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3a follow up > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

1
Q

What should be monitored when magnesium sulphate is given?

A

Respiratory rate and reflexs

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2
Q

When should mothers be referred if they haven’t yet felt movements?

A

24 weeks

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3
Q

Cut off for iron replacement post delivery?

A

<100g/L

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4
Q

Smear testing intervals for different ages?

A

25-49 = every 3 years
50-64 = every 5 years

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5
Q

When to stop the COCP in relation to planned surgery?

A

Stop 4 weeks before and restart 2 weeks after

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6
Q

UKMEC 3 Criteria?

A

> 35yrs smoking <15/day
BMI >35
VTE in 1st degree relative <45yrs
Controlled hypertension
Immobility
BRCA1/2
Current gallbladder disease

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7
Q

UKMEC 4 Citeria?

A

Migraine with aura
>35yrs smoking >15/day
History of stroke/VTE/HD
Breastfeeding <6 weeks postpartum
Uncontrolled hypertension
Current breast cancer
Antiphospholipid syndrome
Major surgery + prolonged immobilisation

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8
Q

Phases of the menstrual cycle and hormone changes?

A

Follicular - FSH and oestrogen UP
Ovulation - LH spikes
Luteal - progesterone UP

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9
Q

Which cancers is COCP protective for?

A

Endometrial, ovarian, colon

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10
Q

Contraindications for ulipristal acetate (EllaOne)

A

Diseases of malabsorption, severe hepatic dysfunction, asthma, breastfeeding, drugs increasing stomach pH (PPIs)

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11
Q

What is gravidity?

A

Number of pregnancies of any duration, regardless of the outcome

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12
Q

What is parity?

A

Total number of pregnancies carried over the threshold of viability (24w)

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13
Q

Which medication inhibits milk production?

A

Cabergoline

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14
Q

Which types of cancer does the COCP increase the risk of?

A

Breast and cervical

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15
Q

Time limits for different category c-sections?

A

Cat 1 - within 30 minutes
Cat 2 - within 75 minutes
Cat 3 - delivery required but mum and baby are stable
Cat 4 - elective c-section

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16
Q

Indications for category 1 c-section?

A

Uterine rupture, major placental abruption, cord prolapse, fetal hypoxia, persistent fetal bradycardia

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17
Q

Management of placental abruption <36 weeks (live fetus)?

A

No fetal distress: admit for corticosteroids, observe closley
Fetal distress: emergency c-section

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18
Q

Management of placental abruption >36 weeks?

A

Fetal distress: emergency c-section
No fetal distress: vaginal delivery

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19
Q

Bishop score meanings?

A

</=5 - spontaneous labour unlikely
8+ - cervix is ripe/favourable, high chance of spontaneous labour

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20
Q

Guidelines for IOL if bishop score <6 or 6?

A

Vaginal prostoglandins or oral misoprostol
(Sometimes balloon induction)

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21
Q

Guidelines for IOL if bishop score >6?

A

Amniotomy and IV oxytocin infusion

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22
Q

Pharmacological interventions for reduced fetal movements before term?

A

Steroids - for lung maturity
Magnesium sulphate - for neuroprotection

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23
Q

How can ovarian cancer cause raised urea and creatinine?

A

Renal tract obstruction due to tumour

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24
Q

What is Sheehan’s syndrome?

A

Complication of PPH results in avascular necrosis of pituitary gland»hormones produced affected

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25
Q

What can Sheehan’s syndrome cause?

A

Amenorrhoea
Reduced lactation
Adrenal insufficiency
Hypothyroidism

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26
Q

What is Asherman’s syndrome?

A

Adhesions formed within the uterus following damage e.g. D&C, uterine surgery, pelvic infection

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27
Q

How to treat thrush in pregnancy?

A

Topical treatments only - cream or pessary

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28
Q

Blood tests results in menopause?

A

LH/FSH high
Oestrogen and progesterone low

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29
Q

How long to use contraception for after menopause?

A

> 50 = 12 months after last period
<50 = 24 months after last period

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30
Q

Blood results for premature ovarian insufficiency?

A

High FSH/LH (on two samples 4-6 weeks apart)
Low oestrogen

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31
Q

Causes of premature ovarian insufficiency?

A

Idiopathic
Bilateral oophorectomy
Radio/Chemotherapy
Autoimmune disorders
Resistant ovary syndrome - FSH receptor abnormalities

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32
Q

What is included in the Rotterdam criteria?

A

Oligoovuation/anovulation
Hyperandrogenism (hirsutism/acne)
Polycystic ovaries on USS (>12 follicles or ovarian volume >10cm3)

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33
Q

Blood tests results in PCOS?

A

Raised LH:FSH ratio
Raised testosterone
Raised insulin
Low sex hormone-binding globulin

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34
Q

What is the combined test for Down’s syndrome and positive results?

A

Beta-HCG - increased
PAPPA - decreased

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35
Q

What is the triple test for Down’s syndrome and positive results?

A

Beta-HCG - increased
AFP - decreased
Serum oestriol - decreased

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36
Q

What is the quadruple test for Down’s syndrome and positive results?

A

Beta-HCG - increased
AFP - decreased
Serum oestriol - decreased

+ Inhibin-A - increased

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37
Q

Is nuchal translucency increased or decreased with a higher chance of Down’s?

A

Increased nuchal thickness = Down’s more likely

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38
Q

Following screening, when are mothers offered antenatal testing for Down’s syndrome?

A

If the risk is greater than 1 in 150

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39
Q

What tests will be offered in higher risk of Down’s?

A

Non-invasive prenatal screening test (NIPT) - blood sample
or
Amniocentesis
or
Chorionic villus sampling

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40
Q

What is occult vs overt cord prolapse?

A

Occult (incomplete) = cord descends alongside presenting part but not beyond it
Overt (complete) = cord descends past the presenting part

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41
Q

Quadruple test results for edwards syndrome?

A

B-HCG low
AFP low
Oestriol low
Inhibin A normal

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42
Q

When women are at risk of pre-eclampsia what should they take during pregnancy?

A

Aspirin 75mg from 12 weeks

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43
Q

Management of postpartum thyroiditis?

A

Propranolol

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44
Q

Blood pressure threshold for immediate assessment in pregnant women?

A

160/110mmHg

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45
Q

Haemoglobin cut offs for iron supplementation?

A

Non-pregnant 115
1st trimester 110
2nd/3rd trimester 105
After childbirth 100

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46
Q

First line medication for hyperemesis gravidarum?

A

Antihistamine - cyclizine or promethazine
phenothiazines - prochlorperazine or chlorpromazine

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47
Q

Second line medication for hyperemesis gravidarum?

A

Ondansetron - risk of cleft palate in first trimester
Metoclopramide - don’t use for more than 5 days (EPSEs)
Domperidone

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48
Q

Diagnostic triad for hyperemesis gravidarum?

A

5% weight loss
Electrolyte disturbance
Dehydration

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49
Q

Choice of fluids of dehydration in hyperemesis gravidarum?

A

0.9% saline + potassium

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50
Q

Intervention to reduce stillbirth in obstetric cholestasis?

A

Induction of labour 37-38 weeks

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51
Q

How long until different contraceptives are effective?

A

IUD = immediately
POP = 2 days
COCP, IUS, injection, implant = 7 days

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52
Q

How long to take folic acid for?

A

Until end of first trimester (12 weeks)

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53
Q

Which women should take higher dose of folic acid?

A

BMI >30
Diabetes
Sickle cell disease
Coeliac
Anti-epileptic drugs
FHx neural tube defects
Prev child with NTD

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54
Q

NOACs in pregnancy?

A

Switch to LMWH

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55
Q

Main complication of IOL?

A

Uterine hyperstimulation

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56
Q

When to offer external cephalic version?

A

36 weeks in nulliparous women
37 weeks in the others

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57
Q

Staging for ovarian cancer?

A

Stage 1 - Tumour confined to ovary
Stage 2 - Outside ovary but in pelvis
Stage 3 - Outside ovary but in abomen
Stage 4 - Distant metastasis

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58
Q

SSRI for postmenopausal symptoms?

A

Fluoxetine

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59
Q

What is lochia?

A

Passage of blood, mucus and uterine tissue that occurs during the puerperium

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60
Q

How long is normal for lochia to continue?

A

4-6 weeks

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61
Q

When should HTN in pregnancy be urgently referred/admitted?

A

> 160/110
140/90 + proteinuria/other organ involvement

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62
Q

Drugs for urge incontinence?

A

Oxybutynin/Tolterodine - antimuscarinincs

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63
Q

Which drug given for urge incontinence if worries of anticholinergic S/Es?

A

Mirabegron - beta-3 agonist

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64
Q

USS finding of ovarian torsion?

A

Whirlpool sign

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65
Q

Age bracket for breast cancer screening?

A

50-70 every 3 years

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66
Q

Risk factors for ectopic pregnancy?

A

Prev ectopic
IUD
Prev fallopian surgery

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67
Q

Risk factors for placental abruption?

A

ABRUPTION
Abruption (previous)
Blood pressure - HTN
Rupture of membranes
Uterine trauma
Polyhydramnios
Twins
Infection
Older age
Narcotic use

68
Q

Risk factors for pre-eclampsia?

A

Pre-existing HTN
Prev. pre-eclampsia
SLE (autoimmune conditions)
Diabetes
CKD
>40 yrs
>35 BMI

69
Q

Indications for OGTT?

A

BMI >30
Prev GDM
1st degree relative with DM
Prev macrosomic baby
Ethnicity - black Caribbean, south Asian, middle eastern

70
Q

Examination findings for endometriosis (physical)?

A

Fixed retroverted uterus
Pelvic mass/endometriomas
Pelvic tenderness

71
Q

Endometriosis increases risk of what?

A

Adhesions
Ectopic pregnancy

72
Q

Endometrial cancer examination findings?

A

Uterine/adnexal mass
Fixed uterus
Abdominal distension

73
Q

Surgical repair for cystocele?

A

Vaginal wall repair

74
Q

Investigations for suspected misarriage?

A

B-HCG and repeat in 24 hours

75
Q

Placenta praevia vs vasa praevia?

A

Fetal distress in vasa praevia

76
Q

UTI treatment in pregnancy?

A

1st line Nitrofurantoin - not in 3rd trimester
2nd line - Amoxicillin or cefalexin

77
Q

Stages of labour?

A

Latent first stage - up to 3cm dilated
Active first stage - up to full 10cm dilation
2nd stage - delivery of fetus
3rd stage - delivery of placenta

78
Q

Most common types of cervical cancer?

A

Squamous cell carcinoma (80%)
Adenocarcinoma (20%)

79
Q

Most common type of ovarian cancer?

A

Epithelial cell

80
Q

Which HPV strains cause cervical cancer?

A

6 and 11

81
Q

Criteria for annual mammograms?

A

1x first degree relative w/ BC <40yrs
1x first degree male relative
1x first degree w/ bilateral BC <50yrs

2x first degree w/ BC any age
1x first/second w BC + 1x first/second w ovarian cancer

3x first/second w/ BC at any age

82
Q

Bacterial vaginosis key identifiers?

A

Clue cells
Fishy smell
Watery discharge
pH >4.5

83
Q

Thrush key identifiers?

A

Curdy discharge
Itching
pH<4.5

84
Q

Trichomoniasis key identifiers?

A

Strawberry cervix
Discharge
pH>4.5

85
Q

Chlamydia key identifiers?

A

Purulent discharge
Gram -ve bacteria
Pelvic pain

86
Q

Gonorrhoea key identifiers?

A

Gram -ve bacteria
Odourless discharge

87
Q

BV treatment?

A

Metronidazole 5-7d

88
Q

Thrush treatment?

A

Stat dose fluconazole 150mg PO
Clotrimazole topical

89
Q

Chlamydia treatment?

A

Doxycycline for 7d
2nd line - azithromycin 3d

90
Q

Gonorrhoea treatment?

A

Stat IM Ceftriaxone 1g

91
Q

Pelvic inflammatory disease treatment?

A

IM Ceftriaxone
14 days doxycycline and metronidazole

92
Q

Contraceptive choices in those after bariatric surgery?

A

No oral contraceptives - poor efficacy due to absorption

93
Q

Which STIs present with painFULL genital ulcers?

A

Genital herpes and chancroid

94
Q

Which STIs present with painLESS genital ulcers?

A

Syphilis and lymphogranuloma venereum

95
Q

Which organism causes syphilis?

A

Treponema pallidum

96
Q

Treatment for trichomoniasis?

A

Metronidazole PO

97
Q

What is normal pH for vagina?

A

4.5

98
Q

pH for Trichomoniasis?

A

Alkalotic - >4.5

99
Q

Trichomoniasis infection symptoms?

A

Dyspareunia, itching, dysuria
Discharge - frothy/yellow-green
STRAWBERRY CERVIX

100
Q

Differences between herpetic and chancroid ulcers?

A

Herpes = multiple small ulcers, going through different stages
Chancroid = solitary, well defined deep ulcer

101
Q

What happens to BP during pregnancy?

A

Falls in first half of pregnancy before rising to pre-pregnancy levels before term

102
Q

When is progesterone only pill a missed pill?

A

3 hours

103
Q

If low lying placenta is found on 20 week scan, when is it reassessed?

A

32 weeks

104
Q

When is the COCP effective immediately?

A

If started on days 1-5 of cycle

105
Q

How long to wait between ulipristal and starting COCP?

A

5 days

106
Q

In pre-eclampsia are patients hyporeflexic or hyperreflexic?

A

HypERreflexia is seen

107
Q

What drug should be given in cord prolapse and why?

A

Terbutaline - decreases uterine contractions while waiting for emergency c-section

108
Q

Definition of PPH?

A

> 500mL blood loss within 24 hours of delivery of the baby

109
Q

Degrees of perineal tear?

A

1 - no muscle involvement
2 - perineal muscle (nil sphincter)
3a - <50% external anal sphincter
3b - >50% external anal sphincter
3c - internal anal sphincter torn
4 - including rectal mucosa

110
Q

What is a complete molar pregnancy?

A

Sperm fertilises an empty egg

111
Q

What is a partial molar pregnancy?

A

Egg fertilised by 2 sperm (three sets of chromosomes)

112
Q

Criteria for urgent breast referral (2-week wait)?

A

> 30yrs + unexplained breast lump +/-pain

> 50yrs + discharge/retraction/other changes of concern in one nipple

113
Q

When would you do a non-urgent breast referral?

A

<30yrs with an unexplained breast lump with or without pain

114
Q

Treatment for MgSO4 induced respiratory depression?

A

Calcium gluconate

115
Q

When is VZIG given in pregnant women?

A

<20 weeks 7-14 days post exposure

116
Q

Advice when switching from POP to COCP?

A

Additional protection needed for 7 days

117
Q

Advice for flying when pregnant?

A

Singleton - up to 37 weeks
Multiple - up to 32 weeks

118
Q

When should fibroadenomas be excised?

A

If >3cm

119
Q

Which breast condition presents with green nipple discharge?

A

Duct ectasia

120
Q

Which breast condition presents with bloody nipple discharge?

A

Duct papilloma

121
Q

Routine cervical screening schedule?

A

25-49 every 3 years
50-64 every 5 years

122
Q

When to refer HPV +ve but normal cytology on smear?

A

If still positive after 24 months > colposcopy

123
Q

Which drugs should be avoided in breastfeeding?

A

Aspirin
Tetracyclines, chloramphenicol
Lithium
Benzodiazepines
Carbimazole
Amiodarone

124
Q

Side effects of SERM drugs?

A

VTE risk

125
Q

Management of mastitis?

A

1st line = continue breastfeeding
2nd line = Flucloxacillin 10-14d

2nd line if systemically unwell, if nipple fissure present, if symptoms do not improve after 12-24 hours of effective milk removal

126
Q

Risk of complete molar pregnancy?

A

Gestational trophoblastic neoplasia

127
Q

What percentage of molar pregnancy progress to GTN?

A

15%

128
Q

TV USS findings diagnostic of miscarriage?

A

crown-rump length >7mm with no cardiac activity

129
Q

How are women with existing T2DM managed during pregnancy?

A

Metformin and insulin (stop all other agents)

130
Q

Classification of PPH?

A

Minor <1000mL
Major <1000mL
- Moderate 1000-2000mL
- Severe >2000mL

Primary <24 hours following birth
Secondary >24 hours - 12 weeks

131
Q

Which liver enzyme is normal to be raised during pregnancy?

A

ALP

132
Q

Signs of breast abscess on USS?

A

Mutlioculated, hypoechoic collection

133
Q

Management of breast abscess?

A

Urgent referral for USS confirmation, drainage and culture

134
Q

Blood tests for diagnosing menopause?

A

Two samples FSH 4 weeks apart = RAISED

135
Q

Minimum time for pelvic floor training in stress incontinence?

A

Minimum 3 months

136
Q

Symptoms of Syphilis?

A

Primary - chancre, NON-tender lymphadenopathy

Secondary - fevers, lymphadenopathy, rash, condylomata lata

Tertiary - gummas, aortic aneurysms, general paralysis of the insane

137
Q

When is AFP increased in pregnancy?

A

Fetal abdominal wall defects (e.g. omphalocele)

138
Q

APH definition?

A

Bleeding from the genital tract after 24 weeks pregnancy, prior to delivery of fetus

139
Q

Risk factors for placenta previa?

A

Previous C-section/uterine surgery
Multiple pregnancy

140
Q

When should anti-D be given in relation to miscarriage?

A

If miscarriage >12 weeks

141
Q

Indications for anti-D immunoglobulins?

A

Delivery
TOP
Miscarriage >12w
Ectopic (if surgical)
External cephalic version
APH
Amniocentesis/CVS/FBS
Abdominal trauma

142
Q

When is Ca-125 raised?

A

Ovarian cancer
Endometriosis
Adenomyosis
Fibroids
Liver disease
Pelvic infection

143
Q

Which investigation diagnoses active syphilis infection?

A

VDRL

144
Q

Most common cause of cord prolapse?

A

Artificial amniotomy

145
Q

Definition of small for gestational age?

A

Below the 10th centile for their gestational age

146
Q

What is gestation age measurement based on?

A

Estimated fetal weight (EFW)
Fetal abdominal circumference (AC)

147
Q

Treatment for empirically treating suspected chlamydia/gonorrhoea?

A

Azithromycin 1g STAT

148
Q

Guidance for semen sample?

A

Abstain from ejaculation for 3-7d
Avoid hot baths, sauna and tight underwear in lead up
Attempt to catch the full sample
Deliver sample within 1hr
Keep the sample warm before delivery

149
Q

Three groups of causes for male inferility?

A

Pre-testicular
Testicular
Post-testicular

150
Q

Examples of pre-testicular factors for male infertility?

A

LOW testosterone
Stress
Kallmann syndrome
Pathology of pituitary/hypothalamus

151
Q

Examples of testicular factors for male infertility?

A

Mumps
Trauma
Undescended testes
Radio/Chemo/Cancer

152
Q

Examples of post-testicular factors for male infertility?

A

Ejaculatory duct obstruction
Retrograde ejaculation
Absence of vas deferens (CF)
Scarring from epididymitis e.g. chlamydia

153
Q

Causes of increased nuchal translucency
thickness?

A

Down’s
Congenital heart defects
Structural abnormalities

154
Q

Typical onset of postpartum psychosis?

A

Usually 2-3 weeks

155
Q

What percentage of pregnant women does post partum depression affect?

A

5-15%

156
Q

When does postpartum depression presentation peak?

A

~3 months

157
Q

Causes of recurrent spontaneous miscarriage?

A

Infection
Chromosomal abnormalities
Uterine abnormalities
Antiphospholipid antibodies

158
Q

4 main causes of post partum haemorrhage?

A

Tone (uterine atony)
Trauma (perineal tear)
Tissue (retained placenta)
Thrombin (clotting/bleeding disorder)

159
Q

Symptoms of uterine fibroid degredation?

A

Often during pregnancy
Low grade fever
Pain
Vomiting

160
Q

Uterine fibroid degredation treatment?

A

Conservative management:
Rest and analgesia

Resolve in 4-7 days

161
Q

Combined and quadruple tests for Down’s dates?

A

11-13+6 combined test
15-20 quadruple test

162
Q

Triad of symptoms for disseminated gonococcal infection?

A

Tenosynovitis
Migratory polyarthritis
Dermatitis

163
Q

Risk factors for IUGR?

A

Booking BMI
Pre-existing HTN
PMH of pre-eclampsia
Smoking/drugs
Multiple pregnancy
Previous IUGR

164
Q

Primary vs secondary infertility?

A

Primary = never conceived
Secondary = previously conceived

165
Q

Why bradycardia with IUD insertion?

A

Cervical shock = vasovagal reaction = reflex bradycardia

166
Q

Most common type endometrial cancer?

A

Adenocarcinoma

167
Q

Lymphogranuloma venereum treatment?

A

Doxycycline for 21 days

3a follow up (7 decks)

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