Obs and gynae Flashcards
What is 1st line treatment for stress incontinence? and for how long?
Pelvic floor muscle training for 8 contractions 3x a day for at least 12 weeks
What is 1st line for mixed or urgency incontinence?
Bladder training
In which scenario may oxybutynin be started in incontinence?
Mixed or overactive bladder
What does oxybutynin do to the bladder?
Relaxes the muscles so bladder can hold more water
What is the definition of major primary post partum haemorrhage?
any bleeding from the genital tract with an estimated blood loss of > 1000 mls within 24 hours of delivery
What is the most common cause of primary post partum haemorrhage?
Uterine atony (uterine muscles don’t contract enough to clamp the placental blood vessels shut after childbirth)
What is the definition of secondary post partum haemorrhage?
Abnormal bleeding from the genital tract from 24 hours until 12 weeks post-partum
What is the definition of minor primary post partum haemorrhage?
Blood loss > 500 mls, within 24 hours of delivery
Antibiotics for toxic shock syndrome are?
Clindamycin and vancomycin
What bacteria usually causes toxic shock?
Staph aureus
What is mechanism of action of clindamycin?
Inhibits bacterial protein synthesis
What is the ratio of LH:FSH in PCOS
It’s inverted so LH is greater than FSH
What type of tumours are virilizing ovarian tumours?
Sex cord stromal tumours
What do sex cord stromal tumour secrete excess of?
Steroid hormones: estrogen and androgen
What are manifestations of a virilising ovarian tumour?
Hirsutism, Oligomenorrhea or amenorrhea, Postmenopausal hemorrhage, and Thickened endometrial lining.
At week does the abdo distension in a pregnant women reach the umbilicus?
20 weeks
What does the symphysial fundal height equal to ?
+ or - two weeks of no. weeks gestations
At 16 weeks gestation where can fundus of uterus be palpated?
Midpoint between umbilicus and pubic symphysis
What’s the limit of paracetamol in pregnancy? and does it cross the placenta?
Yes it does cross and max 1g every 4-6 hours
If low dose codeine phosphate is taken closer to delivery what must the delivering doctor be vigilant about?
Signs of resp distress
Drowsiness
Opioid withdrawal
In labour where can anaestehtic be injected?
Around pudendal nerve trunk
When can a frenotomy (frenulum is divided) be performed without anaesthesia?
If baby is under 3 months
What are some common presenting symptoms of endometrial cancer?
Bloating
What are risk factors for endometrial cancer?
PCOS history, nulliparity, late menopause, obesity , use of tamoxifen
What would a fetus of oesophageal atresia struggle with in utero? and what condition does this cause
Swallowing so polyhydramnios due to issue with circulation of amniotic fluid - so fluid builds up - seen on US
What are the causes of oligohydramnios?
Renal agenesis
Intrauterine growth restriction
Chromosomal abnormalities
What defines fetal oedema?
also known as hydrops fetalis, is characterised by an excess of fluid in the fetus in a minimum of two fetal compartments, such as scalp tissue, the pleural cavity or the abdominal cavity, among others.
What is an immunological cause of hydrops fetalis (fetal oedema)
Rhesus D haemolytic disease of the newborn
What are some non-immunological causes of fetal oedema?
iron deficiency anaemia, alpha thalassaemia and Down syndrome.
How often should diabetic females be seen at joint diabetes and antenatal clinic during pregnancy?
Every 1-2 weeks
How often should diabetic women be offered a fetal scan?
Every 4 weeks from 28 weeks to 36 weeks gestations
When should elective induction of labour be done for diabetic pregnancies? or c-section and why
37+0 to 38+6 . As there is an increased risk of stillbirth
How does lichen planus present in the genital area?
Purple and red plaques on labia with central erosions and overlying lacy white striated patches - often causing adhesions
What is first line management for females having breastfeeding issues?
1-to-1 visit from health visitor or specialised nurse
What is discharge like in BV?
Thin grey and watery and fishy
Treatment for BV?
Metronidazole 400mg twice a day for a week
What is definitive treatment for eclampsic attack?
Delivery of fetus
What are some medical managements of eclampsic attack?
Magnesium sulphate infusion
Hydralazine or labetalol infusion
Which cells in sex cord stromal tumour will cause virilisation?
Leydig cells
Where does an ectopic pregnancy usually implant?
Ampullary region of fallopian tube
Where may referred pain in ectopic pregnancy go to?
Shoulder tip pain due to phrenic nerve irritation
What is treatment of ectopic?
laparoscopy or laparotomy
What is management for HIV pregnancies?
All HIV females should commence combined anti-retroviral therapy by 24th week of gestation and continue lifelong
What is irregular and unpredictable uterine bleeding caused by in first few years of menarche?
Anovulatory dysfunction uterine bleeding due to inadequate gonadotrophin release and LH surge and ovulation may fail to occur
The most common site of referred pain bcos of PCOS is the…?
Periumbilical region
Which nerves innervate the ovaries?
Ovarian plexus and uterine plexus
Where does ovarian plexus originate from? - which level
T10
If obturator nerve is stimulated where can pain be located to?
Ipsilateral inner thigh
What are safer epilepsy medications than sodium valproate in pregnancy?
Lamotrigine and carbamazepine
What risk are associated with carbamazepine in pregnancy?
Cleft palate
What are risk of lamotrigine in pregnancy?
Aggression and fatigue
Which part of fallopian tube is most likely to rupture due to ectopic pregnancy?
Isthmus - it’s the narrowest part
What is placenta increta?
Placenta infiltrate into myometrium (uterine wall)
What are the risk factors for placenta increta?
Previous C sections
Myomectomy (removal or uterine fibroids)
Multiparity
old mum
What is pregnancy plan of placenta increta?
C section elective
What is definitive management of placenta increta?
Hysterectomy
What is placenta praevia?
Low lying placenta that can obscure the internal cervical os - common cause of antepartum haemorrhage
What is the triad of symptoms in pre-eclampsia?
High BP
Ankle oedema
Proteinuria
If found to be at risk of pre-eclampsia what medication should be taken?
75mg low dose aspirin once daily from 12 weeks gestation onwards
What is 1st line medical treatment of pre-eclampsia?
Labetalol
What is HELLP syndrome?
Haemolysis
Elevated liver enzymes
Low platelets
It’s a complication of pre-eclampsia
What is a threatened miscarriage?
Vaginal bleeding and ongoing pregnancy
What is an inevitable misscarriage?
Cervix begins to dilate
What’s an incomplete miscarriage?
Pass of some but not all conception products
What is a complete misscariage?
All products of conception are expelled from uterus
What is a missed miscarriage?
Fetus dies in utero but not expelled?
How many miscarriages is defined as recurrent miscarriages?
3 or more consecutive
What is the difference between a salpingotomy and a salpingectomy?
Salpingotomy remove ectopic whilst preserving fallopian tube
Whereas a salpingectomy remove the fallopian tube
What characterises posterior tongue tie?
Short and thickened frenulum restricting tongue movement and issues latching to breast
Frenulum won’t be visible
Is frenulum visible in anterior tongue tie?
Yes bcos the tie is close to tip of of tongue
What marker is suggestive of ovarian cancer?
CA-125
What is marker for pancreatic cancer?
CA-19-9
What is marker for breast cancer?
CA15-3
What is marker for colorectal cancer?
CEA
Which groups of women should be taking the 5mg rather than 400microgram dose of folic acid?
Women taking anti-epileptics
Obese
Diabetics
History or family history of neural tube defects
How long should folic acid be taken till?
Up to 12 weeks gestation
Which medication is preferred for severe allergic rhinitis during pregnancy?
Oral loratadine as it’s not teratogenic
What medication is given as a routine prophylactic measure for all women undergoing abdo hysterecotmy?
Co-amoxiclav IV intraoperatively
What does a molar pregnancy look like on US?
Snow storm
What is important follow up after post evacuation for molar pregnancy?
Monitor serum HCG
What is a molar pregnancy?
Type of tumour that grows like a pregnancy inside the uterus.
What are the two type of molar pregnancy?
complete mole and a partial mole.
What is a complete molar pregnancy?
two sperm cells fertilise an ovum that contains no genetic material (an “empty ovum”). These sperm then combine genetic material, and the cells start to divide and grow into a tumour called a complete mole. No fetal material will form.
What is a partial molar pregnancy?
two sperm cells fertilise a normal ovum (containing genetic material) at the same time. The new cell now has three sets of chromosomes. The cell divides and multiplies into a tumour called a partial mole.
What levels will be high in molar pregnancy?
hCG
What symptoms can differentiate normal pregnancy from a molar pregnancy?
More severe morning sickness
Vaginal bleeding
Increased enlargement of the uterus
Abnormally high hCG
Thyrotoxicosis (hCG can mimic TSH and stimulate the thyroid to produce excess T3 and T4)
What is treatment and follow up plan for a molar pregnancy?
- Evacuation of uterus
- Referral to gestational trophoblastic disease centre
- hCG levels monitored till they are back to normal
- If molar metastasises then systemic chemo
What % of complete molar pregnancies go on to become invasive?
15%
What can be common presentation of von willebrand’s disease in women?
Easy bruising
Menorrhagia
Easy bleeding from tiny wounds
What medication can be used to treat hirsutism and acne in PCOS?
Co-cyprindiol (Dianette)
How does co-cyprindiol work?
Is an anti-androgen - reduces sebum production and hair growth also inhibits ovulation and induce withdrawal bleeds
What is APTT and bleeding time like in von willerbrand?
Prolonged
What is the turtle neck sign?
Foetal head retracts back into perineum
What is management for shoulder dystocia ?
Mcroberts position - widen pelvic outlet
Then manoeuvre to rotate anterior shoulder to foetal chest then posterior shoulder back to dislodge the shoulder dystocia
What is first line medical management for overactive bladder and urge incontinence?
Oxybutinin
If person is super old with urge incontinence would you still give them oxybutynin and why?
No because you should avoid anticholinergics in the elderly as it can precipitate falls so give them botox
What is medical management for overactive bladder in elderly?
Mirabegron
What is 1st line management for urge incontinence?
Bladder exercises
What is 1st line management for stress incontinence?
Pelvic floor
What is management for a uterus prolapse?
Vaginal pessary
What is medication and doses for a medical abortion?
Mifipristone - 200mg then misopristol 800 mcg
What does a Scalp baby pH of less than 7.2 indicate and what category c section is it?
It’s category 1 and indicates not enough oxygen getting to baby
What categoryc-section is cord prolapse?
Category 1
What is anti-mullerian hormone a measure of?
Number off eggs. So if AMH is low it may indicate primary ovarian failure
What is FSH and LH like in primary ovarian failure?
High due to negative feedback on pituitary gland due to reduction in ovarian oestrogen
What is a cervical ectropian?
Cervical ectropion occurs when the columnar epithelium of the endocervix (the canal of the cervix) has extended out to the ectocervix (the outer area of the cervix). The lining of the endocervix becomes visible on examination of the cervix using a speculum. This lining has a different appearance to the normal endocervix.
The cells of the endocervix (columnar epithelial cells) are more fragile and prone to trauma. They are more likely to bleed with sexual intercourse. This means cervical ectropion often presents with postcoital bleeding.
Cervical ectropion is associated with higher oestrogen levels, and therefore, is more common in younger women, the combined contraceptive pill and pregnancy.
What is 1st line management of endometriosis related pain?
Mefanamic acid - NSAID trial
What endometrial thickness do you worry about?
Over 5mm. Under is usually atrophic vaginitis
What is a cystocele?
Bladder herniates into vagina
What is an enterocele?
Prolapse of small bowel into vagina
When may a vaginal vault prolapse be likely to occur?
Post hysterctomy
If cervix is in abnormal position what can this indicate?
Uterine prolapse
On speculum what could indicate premature prelabour rupture of membranes?
Watery fluid pooling in posterior vaginal vault
What sign on CT or US is characteristic of ovarian torsion?
Whirlpool sign - it represents twisting of ovarian pedicle
In a intrauterine viable pregnancy vs. miscarriage what do you expect to happen to repeat beta hcg?
Viable: double
Miscarriage 1/2
What would be expected on nuchal translucency in trisomy 21?
Thickened due to fluid behind the neck
What substance are low in down’s syndrome?
AFP
Oestriol
PAPP-A
What is b-hcg like in down’s?
High
When are women offered chromosome defects test?
11-13 weeks +6
What can cause polyhydramnios?
Abnormally large level of amniotic fluid can be due to any contion that prevents fetus from swallowing the amniotic fluid like… oesophageal atresia and CNS abnormalities.
What’s the measurement of polyhydroamnios?
Over 2-3 L
What’s the measurement for oligohydroamnios?
Less than 500 ml at 32-36 weeks
What are the risk factors for oligohydroamnios?
Renal agenisis
Intrauterine growth factor
Premature rupture of membranes
Post term gestation
What is placenta praevia?
Placenta covers cervical os - complete or partial
How does placenta praevia present?
Painless bleeding after 20 weeks gestation
What is placental increta?
Placenta infiltrates myometrium and muscle instead of being confined to endometrium
What hormones are high in placental increta?
Fetoprotein
B-hcg
Are c sections advised in placental increta? and what is definitive management?
Yes - hystectomy
What is vasa praevia?
Foetal vessels cross over internal os - c section recommended
What is placental abruption?
Sudden separation of placenta from uterine wall in third trimester presents with sudden abdo pain and vaginal bleeding
What is an absolute contraindication of external cephalic version?
Antepartum haemorrhage during the last 7 days
When is ECV offered for both a nulliparous women and a multiparous woman?
Nulliparous at 36 weeks
mULTIPAROUS: 37 WEEKS
What is 1st line for investigation of bleeding in pregnancy?
Transvaginal US
What’s the dose for thrush of oral fluconazole?
Once - 150mg single dose
What is the definition of preterm premature rupture of membranes?
Early rupture of membranes before 37 weeks
What are the signs of PPROM?
Cervical effacement
Dilation and rupturing of membranes
Onset of contractions
What is management of PPROM?
Corticosteroids : betamethasone + dexamethasone to accelerate foetal lung maturation
IV antibiotics for group b strep - benzylpenicillin
Nifedipine (tocolytic agent - slow down contraction) - if wanted to delay labour
What test can be used to assess the risk of preterm delivery after PPROM?
Foetal fibronectin test (fFN test) a negative fFN indicates a low risk of delivery within the next 7-14 days
What is prolonged premature rupture of membranes?
Rupture of membranes more than 24 hours before onset of labour
What is premature rupture of membranes (PROM)?
Delivery of baby after 20 weeks but before 37
What happens if corpus luteum fails to regress after not being fertilised?
Can cause a corpus luteal cyst which can rupture and cause pain
What’s the management of a corpus luteal cyst?
Under 5cm - no follow up - just pai managment
5-7 cm: repeat TV USS yearly
If over 7cm MRI with/without surgery (laparoscopic cystectomy)
Medical: for recurrent or unresolved: OCCP
What is the Kleihauer test?
Quantifies the dose of Rh-D antigen in maternal circulation - can guide the amount of anti-D IG needed to prevent maternal sensitisation
Which UTI medication is safe during third trimester?
Trimethoprim - 7 day course
Can trimethoprim be used in first and second trimester?
No due to risk of congenital malformations e.g. neural tube defects
When can nitrofuratoin be used vs. not used in pregnancy?
Fine in first and 2nd trimester but must avoid near term due to risk of neonatal haemolysis
Why if cefalexin not really given if a patient is pen allergic?
10% Cross sensitivity between penicillin and 1st gen cephalosporins like cefalexin
Which medication can be given to help ECV and what class of drug is it?
Terbutaline - it’s a tocolytic agent with beta-mimetic effect
What class of drug is nifedipine?
Its a tocolytic calcium channel blocker
Describe the tears?
1st degree: superficial perineal skin or vag mucosa only
2nd: perineal tear and fascia but anal sphincters intact
3rd: tear to anal sphincter 3a) less than 50% external sphincter involved 3b) more than 50% external anal sphincter but internal is fine 3c) internal and external spincter torn
4th: sphincters and anal muscosa torn
3rd and 4th degree tears will always need surgical repair in operating theatre but 1st and 2nd can be sutured on ward by clinican or midwife
When carrying out an instrumental delivery what type of nerve block is needed?
Pudendal nerve block - blocks perineum, external genitalia and external anal sphincter
When does IV antibiotics for GBS happen?
After onset of labour or membrane rupture
If pen allergic what is given for GBS instead of benzylpenicillin?
Vancomycin
What is presentation of acute fatty liver in pregnancy?
few days of malaise , anorexia, vomiting and jaundice, low platelets, elevated LFT’s and prolonged PT and raised bilirubin
What is definitive treatment for acute fatty liver in pregnancy?
Immediate delivery
What risks does NSAID’s pose in pregnancy?
Foetal ductus arteriosus in utero
Resistant pulmonary hypertension of newborn
Delayed onset of labour
What would be seen on blood film in g6pd?
Heinz bodies and bite cells and coombs would be negative
Which does a positive coomb test indicate?
Haemolytic anaemia is immune mediated - rhesus haemolytic disease of newborn - normocytic anaemia
At what weeks is anti -d injections given?
28 weeks and 34 weeks
If pt presents for trisomy stuff beyond the 11-13 week +6 window what tests can be done?
serum oestriol
HCG
AFP
Inhibin A (would be increased)
What is the uterus like in placental abruption?
Tense ‘woody’ uterus
Dark red blood vaginally
Pain and evidence of shock
Blood loss may be disproportionate for the shock - because bood mostly remains between placenta and uterine wall so external losses can be minimal
What is the presentation of vulval carcinomas?
Vulval soreness
Burning
Pruritus
Bleeding
What is the bishop score?
Based on digital cervical exam and socred on cervical dilation, position, effacement and consistency of cervix and foetal station.
Firm cervix = 0 - feels like tip of nose. Soft cervix = 2 and feels like lips
What is cervical effacement?
Thinning and shortening of cervix prepping for labour?
What does a high bishop score indicate?
8 or more = labour is likely to begin soon
9 or more = pt is good for induction
What is potter’s syndrome?
Potter sequence is the atypical physical appearance of a baby due to oligohydramnios experienced when in the uterus. It includes clubbed feet, pulmonary hypoplasia and cranial anomalies related to the oligohydramnios.
What is treatment for pregnant women with hsv genitals?
Oral acyclovir and elective c section
What is twin to twin transfusion syndrome?
Monochorionic twins have anastamoses of umbilical vessels so both fetuses are atrisk of developing heart failure and hydrops. The donor twin will suffer from high CO heart failure and severe anaemia and the recipient twin suffers from fluid overload
What is treatment for twin to twin transfusion syndrome?
Laser transection of problematic vessels in utero
What can green tinged liquor suggest?
Meconium is present and inhaled by infant before or during birth - risk of meconium aspiration syndrome - increases after 40 weeks gestation
What causes the symptoms in ovarian hyperstimulation syndrome?
High concentration of oestrogen leads to nausea and vomiting
High levels of vascular endothelial growth factor lead to leaking vasculature causing fluid retention and weight gain
Ovaries may enlarge which explain abdo discomfort
What is the definition uterine hyperstimulation?
Greater than 5 contractions occuring within 10 mins due to administration of protaglandins or oxytocin for induction of labour.
What is risk of uterine hyperstimulation?
Fetal bradycardia due to increased frequency of contractions and therefore increased compression of fetal head
How is uterine hyperstimulation reversed?
Tocolytic agents
What is placenta accreta?
Increased risk of placental abnormalities for future pregnancies following c-section - abnormal implantation of placenta into uterine wall - common site being the old c section scar
What is symphysis pubis dysfunction?
Common in pregnancy presents as pelvic pain
How does transmission of hsv occur from mum to baby?
If mum has a primary infection within 6 weeks of birth
How does a baby with congenital rubella syndrome present?
Sensorineural hearing loss
Ocular defects - cataracts
Congenital heart disease
P
What is the characteristic rash called in Congenital rubella syndrome?
Blueberry muffin rash -purpuric rash
What is a frank breech?
Legs fully extended up to shoulders and presenting part is bum
What is complete breech?
Hip and knees are both flexed and presenting part is bum
If woman has had gestational diabetes previously what should be done?
2 hour oral glucose tolerance test ASAP following booking visit - don’t wait till 24-28 weeks
What is anencephaly?
most severe form of neural tube defects - absence of cortical brain tissue and cranial vault
Classic frog eye or mickey mouse appearance of the head
What can causes rhesus sensitisation?
antepartum haemorrhage
Placental abruption
Abdo trauma
ECV
Invasive uterine procedures like amniocentesis and chorionic villus sampling
Rhesus positive blood transfusions
Intrauterine death
Miscarriage
Termintation
Ectopic
Delivery
What is immediate management for meconium aspiration syndrome?
Admit to NICU for oxygen and antibiotic therapy
What is meconium ileus?
Meconium obstructs neonatal bowel often indicated CF
What are the signs of meconium ileus?
Bilious vomiting
Distended abdomen
Failure to pass meconium in first 24 hours
What are the symptoms of meconium aspiration?
Meconium stained liquor
Foetal distress
Hypoxia
Expiratory grunting
Accessory use of resp muscles
Pink neonate
What is the combined test?
1st line screeing for Down’s between 11 and 13 + 6 weeks - measures PAPP-A and B-HCG and US to measure nuchal translucency
What is quadruple test?
Screening for down’s with women presenting after 13 weeks - no US but BHCG, AFP, UE3 and inhibin A
What is classical sign on chest x-ray that there is transposition of the great arteries?
Egg on a string appearance
In which type of mothers are most at risk of having babies with transposition of great arteries?
Type 1 and 2 diabetics
What is success rate of ECV?
50%
Is it safe for lamotrigine to be used in pregnancy and breastfeeding? what other epilepsy medication is safe?
Yes
Levetiracetam
What is amniotic fluid embolism?
Amniotic fluid enters maternal circulation leading to symptoms similar to a PE
What can amniotic fluid embolism then go on to cause?
DIC
What would liquor be like in chorioamnionitis?
Offensive smelling and stained underwear
What is treatment of chorioamnionitis?
IV ampicillin and gentamicin until delivery and bacterial culture
What is management after 3 pulls are unsuccessful in a ventouse delivery?
Convert to lower segment c -section
What is uterine inversion?
Fundus of uterus drops down through uterine cavity and cervix turning inside out. Typically presents with a large post partum haemorrhage
How is uterine inversion managed?
Johnson manoeuvre - push the inversion back with hand
Hydrostatis methods with warm saline
Laparotomy
When does operating need to happen for category 1 c section?
Within 30 mins
How long does c section have to happen in in category 2 ?
75 mins
What is restitution and what happens after it?
Fetus externally rotate to bring shoulders into antero-posterior position facilitating delivery of anterior shoulder then the posterior shoulder
What medication are pregnant women given before c -section? and why?
Omeprazole because it reduces the maternal gastric volume and acidity which reduces the risk of aspiration of gastric contents during surgery and subsequent aspiration pneumonitis
How does obstetric cholestasis present?
Pruritus on palms and soles and excoriations and raised bilirubin
What is formula to calculate estimated delivery date?
First day of last menstrual period + 9 months + 7 days - pt need to have a regular cycle for this tho
What does a lambda sign on Ultrasound indicate?
Diamniotic twin pregnancy - they each have their own placenta and amnion
When should diamniotic twins be delivered?
37 weeks
What is medical management for a ectopic?
Methotrexate
What are the surgical indications for ectopic?
Pt in lots of pain
Mass is bigger than 35mm
US sees fetal heartbeat
B-HCG is over 5000
What is ebstein’s anomoly?
congenital heart defect in which the septal and posterior leaflets of the tricuspid valve are displaced downwards towards the apex of the right ventricle of the heart.
Which drug during pregnancy can cause ebstein’s anomoly?
Lithium
How long after hyatidaform mol should pregnancy be avoided?
If beta hcg still goes up after evacuation what should be suspected?
1 year
Choriocarcinoma
When does beta hcg reach peak levels?
8-10 weeks
What is mechanism of action of methotrexate?
Folic acid antagonist that targets and inhibts rapidly dividing cells
What is 1st line for strong opiod analgesia in latent first stage of labour?
Diamorphine 5mg IM
How long does Diamorphine 5mg IM taken to take effect and how long does it last for?
Onset 20 mins
Lasts for 2-4hrs
When is pudendal nerve block used?
Delivery which require rapid regional anaesthesia such as episiotomy or operative vaginal delivery
What is latent labour?
the very beginning part of the first stage of labour. The latent phase begins with a long, firm cervix that is closed accompanied by irregular contractions
When can epidural be used?
Established labour is a must
When does polymorphic eruption of pregnancy usually occur?
Red patches often first appears on abdomen particularly over striae - usually in third trimester
What IM injection is recommended for b12 deficiency?
Cyanocobalamin 12mg
What is an absolute contraindication to VBAC?
Classic c-section scar (vertical scar)
What is the signs of hypermesis gravidarum?
Vomiting before 20 weeks of pregnancy leading to triad of weight loss , dehydration and electrolyte disturbance
Early signs: ketonuria and or weight loss up to % of overall pre-pregnancy weight
Who are intrapartum antibiotics offered to?
Women with risk factors for GBS infection and all women in preterm labour
Risk factor can include pregnancy with previous gbs infection
When can early scan to confirm dates be done and exclude multiple pregnancies?
11=2 weeks and 14+1 weeks
Which medication can suppress lactation and what is it’s mechanism?
Cabergoline - it’s a dopamine receptor agonist which inhibits prolactin production to suppression of lactation
What should patients taking lithium do during pregnancy?
Every pregnant patient on lithium should gradually switch to an atypical antipsychotic eve if they’re unstable bipolar
What’s the regiment for the monthly cyclical HRT?
Oestrogen is taken daily and progesterone is given for the last 10-14 days of each cycle
Produces a withdrawal bleed during progesterone phase
What is definitive diagnostic investigation for endometriosis?
Laparoscopy
What is investigation for cervical ectropic?
Colposcopy
Which part of vulva is most commonly affected in vulval cancer?
Labia majora
What is 1st line management for menorrhagia in a women who isn’t trying to become pregnant?
Levonorgestrel releasing intrauterine system
How do you know if there is an ectopic from repeated 48hr beta hcg levels?
If the 48 hr reading is between half and double the first reading - basically suboptimal increase in beta hcg
Which type of HRT is the only that acc may reduce CVD risk?
Oestrogen only
What is fitz hugh curtis syndrome?
Complicationof PID where liver capsule becomes inflamed and causes adhesions in peritoneum - pain located in RUQ radiating to shoulder - also fever and discharge
Which medication is reserved for severe pain during labour?
Pethidine - opioid
Why is COCP contraindicated in migraine with aura?
Increase risk of stroke
What is the difference between urge incontinence and overactive bladder syndrome?
Both caused by detrusor muscle overactivity but in urge there is involuntary leakage of urine but in overactive bladder there is not. Also in overactive they will need to pee way more
What is the most common bacteria that cause an infected Bartholin cyst?
E.coli
How does uterine rupture present?
How is it managed?
Sudden onset of abdominal pain and loss of contractions during labour esp in context of a previous c section
Emergency c-section and uterine repair should be tried after delivery but a caesarean hysterectomy is often needed.
What is surgical treatment for cystocele?
Anterior colporrhapy
What are stages of labour?
1st: cervical dilation till 10cm
2nd: pushing baby out
3rd: birthing placenta
4: recovery, uterus relaxes and you are monitored
What chromosomal abnormalities does the combined test test for vs. the quadruple?
Combined: down’s, edward syndrome, patau; PAPPA nad b-hcg
Quadruple: down’s only : Low afp and UE3 and raised bhcg and raised inhibin
What’s the difference between early onset and late onset GBS?
Early: within 48 hrs of birth -lower mortality
Late: More than 1 week of birth and often presents as meningitis
What’s first line medication for post-partum haemorrhage?
Uterotonic agents like oxytocin- stimulate uterine contractions and help reduce bleeding
Which dermatome does nerve injury occur in erb’s palsy?
C5-C6
Which hormone can be used as a reliable marker for imminent ovulation?
LH - An LH surge triggers ovulation . There is also a smaller FSH surge at same time. ovulation will occur 12 hours after peak in LH
What is the most common vulval carcinoma?
SCC
How is karyotyping sample obtained for combined test?
Chorionic villus sampling
What is 1st line treatment for females with fibroid associated menorrhagia?
Progesterone releasing IUS
Why isn’t the IUS recommended for patient with large fibroids?
Due to distortion of uterine cavity
How long does a mum have to wait to start cocp after giving birth and why?
After 6 weeks due to hypercoagulable state
If after three months on oxybutynin for urge incontinence and there is no improvement what can be done?
Botox into dome of bladder during a cystoscopy procedure
If clob doesn’t help for lichen sclerosus what can be given?
Topical tacrolimus (calcineurin inhibitor - immunosuppressant that reduces inflammation by controlling t cell proliferation)
In PCOS what is FSH and LH levels like?
FSH secretion is inhibited but LH secretion is stimulated. So LH high and FSH low
Can NSAIDs be used in breastfeeding period?
Yes
Is fluoxetine contraindicated in women with breast cancer history using tamoxifen ? and why?
Yes it is because fluoxetine is predicted to reduce the efficacy of tamoxifen
