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UKMLA > Obs and gynae > Flashcards

Obs and gynae Flashcards

1
Q

What is 1st line treatment for stress incontinence? and for how long?

A

Pelvic floor muscle training for 8 contractions 3x a day for at least 12 weeks

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2
Q

What is 1st line for mixed or urgency incontinence?

A

Bladder training

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3
Q

In which scenario may oxybutynin be started in incontinence?

A

Mixed or overactive bladder

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4
Q

What does oxybutynin do to the bladder?

A

Relaxes the muscles so bladder can hold more water

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5
Q

What is the definition of major primary post partum haemorrhage?

A

any bleeding from the genital tract with an estimated blood loss of > 1000 mls within 24 hours of delivery

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6
Q

What is the most common cause of primary post partum haemorrhage?

A

Uterine atony (uterine muscles don’t contract enough to clamp the placental blood vessels shut after childbirth)

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7
Q

What is the definition of secondary post partum haemorrhage?

A

Abnormal bleeding from the genital tract from 24 hours until 12 weeks post-partum

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8
Q

What is the definition of minor primary post partum haemorrhage?

A

Blood loss > 500 mls, within 24 hours of delivery

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9
Q

Antibiotics for toxic shock syndrome are?

A

Clindamycin and vancomycin

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10
Q

What bacteria usually causes toxic shock?

A

Staph aureus

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11
Q

What is mechanism of action of clindamycin?

A

Inhibits bacterial protein synthesis

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12
Q

What is the ratio of LH:FSH in PCOS

A

It’s inverted so LH is greater than FSH

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13
Q

What type of tumours are virilizing ovarian tumours?

A

Sex cord stromal tumours

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14
Q

What do sex cord stromal tumour secrete excess of?

A

Steroid hormones: estrogen and androgen

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15
Q

What are manifestations of a virilising ovarian tumour?

A

Hirsutism, Oligomenorrhea or amenorrhea, Postmenopausal hemorrhage, and Thickened endometrial lining.

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16
Q

At week does the abdo distension in a pregnant women reach the umbilicus?

A

20 weeks

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17
Q

What does the symphysial fundal height equal to ?

A

+ or - two weeks of no. weeks gestations

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18
Q

At 16 weeks gestation where can fundus of uterus be palpated?

A

Midpoint between umbilicus and pubic symphysis

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19
Q

What’s the limit of paracetamol in pregnancy? and does it cross the placenta?

A

Yes it does cross and max 1g every 4-6 hours

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20
Q

If low dose codeine phosphate is taken closer to delivery what must the delivering doctor be vigilant about?

A

Signs of resp distress
Drowsiness
Opioid withdrawal

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21
Q

In labour where can anaestehtic be injected?

A

Around pudendal nerve trunk

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22
Q

When can a frenotomy (frenulum is divided) be performed without anaesthesia?

A

If baby is under 3 months

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23
Q

What are some common presenting symptoms of endometrial cancer?

A

Bloating

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24
Q

What are risk factors for endometrial cancer?

A

PCOS history, nulliparity, late menopause, obesity , use of tamoxifen

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25
Q

What would a fetus of oesophageal atresia struggle with in utero? and what condition does this cause

A

Swallowing so polyhydramnios due to issue with circulation of amniotic fluid - so fluid builds up - seen on US

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26
Q

What are the causes of oligohydramnios?

A

Renal agenesis
Intrauterine growth restriction
Chromosomal abnormalities

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27
Q

What defines fetal oedema?

A

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.

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28
Q

What is an immunological cause of hydrops fetalis (fetal oedema)

A

Rhesus D haemolytic disease of the newborn

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29
Q

What are some non-immunological causes of fetal oedema?

A

iron deficiency anaemia, alpha thalassaemia and Down syndrome.

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30
Q

How often should diabetic females be seen at joint diabetes and antenatal clinic during pregnancy?

A

Every 1-2 weeks

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31
Q

How often should diabetic women be offered a fetal scan?

A

Every 4 weeks from 28 weeks to 36 weeks gestations

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32
Q

When should elective induction of labour be done for diabetic pregnancies? or c-section and why

A

37+0 to 38+6 . As there is an increased risk of stillbirth

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33
Q

How does lichen planus present in the genital area?

A

Purple and red plaques on labia with central erosions and overlying lacy white striated patches - often causing adhesions

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34
Q

What is first line management for females having breastfeeding issues?

A

1-to-1 visit from health visitor or specialised nurse

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35
Q

What is discharge like in BV?

A

Thin grey and watery and fishy

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36
Q

Treatment for BV?

A

Metronidazole 400mg twice a day for a week

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37
Q

What is definitive treatment for eclampsic attack?

A

Delivery of fetus

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38
Q

What are some medical managements of eclampsic attack?

A

Magnesium sulphate infusion
Hydralazine or labetalol infusion

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39
Q

Which cells in sex cord stromal tumour will cause virilisation?

A

Leydig cells

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40
Q

Where does an ectopic pregnancy usually implant?

A

Ampullary region of fallopian tube

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41
Q

Where may referred pain in ectopic pregnancy go to?

A

Shoulder tip pain due to phrenic nerve irritation

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42
Q

What is treatment of ectopic?

A

laparoscopy or laparotomy

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43
Q

What is management for HIV pregnancies?

A

All HIV females should commence combined anti-retroviral therapy by 24th week of gestation and continue lifelong

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44
Q

What is irregular and unpredictable uterine bleeding caused by in first few years of menarche?

A

Anovulatory dysfunction uterine bleeding due to inadequate gonadotrophin release and LH surge and ovulation may fail to occur

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45
Q

The most common site of referred pain bcos of PCOS is the…?

A

Periumbilical region

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46
Q

Which nerves innervate the ovaries?

A

Ovarian plexus and uterine plexus

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47
Q

Where does ovarian plexus originate from? - which level

A

T10

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48
Q

If obturator nerve is stimulated where can pain be located to?

A

Ipsilateral inner thigh

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49
Q

What are safer epilepsy medications than sodium valproate in pregnancy?

A

Lamotrigine and carbamazepine

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50
Q

What risk are associated with carbamazepine in pregnancy?

A

Cleft palate

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51
Q

What are risk of lamotrigine in pregnancy?

A

Aggression and fatigue

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52
Q

Which part of fallopian tube is most likely to rupture due to ectopic pregnancy?

A

Isthmus - it’s the narrowest part

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53
Q

What is placenta increta?

A

Placenta infiltrate into myometrium (uterine wall)

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54
Q

What are the risk factors for placenta increta?

A

Previous C sections
Myomectomy (removal or uterine fibroids)
Multiparity
old mum

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55
Q

What is pregnancy plan of placenta increta?

A

C section elective

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56
Q

What is definitive management of placenta increta?

A

Hysterectomy

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57
Q

What is placenta praevia?

A

Low lying placenta that can obscure the internal cervical os - common cause of antepartum haemorrhage

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58
Q

What is the triad of symptoms in pre-eclampsia?

A

High BP
Ankle oedema
Proteinuria

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59
Q

If found to be at risk of pre-eclampsia what medication should be taken?

A

75mg low dose aspirin once daily from 12 weeks gestation onwards

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60
Q

What is 1st line medical treatment of pre-eclampsia?

A

Labetalol

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61
Q

What is HELLP syndrome?

A

Haemolysis
Elevated liver enzymes
Low platelets
It’s a complication of pre-eclampsia

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62
Q

What is a threatened miscarriage?

A

Vaginal bleeding and ongoing pregnancy

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63
Q

What is an inevitable misscarriage?

A

Cervix begins to dilate

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64
Q

What’s an incomplete miscarriage?

A

Pass of some but not all conception products

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65
Q

What is a complete misscariage?

A

All products of conception are expelled from uterus

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66
Q

What is a missed miscarriage?

A

Fetus dies in utero but not expelled?

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67
Q

How many miscarriages is defined as recurrent miscarriages?

A

3 or more consecutive

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68
Q

What is the difference between a salpingotomy and a salpingectomy?

A

Salpingotomy remove ectopic whilst preserving fallopian tube
Whereas a salpingectomy remove the fallopian tube

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69
Q

What characterises posterior tongue tie?

A

Short and thickened frenulum restricting tongue movement and issues latching to breast
Frenulum won’t be visible

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70
Q

Is frenulum visible in anterior tongue tie?

A

Yes bcos the tie is close to tip of of tongue

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71
Q

What marker is suggestive of ovarian cancer?

A

CA-125

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72
Q

What is marker for pancreatic cancer?

A

CA-19-9

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73
Q

What is marker for breast cancer?

A

CA15-3

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74
Q

What is marker for colorectal cancer?

A

CEA

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75
Q

Which groups of women should be taking the 5mg rather than 400microgram dose of folic acid?

A

Women taking anti-epileptics
Obese
Diabetics
History or family history of neural tube defects

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76
Q

How long should folic acid be taken till?

A

Up to 12 weeks gestation

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77
Q

Which medication is preferred for severe allergic rhinitis during pregnancy?

A

Oral loratadine as it’s not teratogenic

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78
Q

What medication is given as a routine prophylactic measure for all women undergoing abdo hysterecotmy?

A

Co-amoxiclav IV intraoperatively

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79
Q

What does a molar pregnancy look like on US?

A

Snow storm

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80
Q

What is important follow up after post evacuation for molar pregnancy?

A

Monitor serum HCG

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81
Q

What is a molar pregnancy?

A

Type of tumour that grows like a pregnancy inside the uterus.

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82
Q

What are the two type of molar pregnancy?

A

complete mole and a partial mole.

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83
Q

What is a complete molar pregnancy?

A

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.

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84
Q

What is a partial molar pregnancy?

A

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.

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85
Q

What levels will be high in molar pregnancy?

A

hCG

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86
Q

What symptoms can differentiate normal pregnancy from a molar pregnancy?

A

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)

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87
Q

What is treatment and follow up plan for a molar pregnancy?

A
  1. Evacuation of uterus
  2. Referral to gestational trophoblastic disease centre
  3. hCG levels monitored till they are back to normal
  4. If molar metastasises then systemic chemo
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88
Q

What % of complete molar pregnancies go on to become invasive?

A

15%

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89
Q

What can be common presentation of von willebrand’s disease in women?

A

Easy bruising
Menorrhagia
Easy bleeding from tiny wounds

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90
Q

What medication can be used to treat hirsutism and acne in PCOS?

A

Co-cyprindiol (Dianette)

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91
Q

How does co-cyprindiol work?

A

Is an anti-androgen - reduces sebum production and hair growth also inhibits ovulation and induce withdrawal bleeds

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92
Q

What is APTT and bleeding time like in von willerbrand?

A

Prolonged

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93
Q

What is the turtle neck sign?

A

Foetal head retracts back into perineum

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94
Q

What is management for shoulder dystocia ?

A

Mcroberts position - widen pelvic outlet
Then manoeuvre to rotate anterior shoulder to foetal chest then posterior shoulder back to dislodge the shoulder dystocia

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95
Q

What is first line medical management for overactive bladder and urge incontinence?

A

Oxybutinin

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96
Q

If person is super old with urge incontinence would you still give them oxybutynin and why?

A

No because you should avoid anticholinergics in the elderly as it can precipitate falls so give them botox

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97
Q

What is medical management for overactive bladder in elderly?

A

Mirabegron

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98
Q

What is 1st line management for urge incontinence?

A

Bladder exercises

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99
Q

What is 1st line management for stress incontinence?

A

Pelvic floor

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100
Q

What is management for a uterus prolapse?

A

Vaginal pessary

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101
Q

What is medication and doses for a medical abortion?

A

Mifipristone - 200mg then misopristol 800 mcg

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102
Q

What does a Scalp baby pH of less than 7.2 indicate and what category c section is it?

A

It’s category 1 and indicates not enough oxygen getting to baby

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103
Q

What categoryc-section is cord prolapse?

A

Category 1

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104
Q

What is anti-mullerian hormone a measure of?

A

Number off eggs. So if AMH is low it may indicate primary ovarian failure

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105
Q

What is FSH and LH like in primary ovarian failure?

A

High due to negative feedback on pituitary gland due to reduction in ovarian oestrogen

106
Q

What is a cervical ectropian?

A

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.

107
Q

What is 1st line management of endometriosis related pain?

A

Mefanamic acid - NSAID trial

108
Q

What endometrial thickness do you worry about?

A

Over 5mm. Under is usually atrophic vaginitis

109
Q

What is a cystocele?

A

Bladder herniates into vagina

110
Q

What is an enterocele?

A

Prolapse of small bowel into vagina

111
Q

When may a vaginal vault prolapse be likely to occur?

A

Post hysterctomy

112
Q

If cervix is in abnormal position what can this indicate?

A

Uterine prolapse

113
Q

On speculum what could indicate premature prelabour rupture of membranes?

A

Watery fluid pooling in posterior vaginal vault

114
Q

What sign on CT or US is characteristic of ovarian torsion?

A

Whirlpool sign - it represents twisting of ovarian pedicle

115
Q

In a intrauterine viable pregnancy vs. miscarriage what do you expect to happen to repeat beta hcg?

A

Viable: double
Miscarriage 1/2

116
Q

What would be expected on nuchal translucency in trisomy 21?

A

Thickened due to fluid behind the neck

117
Q

What substance are low in down’s syndrome?

A

AFP
Oestriol
PAPP-A

118
Q

What is b-hcg like in down’s?

A

High

119
Q

When are women offered chromosome defects test?

A

11-13 weeks +6

120
Q

What can cause polyhydramnios?

A

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.

121
Q

What’s the measurement of polyhydroamnios?

A

Over 2-3 L

122
Q

What’s the measurement for oligohydroamnios?

A

Less than 500 ml at 32-36 weeks

123
Q

What are the risk factors for oligohydroamnios?

A

Renal agenisis
Intrauterine growth factor
Premature rupture of membranes
Post term gestation

124
Q

What is placenta praevia?

A

Placenta covers cervical os - complete or partial

125
Q

How does placenta praevia present?

A

Painless bleeding after 20 weeks gestation

126
Q

What is placental increta?

A

Placenta infiltrates myometrium and muscle instead of being confined to endometrium

127
Q

What hormones are high in placental increta?

A

Fetoprotein
B-hcg

128
Q

Are c sections advised in placental increta? and what is definitive management?

A

Yes - hystectomy

129
Q

What is vasa praevia?

A

Foetal vessels cross over internal os - c section recommended

130
Q

What is placental abruption?

A

Sudden separation of placenta from uterine wall in third trimester presents with sudden abdo pain and vaginal bleeding

131
Q

What is an absolute contraindication of external cephalic version?

A

Antepartum haemorrhage during the last 7 days

132
Q

When is ECV offered for both a nulliparous women and a multiparous woman?

A

Nulliparous at 36 weeks
mULTIPAROUS: 37 WEEKS

133
Q

What is 1st line for investigation of bleeding in pregnancy?

A

Transvaginal US

134
Q

What’s the dose for thrush of oral fluconazole?

A

Once - 150mg single dose

135
Q

What is the definition of preterm premature rupture of membranes?

A

Early rupture of membranes before 37 weeks

136
Q

What are the signs of PPROM?

A

Cervical effacement
Dilation and rupturing of membranes
Onset of contractions

137
Q

What is management of PPROM?

A

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

138
Q

What test can be used to assess the risk of preterm delivery after PPROM?

A

Foetal fibronectin test (fFN test) a negative fFN indicates a low risk of delivery within the next 7-14 days

139
Q

What is prolonged premature rupture of membranes?

A

Rupture of membranes more than 24 hours before onset of labour

140
Q

What is premature rupture of membranes (PROM)?

A

Delivery of baby after 20 weeks but before 37

141
Q

What happens if corpus luteum fails to regress after not being fertilised?

A

Can cause a corpus luteal cyst which can rupture and cause pain

142
Q

What’s the management of a corpus luteal cyst?

A

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

143
Q

What is the Kleihauer test?

A

Quantifies the dose of Rh-D antigen in maternal circulation - can guide the amount of anti-D IG needed to prevent maternal sensitisation

144
Q

Which UTI medication is safe during third trimester?

A

Trimethoprim - 7 day course

145
Q

Can trimethoprim be used in first and second trimester?

A

No due to risk of congenital malformations e.g. neural tube defects

146
Q

When can nitrofuratoin be used vs. not used in pregnancy?

A

Fine in first and 2nd trimester but must avoid near term due to risk of neonatal haemolysis

147
Q

Why if cefalexin not really given if a patient is pen allergic?

A

10% Cross sensitivity between penicillin and 1st gen cephalosporins like cefalexin

148
Q

Which medication can be given to help ECV and what class of drug is it?

A

Terbutaline - it’s a tocolytic agent with beta-mimetic effect

149
Q

What class of drug is nifedipine?

A

Its a tocolytic calcium channel blocker

150
Q

Describe the tears?

A

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

151
Q

When carrying out an instrumental delivery what type of nerve block is needed?

A

Pudendal nerve block - blocks perineum, external genitalia and external anal sphincter

152
Q

When does IV antibiotics for GBS happen?

A

After onset of labour or membrane rupture

153
Q

If pen allergic what is given for GBS instead of benzylpenicillin?

A

Vancomycin

154
Q

What is presentation of acute fatty liver in pregnancy?

A

few days of malaise , anorexia, vomiting and jaundice, low platelets, elevated LFT’s and prolonged PT and raised bilirubin

155
Q

What is definitive treatment for acute fatty liver in pregnancy?

A

Immediate delivery

156
Q

What risks does NSAID’s pose in pregnancy?

A

Foetal ductus arteriosus in utero
Resistant pulmonary hypertension of newborn
Delayed onset of labour

157
Q

What would be seen on blood film in g6pd?

A

Heinz bodies and bite cells and coombs would be negative

158
Q

Which does a positive coomb test indicate?

A

Haemolytic anaemia is immune mediated - rhesus haemolytic disease of newborn - normocytic anaemia

159
Q

At what weeks is anti -d injections given?

A

28 weeks and 34 weeks

160
Q

If pt presents for trisomy stuff beyond the 11-13 week +6 window what tests can be done?

A

serum oestriol
HCG
AFP
Inhibin A (would be increased)

161
Q

What is the uterus like in placental abruption?

A

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

162
Q

What is the presentation of vulval carcinomas?

A

Vulval soreness
Burning
Pruritus
Bleeding

163
Q

What is the bishop score?

A

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

164
Q

What is cervical effacement?

A

Thinning and shortening of cervix prepping for labour?

165
Q

What does a high bishop score indicate?

A

8 or more = labour is likely to begin soon
9 or more = pt is good for induction

166
Q

What is potter’s syndrome?

A

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.

167
Q

What is treatment for pregnant women with hsv genitals?

A

Oral acyclovir and elective c section

168
Q

What is twin to twin transfusion syndrome?

A

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

169
Q

What is treatment for twin to twin transfusion syndrome?

A

Laser transection of problematic vessels in utero

170
Q

What can green tinged liquor suggest?

A

Meconium is present and inhaled by infant before or during birth - risk of meconium aspiration syndrome - increases after 40 weeks gestation

171
Q

What causes the symptoms in ovarian hyperstimulation syndrome?

A

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

172
Q

What is the definition uterine hyperstimulation?

A

Greater than 5 contractions occuring within 10 mins due to administration of protaglandins or oxytocin for induction of labour.

173
Q

What is risk of uterine hyperstimulation?

A

Fetal bradycardia due to increased frequency of contractions and therefore increased compression of fetal head

174
Q

How is uterine hyperstimulation reversed?

A

Tocolytic agents

175
Q

What is placenta accreta?

A

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

176
Q

What is symphysis pubis dysfunction?

A

Common in pregnancy presents as pelvic pain

177
Q

How does transmission of hsv occur from mum to baby?

A

If mum has a primary infection within 6 weeks of birth

178
Q

How does a baby with congenital rubella syndrome present?

A

Sensorineural hearing loss
Ocular defects - cataracts
Congenital heart disease
P

179
Q

What is the characteristic rash called in Congenital rubella syndrome?

A

Blueberry muffin rash -purpuric rash

180
Q

What is a frank breech?

A

Legs fully extended up to shoulders and presenting part is bum

181
Q

What is complete breech?

A

Hip and knees are both flexed and presenting part is bum

182
Q

If woman has had gestational diabetes previously what should be done?

A

2 hour oral glucose tolerance test ASAP following booking visit - don’t wait till 24-28 weeks

183
Q

What is anencephaly?

A

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

184
Q

What can causes rhesus sensitisation?

A

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

185
Q

What is immediate management for meconium aspiration syndrome?

A

Admit to NICU for oxygen and antibiotic therapy

186
Q

What is meconium ileus?

A

Meconium obstructs neonatal bowel often indicated CF

187
Q

What are the signs of meconium ileus?

A

Bilious vomiting
Distended abdomen
Failure to pass meconium in first 24 hours

188
Q

What are the symptoms of meconium aspiration?

A

Meconium stained liquor
Foetal distress
Hypoxia
Expiratory grunting
Accessory use of resp muscles
Pink neonate

189
Q

What is the combined test?

A

1st line screeing for Down’s between 11 and 13 + 6 weeks - measures PAPP-A and B-HCG and US to measure nuchal translucency

190
Q

What is quadruple test?

A

Screening for down’s with women presenting after 13 weeks - no US but BHCG, AFP, UE3 and inhibin A

191
Q

What is classical sign on chest x-ray that there is transposition of the great arteries?

A

Egg on a string appearance

192
Q

In which type of mothers are most at risk of having babies with transposition of great arteries?

A

Type 1 and 2 diabetics

193
Q

What is success rate of ECV?

A

50%

194
Q

Is it safe for lamotrigine to be used in pregnancy and breastfeeding? what other epilepsy medication is safe?

A

Yes
Levetiracetam

195
Q

What is amniotic fluid embolism?

A

Amniotic fluid enters maternal circulation leading to symptoms similar to a PE

196
Q

What can amniotic fluid embolism then go on to cause?

A

DIC

197
Q

What would liquor be like in chorioamnionitis?

A

Offensive smelling and stained underwear

198
Q

What is treatment of chorioamnionitis?

A

IV ampicillin and gentamicin until delivery and bacterial culture

199
Q

What is management after 3 pulls are unsuccessful in a ventouse delivery?

A

Convert to lower segment c -section

200
Q

What is uterine inversion?

A

Fundus of uterus drops down through uterine cavity and cervix turning inside out. Typically presents with a large post partum haemorrhage

201
Q

How is uterine inversion managed?

A

Johnson manoeuvre - push the inversion back with hand
Hydrostatis methods with warm saline
Laparotomy

202
Q

When does operating need to happen for category 1 c section?

A

Within 30 mins

203
Q

How long does c section have to happen in in category 2 ?

A

75 mins

204
Q

What is restitution and what happens after it?

A

Fetus externally rotate to bring shoulders into antero-posterior position facilitating delivery of anterior shoulder then the posterior shoulder

205
Q

What medication are pregnant women given before c -section? and why?

A

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

206
Q

How does obstetric cholestasis present?

A

Pruritus on palms and soles and excoriations and raised bilirubin

207
Q

What is formula to calculate estimated delivery date?

A

First day of last menstrual period + 9 months + 7 days - pt need to have a regular cycle for this tho

208
Q

What does a lambda sign on Ultrasound indicate?

A

Diamniotic twin pregnancy - they each have their own placenta and amnion

209
Q

When should diamniotic twins be delivered?

A

37 weeks

210
Q

What is medical management for a ectopic?

A

Methotrexate

211
Q

What are the surgical indications for ectopic?

A

Pt in lots of pain
Mass is bigger than 35mm
US sees fetal heartbeat
B-HCG is over 5000

212
Q

What is ebstein’s anomoly?

A

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.

213
Q

Which drug during pregnancy can cause ebstein’s anomoly?

A

Lithium

214
Q

How long after hyatidaform mol should pregnancy be avoided?
If beta hcg still goes up after evacuation what should be suspected?

A

1 year
Choriocarcinoma

215
Q

When does beta hcg reach peak levels?

A

8-10 weeks

216
Q

What is mechanism of action of methotrexate?

A

Folic acid antagonist that targets and inhibts rapidly dividing cells

217
Q

What is 1st line for strong opiod analgesia in latent first stage of labour?

A

Diamorphine 5mg IM

218
Q

How long does Diamorphine 5mg IM taken to take effect and how long does it last for?

A

Onset 20 mins
Lasts for 2-4hrs

219
Q

When is pudendal nerve block used?

A

Delivery which require rapid regional anaesthesia such as episiotomy or operative vaginal delivery

220
Q

What is latent labour?

A

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

220
Q

When can epidural be used?

A

Established labour is a must

221
Q

When does polymorphic eruption of pregnancy usually occur?

A

Red patches often first appears on abdomen particularly over striae - usually in third trimester

222
Q

What IM injection is recommended for b12 deficiency?

A

Cyanocobalamin 12mg

223
Q

What is an absolute contraindication to VBAC?

A

Classic c-section scar (vertical scar)

224
Q

What is the signs of hypermesis gravidarum?

A

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

225
Q

Who are intrapartum antibiotics offered to?

A

Women with risk factors for GBS infection and all women in preterm labour
Risk factor can include pregnancy with previous gbs infection

226
Q

When can early scan to confirm dates be done and exclude multiple pregnancies?

A

11=2 weeks and 14+1 weeks

227
Q

Which medication can suppress lactation and what is it’s mechanism?

A

Cabergoline - it’s a dopamine receptor agonist which inhibits prolactin production to suppression of lactation

228
Q

What should patients taking lithium do during pregnancy?

A

Every pregnant patient on lithium should gradually switch to an atypical antipsychotic eve if they’re unstable bipolar

229
Q

What’s the regiment for the monthly cyclical HRT?

A

Oestrogen is taken daily and progesterone is given for the last 10-14 days of each cycle
Produces a withdrawal bleed during progesterone phase

230
Q

What is definitive diagnostic investigation for endometriosis?

A

Laparoscopy

231
Q

What is investigation for cervical ectropic?

A

Colposcopy

232
Q

Which part of vulva is most commonly affected in vulval cancer?

A

Labia majora

233
Q

What is 1st line management for menorrhagia in a women who isn’t trying to become pregnant?

A

Levonorgestrel releasing intrauterine system

234
Q

How do you know if there is an ectopic from repeated 48hr beta hcg levels?

A

If the 48 hr reading is between half and double the first reading - basically suboptimal increase in beta hcg

235
Q

Which type of HRT is the only that acc may reduce CVD risk?

A

Oestrogen only

236
Q

What is fitz hugh curtis syndrome?

A

Complicationof PID where liver capsule becomes inflamed and causes adhesions in peritoneum - pain located in RUQ radiating to shoulder - also fever and discharge

237
Q

Which medication is reserved for severe pain during labour?

A

Pethidine - opioid

238
Q

Why is COCP contraindicated in migraine with aura?

A

Increase risk of stroke

239
Q

What is the difference between urge incontinence and overactive bladder syndrome?

A

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

240
Q

What is the most common bacteria that cause an infected Bartholin cyst?

A

E.coli

241
Q

How does uterine rupture present?
How is it managed?

A

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.

242
Q

What is surgical treatment for cystocele?

A

Anterior colporrhapy

243
Q

What are stages of labour?

A

1st: cervical dilation till 10cm
2nd: pushing baby out
3rd: birthing placenta
4: recovery, uterus relaxes and you are monitored

244
Q

What chromosomal abnormalities does the combined test test for vs. the quadruple?

A

Combined: down’s, edward syndrome, patau; PAPPA nad b-hcg
Quadruple: down’s only : Low afp and UE3 and raised bhcg and raised inhibin

245
Q

What’s the difference between early onset and late onset GBS?

A

Early: within 48 hrs of birth -lower mortality
Late: More than 1 week of birth and often presents as meningitis

246
Q

What’s first line medication for post-partum haemorrhage?

A

Uterotonic agents like oxytocin- stimulate uterine contractions and help reduce bleeding

247
Q

Which dermatome does nerve injury occur in erb’s palsy?

A

C5-C6

248
Q

Which hormone can be used as a reliable marker for imminent ovulation?

A

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

249
Q

What is the most common vulval carcinoma?

A

SCC

250
Q

How is karyotyping sample obtained for combined test?

A

Chorionic villus sampling

251
Q

What is 1st line treatment for females with fibroid associated menorrhagia?

A

Progesterone releasing IUS

252
Q

Why isn’t the IUS recommended for patient with large fibroids?

A

Due to distortion of uterine cavity

253
Q

How long does a mum have to wait to start cocp after giving birth and why?

A

After 6 weeks due to hypercoagulable state

254
Q

If after three months on oxybutynin for urge incontinence and there is no improvement what can be done?

A

Botox into dome of bladder during a cystoscopy procedure

255
Q

If clob doesn’t help for lichen sclerosus what can be given?

A

Topical tacrolimus (calcineurin inhibitor - immunosuppressant that reduces inflammation by controlling t cell proliferation)

256
Q

In PCOS what is FSH and LH levels like?

A

FSH secretion is inhibited but LH secretion is stimulated. So LH high and FSH low

257
Q

Can NSAIDs be used in breastfeeding period?

A

Yes

258
Q

Is fluoxetine contraindicated in women with breast cancer history using tamoxifen ? and why?

A

Yes it is because fluoxetine is predicted to reduce the efficacy of tamoxifen

259
Q
A

UKMLA (12 decks)

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