measure bHCG and then retest 48 hours later, it should double in this time.
Intrauterine pregnancies are visible from around 5 weeks onwards so may not be visible.

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5
Q

How doe you diagnose gestational diabetes?

A

Fasting plasma glucose >5.6mmol/L or 2 hour post OGTT >7.8mmol/L.
Best performed around 24-28 weeks.

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6
Q

How do you manage gestational diabetes?

A

If fasting glucose is <7mmol/L: metformin and lifestyle modifications.
If >7mmol/L: insulin injections OD in morning and lifestyle measures.

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7
Q

How do you define gestational hypertension?

A

30mmHg rise from booking bloods without evidence of proteinuria.

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8
Q

What is first line for gestational hypertension?

A

labetalol (nifedipine if asthmatic).

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9
Q

What is first line for hypothyroidism in pregnancy?

A

PTU (propylthiouracil).

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10
Q

What is Placenta praevia? When is it seen/when does it present?

A

Placenta sitting in the lower region of the uterus.
Can be seen from around 16-20 weeks on USS but may present with PAILNESS bright red bleeding.

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11
Q

What are the stages of placenta praevia?

A

1: placenta does not reach internal os but is lying low.
2: placenta reaches margin of os but does not cover it.
3: placenta covers os when undilated but not when dilated.
4: Placenta completeely covers os.

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12
Q

How should a symptomatic placenta praevia >34 weeks be managed?

A

NOT SAFE TO DISCHARGE
Only definitive management is delivery - C-section.

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13
Q

What are the RFs for intrauterine growth restriction?

A

Smoking, alcohol use, low maternal BMI, infection, multip pregnancy, chromosomal defects.

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14
Q

How is hyperemesis gravidum defined?

A

loss of 5% of pre-pregnancy body weight despite anti-emetic treatment OR ketonuria.

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15
Q

How is hyperemesis gravidum managed?

A

Antihistamine anti-emetoc (promethazine).
Monitoring/correction of electrolytes.
Rehydration.

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16
Q

When should rhesus -ve mums be given anti-D?

A

28 and 34 weeks and after any foetal maternal haemorrhage.

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17
Q

What is the Kleihauer test?

A

Determines how many foetal cells are in maternal circulation after a foetal-maternal haemorrhage. This informs how much anti-D to give.

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18
Q

What are the potential complications of bacterial vaginosis in pregnancy? How is it managed?

A

Increases risk of low birthweight and premature birth.
Give PV metronidazole and monitor pt.

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19
Q

What are the stages/forms of placental/villous implantation?

A

1) Placenta accrete: placenta attaches to nitanuch layer but not the myometrium itself.
2) Placenta Increta: placenta invades myometrium
3) Placenta percreta: villous invasion all the way through the myometrium and can reach other structures such as the bladder.

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20
Q

How should abnormal placental implantation be managed?

A

Delivery via c-section and hysterectomy is the safest option but can try to preserve fertility with a less radical approach.

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21
Q

How does acute fatty liver of pregnancy usually present?

A

Nulliparous women in 3rd trimester with abdo pain, vomiting, nausea, anorexia, and jaundice.

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22
Q

What biochemistry results come back for a women with an acute fatty liver of pregnancy?

A

Coagulopathy: low platelets, prolonged PT.
Raised AST, ALT, bilirubin, ammonia, creatinine, lactate and serum uric acid.

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23
Q

How do you manage an acute fatty liver of pregnancy?

A

Delivery of foetus and post-partum support.

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24
Q

How does intrahepatic cholestasis of pregnancy present?

A

Pruritis, excoriation marks usually in the 3rd trimester.
Raised bili on biochemistry.

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25
Q

How do you manage intrahepatic cholestasis of pregnancy?

A

<37 weeks give ursodeoxycholic acid to reduce serum bile and reduce pruritis.
>37 weeks consider induction/C-section.
These pts have an increased bleeding risk for vitamin K may be given during delivery.

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26
Q

When would you remove a perinatal renal stone?

A

> 1cm = uteroscopic removal as is unlikely to pass on its own.

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27
Q

What is polyhydramnios? What does it increase the risk of?

A

Excess fluid in utero.
Umbilical cord prolapse as excess fluid prevents engagement of baby and allows cord to advance past presenting point.

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28
Q

Oesophageal atresia in utero may present as what amniotic fluid abnormality?

A

Polyhydramnios - inability of foetus to swallow the fluid leads to a build up on the outside.

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29
Q

What is chorioamnionitis?

A

ascending infection which begins in the lower genitourinary tract and ascends to the amniotic cavity.
This could transmit to foetus and cause PROM.

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30
Q

How does chorioamnionitis present? What is the immediate management?

A

Foul smelling liquor stained underwear after feeling of waters breaking.
Needs broad spec IV abx and and blood cultures.

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31
Q

What are the TORCH infections?

A

Toxoplasmosis, other (HIV, VZV, parvovirus B19, treponema pallidum), rubella, CMV, HSV.

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32
Q

What are the characteristics of congenital rubella syndrome?

A

Congenital cataracts, blueberry muffin rash, salt and pepper chorioretinitis sensorineural hearing loss.

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33
Q

If mum is infected with CMV during pregnancy and has no immunity to it, what are the consequences for the baby?

A

Short term: low birth weight, jaundice, pneumonia, petechial rash
Long term: hearing loss, visual impairment, learning disabilities, neurological abnormalities.

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34
Q

What methods can be used to induce labour?

A

Membrane sweep, prostaglandin pessary, balloon catheter, artificially breaking waters, giving synthetic oxytocin.

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35
Q

How do you manage a GBS +ve women in labour?

A

Gove IV abx in labour (e.g., erythromycin)

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36
Q

What is the classification for perineal tears?

A

1st degree: superficial perineal skin/vaginal mucosa only
2nd: tear extends to perineal muscles and fascia but the sphincters remain intact
3rd: <50% tear of external sphincter is type A, >50% in type B but internal sphincter intact. In C the internal sphincter is affected but mucosa is intact.
4th: perineal skin, internal and external and mucosa torn.

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37
Q

What Bishop’s score indicates a favourable/unfavourable induction?

A

> 8 is favourable, <6 is unfavourable (consider C-section)

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38
Q

What is first line for pain relief during the latent first stage of labour?

A

IM diamorphine

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39
Q

What is Sheehan’s syndrome?

A

Major blood loss causes ischaemia to the pituitary gland causing necrosis and therefore malfunction.

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40
Q

What are the consequences of Sheehan’s Syndrome?

A
  • Hypothyroidism (cold, constipation, tired, etc)
  • Hypoadrenalism (hypoglycaemia, hyponatremia, confusion, etc)
  • Hypogonadism (amenorrhoea, hot flushes, loss of libido, etc)
  • GH deficiency (fatigue, reduced muscle mass)
  • Usually means failure of lactation
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41
Q

What are the managements for PPROM?

A

Prolonged, premature, rupture of membranes…
- Steroids for baby’s lungs
- IV abx to reduce infection risk

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42
Q

How are minor and major postpartum haemorrhages classified?

A

Minor: 500-1000ml over 24 hours
Major: >1000ml in 24 hours. Can be moderate (1000-2000) and severe (>2000)

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43
Q

What are the major components of pre-eclampsia?

A

HeTN and proteinuria.

44
Q

Who is at risk of pre-eclampsia? How should these be managed?

A

T1DM, family hx, high BMI, first pregnancy, multip pregnancy.
Give low dose aspirin from 12 weeks until birth.

45
Q

How do we monitor/treat someone with pre-eclampsia?

A

1st line is labetalol (nifedipine if asthmatic).
U+Es, FBCs, transaminases and bili 3x per week until delivery.

46
Q

How would you manage eclampsia?

A

This is the progression to seizures - give magnesium sulphate.

47
Q

What is HELLP syndrome?

A

Haemolysis, elevated liver enzymes, low platelets.
Severe pre-eclamptic pts.

48
Q

Why do newborns tend to have an injection of vitamin K?

A

Breast milk is deficient in vitamin K and it doesn’t cross the placenta very well so this helps to prevent haemolytic disease of the newborn.

49
Q

What can be given to suppress lactation?

A

Cabergoline (dopamine receptor agonist) inhibits prolactin.

50
Q

What causes the majority of PPHs? What are the RFs?

A

Uterine atony.
Multip pregnancies, polyhydramnios, foetal macrosomia, uterine fibroids.

51
Q

What is adenomyosis? How does it present? How is it managed?

A

endometrial tissue remains inside myometrium after trauma to the uterus (e.g., C-section).
Presents with heavy, painful periods after multiple traumas to the uterus (pregnancy).
Mefanamic acid to reduce pain and bleeding if trying to conceive. Otherwise contraceptive methods can be used.

52
Q

What is first line for postpartum depression?

A

CBT

53
Q

What is first line pharmacotherapy for postpartum depression?

A

SSRIs such as paroxetine and sertraline as they are safe in breastfeeding.

54
Q

What medications are used in a medical termination of a pregnancy?

A

Mifepristone: anti-progesterone agent to stop progesterone support of pregnancy.
Misoprostol: prostaglandin E1 which aids contractions to expel foetus.

55
Q

What time frame can mifepristone and misoprostol be used within?

A

This method is most effective <10 weeks, but can be considered up to 24 weeks.
Caution should be taken between 10 and 24 weeks with higher risk women such as those with uncontrolled diabetes due to risk of infection, bleeding, and retained products of conception.

56
Q

When would surgical management of an ectopic be used?

A

Pt is symptomatic, mass>35mm, USS identifies foetal HR, serum b-HCG >5000.

57
Q

What are the types of molar pregnancy?

A

complete: 1 sperm and an empty egg, usually no foetal tissue in uterus.
partial: 2 sperm, 1 egg, usually foetal tissue in uterus.

58
Q

What are the findings for a threatened miscarriage?

A

Painless vaginal bleeding around 6-9 weeks, cervical os is closed, foetal HR detectable.

59
Q

What are the findings for a missed miscarriage?

A

Hx of painless, light vaginal bleeding, no foetal HR detectable at scheduled scan.
Cervical os is closed.

60
Q

What is the mx of a missed miscarriage?

A

Mifepristone and misoprostol 48 hours later.

61
Q

What are the findings for an inevitable miscarriage?

A

Heavy, painful, vaginal bleeding with clots.
Cervical os open, passage of foetal products underway.

62
Q

What are the findings of an incomplete miscarriage?

A

PV bleeding, abdo pain, cervical os open, but products of conception still in utero.

63
Q

What is the mx of an incomplete miscarriage?

A

Single dose misoprostol

64
Q

What are the findings of a septic miscarriage?

A

Products of conception remain in uterus (become infected), no foetal HR. Cervical os usually open.
Pt presents with signs of sepsis.

65
Q

Is metformin safe in pregnancy?

A

Yes

66
Q

When is trimethoprim CI in pregnancy?

A

1st trimester (folate antagonist)

67
Q

Is lithium safe in pregnancy?

A

NO- swap to atypical antipsychotic.

68
Q

Are ACEIs safe in pregnancy?

A

NO- can cause oligohydramnios, renal failure, bony malformations, limb contractures, pulmonary hypoplasia, prolonged hypotension, and neonatal death.

69
Q

Why might a pregnant lady present with features of bilateral carpel tunnel?

A

Fluid retention and swelling compresses carpel tunnel.

70
Q

What is the difference between endometriosis and adenomyosis?

A

Endo - ectopic endometrial tissue
Aden - endometrium growing into myometrium

71
Q

How many days after UPSI can ellaone and levonelle be used?

A

E - 5 days
L - 3 days

72
Q

Asthmatics are CI to which emergency birth control?

A

ellaone

73
Q

In what timeframe can the copper coil be inserted as emergency contraception?

A

5 days post UPSI or 5 days post ovulation, whichever is longer.

74
Q

What is a Nabothian cycst?

A

When squamous epithelium slightly covers columnar (close to the os where it changes), mucus can be secreted from the columnar and becomes trapped forming cysts.
More common in parous women.

75
Q

What is the difference between a cystocele and a uterine prolapse?

A

Cystocele is collapse of the bladder into the anterior vaginal wall.
Uterine prolapse is where the depth of the vagina is reduced as the uterus prolapses down the vaginal canal.

76
Q

What are the symptoms of endometriosis?

A

Secondary dysmenorrhoea (pain before menstruation), deep dyspareunia, pelvic pain.

77
Q

What are the symptoms of uterine fibroids? How do you investigate and manage it?

A

Bulky uterus, heavy periods.
TV USS.
Can watch and wait but if they are >3cm or symptomatic then can do myomectomy.

78
Q

How do you manage CIN (cervical intraepithelial neoplasia) I to III?

A

I - conservative management, repeat cytology in 6 months time to see if it has regressed or progressed.
II + III - excisional treatment should be considered.

79
Q

Which organism is most commonly associated with a Bartholian’s Cyst?

A

E.Coli.

80
Q

A women presenting with grey/white watery discharge, and an odour worse after menstruation is most likely got what kind of infection? How is it mx?

A

Gardenerella vaginalis - bacterial vaginosis.
Mx - oral/vaginal metronidazole.

81
Q

A women presenting with thick white odourless discharge associated with vulval itching is likely what?

A

Vulvovaginal candidiasis.
Mx - oral (fluconazole), or intravaginal (clotrimazole) antifungals.

82
Q

A women presenting with RUQ and shoulder tip pain on a background of a diagnosis of an STI is likely what?

A

Fitz Hugh Curtis syndrome.

83
Q

What is Fitz Hugh Curtis syndrome? What is it most commonly caused by?

A

Perihepatitis caused by PID (chlamydia and gonorrhoea).

84
Q

How is Fitz High Curtis syndrome managed?

A

Doxycycline or azithromycin.
May need surgery if there is persistent pain/complications due to adhesions.

85
Q

What are the symptoms of PID?

A

Abdo pain, discharge, post-coital bleeding, adnexal tenderness, cervical motion tenderness,

86
Q

What most commonly causes PID?

A

1) Chlamydia
2) Gonorrhoea

87
Q

What is the management of PID?

A
  • Ceftriaxone (IM), doxycycline, metronidazole
    OR
  • Ofloxacin and metronidazole
88
Q

What is lichen sclerosis? What types of cancer does it increase the risk of?

A

Inflammatory condition causing white atrophic patches of skin on the genitals.
Vulvovaginal and penial cancer (SCC).

89
Q

In perimenopause what happens to oestrogen, LH, and FSH?

A

Oestrogen declines and LH/FSH increase.

90
Q

Menopause occurring a) <40 b) 40-45 is classified as what?

A

a) Premature ovarian insufficiency
b) early menopause

91
Q

What is menopause?

A

1 day event where you are 12 months post the last bleed (amenorrhoeic for 12 months), after this you are post-menopause.

92
Q

Where is vulvar cancer most commonly seen?

A

Labia majora

93
Q

What is Ashermann’s Syndrome?

A

Intrauterine adhesions (due to previous surgery/intervention) obstruct menstrual flow.
Cyclical pain/period-related sx alongside amenorrhoea.
Normal labs, often need hysteroscopy for diagnosis and USS not very sensitive.

94
Q

Where do ectopic pregnancies most commonly occur?

A

Ampulla.

95
Q

What pharmacological agent can be used to improve success of ECV?

A

Tocolytics such as terbutaline to relax smooth muscle of uterus (SEs include tachycardia, palpitations, and flushing)

96
Q

When can ECV be offered in nulliparous and multiparous women?

A

N: 36 weeks
M: 37 weeks

97
Q

How does a placental abruption usually present? How is it managed?

A

> 24 weeks with abdo pain, dark red bleeding (not always), and a firm/tense uterus.
Delivery by C if there id maternal/foetal distress,
Delivery by induction if not.
Conservative mx may be tried if gestation is short.
Consider use of anti-D

98
Q

What is a polymorphic eruption of pregnancy? Mx?

A

Papular rash which usually begins on striae gravidarum and spreads. Can become widespread and fluid filled vesicles. Usually 3rd trimester.
Mx- emollients and topical corticosteroids.

99
Q

What is the most common type of ovarian cyst?

A

Functional: most common type of these is a follicular cyst.

100
Q

What is a Krukenberg tumour?

A

A tumour that has metastasis to the ovary

101
Q

What is a cervical ectropion? What puts someone at an increased risk of developing one?

A

Columnar epithelial cells from endocervix migrate to ectocervix causing bleeding on trauma such as sex and speculum examination.
Higher levels of oestrogen put someone at increased risk such as COCP and pregnancy.

102
Q

What are the 4 categories of C-section?

A

1) Immediate threat to mum/baby (decision to delivery 30 minutes).
2) No imminent danger but urgent (decision to delivery 75 minutes).
3) C required but not urgent, mum and baby stable.
4) Elective C.

103
Q

How do you manage pelvic inflammatory disease (PID)?

A
  • IV ceftriaxone until improving (or IM)
  • Oral metronidazole and doxycycline for 14 days.

OR
- Ofloxacin and metronidazole

104
Q

What test is used to quantify proteinuria in Pre-Eclampsia? What is the threshold for significance?

A

Protein: creatinine ratio
>30mg/mmol

105
Q
A

Clinical (27 decks)

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