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Year 4 PassMed Incorrect Qs > Obs and Gynae 2 > Flashcards

Obs and Gynae 2 Flashcards

1
Q

When switching from a traditional POP to COCP what advice should be given?

A

(with correct prior use) 7 days of barrier contraception is needed

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2
Q

Which contraception is safe to use if on rifampicin (enzyme inducer)

A

Depo-Provera

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3
Q

How long should you continue giving MgSO4 infusions for in someone with pre-eclampsia after delivery?

A

Magnesium treatment should continue for 24 hours after delivery or after last seizure

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4
Q

Risk factors for ectopic preg?

A
  • damage to tubes (pelvic inflammatory disease, surgery)
  • previous ectopic
  • endometriosis
  • IUCD/ coil/ IUS
  • progesterone only pill
  • IVF (3% of pregnancies are ectopic)
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5
Q

When should cervical screening take place if preg?

Unless?

A

usually delayed until 3 months post-partum unless missed screening or previous abnormal smears

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6
Q

Contraceptives - time until effective (if not first day period)

IUD
POP
COCP
Depot
Implant
IUS

A

IUD- Immediately
POP- 2 days
COCP- 7 days
Depot- 7 days
Implant- 7 days
IUS- 7 days

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7
Q

Method of termination depending on gestation

  1. Week + method
    2.
    3.
A
  1. < 9 weeks = Mifepristone + misoprostol (vaginal prostoglandin)
  2. < 13week =surgical dilation and suction of uterine contents
  3. > 15 weeks = surgical dilation and evacuation of uterine contents or late medical abortion (induces ‘mini-labour’)
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8
Q

What do you give for VTE prophylaxis in preg and how long for?

What should be avoided in preg? (2)

A
  • If has 4 or more risk factors then LMWH immediately until 6 weeks after
  • If 3 or less risk factors then LMWH from 28 weeks until 6 weeks after
  • DOAC and Warfarin
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9
Q

Risk factors for VTE in preg:
(11)

A
  • Age > 35
  • Body mass index > 30
  • Parity > 3
  • Smoker
  • Gross varicose veins
  • Current pre-eclampsia
  • Immobility
  • Family history of unprovoked VTE
  • Low risk thrombophilia
  • Multiple pregnancy
  • IVF pregnancy
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10
Q

What anti epileptics are good for preg and what are NOT good for preg

A

Good- **Lamotragine, carbamazepine and levetiracetam

Bad- Sadium valporate, phenobarbitone, phenytoin

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11
Q

Hyperemesis gravidarum management

Not lost weight=
First line-
Second line-

Lost weight (how much?) =

A

Not lost weight=
First line- Promethazine or cyclizine (anti-histamine)
Second line- Ondansetron or metoclopramide

Lost weight (> 5% of body weight) =

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12
Q

Hyperemesis gravidarum management

What info do you need to share with mother when discussing:

oral ondansetron (second line)

oral metoclopramide or domperidone (second line) (2)

A

oral ondansetron- If first trimester, assoc. with a small increased risk of cleft lip/palate.

metoclopramide- may cause extrapyramidal side effects in mum! It should therefore not be used for more than 5 days

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13
Q

What is the criteria to admit someone with hyperemisis gravidarum? (3)

A
  • Continued N+V and is unable to keep down liquids or oral antiemetics
  • N+V and Lost > 5% bodyweight or Ketonuria
  • Low threshold if you have pre-exisiting comorbidity
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14
Q

Management of +ve GB Strep swab in preg?

A

It does not require treatment immediately, intrapartum intravenous benzylpenicillin is required to reduce neonatal transmission. alternative would be clindamycin

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15
Q

If mum and baby are struggling with breast feeding- what is the criteria to refer them to a beastfeeding clinic?

A

Breastfed baby loses > 10% of birth weight in the first week of life then referral to a midwife-led breastfeeding clinic may be appropriate

Normal weight loss is between 7-10% in first week

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16
Q

Post-partum contraception
When can you restart these:

At what point do they need contraception?

COCP (2)
- Additional for how long?

POP
- Additional for how long?

IUD or IUS (2)

Lactational Amenorrhoea method

A
  • 21 days post-partum

COCP
- If NOT breast feeding then 3 weeks pp (due to VTE)
- If ARE breast feeding then CANNOT give if < 6 weeks pp
- 7 days of additional barrier after day 21

POP
- Anytime!
- 2 days of additional barrier after day 21

IUD/ IUS
- Can put in during c-section/ within 48hrs of pp
- If not then after 4 weeks

Lactational Amenorrhoea method
- Need to be amenorrhoeic and FULLY breastfeeding (no add feeds) 98% effective up until 6 months pp

17
Q

Common complication of antero-posterior hysterectomy:

2 chronic
1 acute

A

Vaginal vault prolapse
Enterocoele

acute- urinary retention

18
Q

Infomration regarding anti-epileptics and breast-feeding?

A

All safe apart from barbituates eg. phenobarbital

19
Q

What drug increases the risk of endometrial hyperplasia?

A

Tamoxifen- ER+ hormonal treatment in breast cancer for Pre-menopausal women

20
Q

What is the dose of folic acid you prescribe someone preg?
2 options! and until what week?

A

BMI < 30 = 400mcg from now until 12th week

BMI > 30 = 5mg from now until 12th week

21
Q

Pre-menstrual depression/ cyclical depression management

Mild = Conservative (4)
Mod =
Severe =

A

Mild = Conservative- sleep, exercise, small balanced meals rich in carbs
Mod = New COCP- drospirenone 3 mg and ethinylestradiol 0.030 mg
Severe = SSRI. Can be taken continuously or just in luteal phase

22
Q

What is ondansetron and why is it used in preg?

When counselling a patient on it, what do you need to mention?

A

serotonin 5-HT3 receptor antagonists- used in hyperemesis gravidarum

Safe in first 12 weeks gestation

associated with a small increased risk of cleft palate/lip - the MHRA advise that these risks need to be discussed with the pregnant woman before use

23
Q

Trans males assigned female at birth on testosterone, contraception advice

Cannot use…

A

COCP or any oestrogen containing contraception if on testosterone as it can antagonise effect

24
Q

Rubella in preg

Somone is preg and not had MMR vaccine, IgG rubella negative, what is your advice?

A

Keep away from anyone who has rubella and receive MMR vaccine when post-nata

25
Q

What are the option for delivery in HIV preg?

A

vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
a zidovudine infusion should be started four hours before beginning the caesarean section

26
Q

What is the Hb cut off for first trimester iron supplements?

A

110

27
Q

Hep B and pregnancy

How would you determine if baby is high risk of HepB? (2)

What should be offered to the baby and when?

Management
1.
2.
3.
4.

A
  1. mothers who are hepatitis B surface antigen positive
    or 2. are known to be high risk of hepatitis B

Managment
1. At birth - Hep B vaccine
2. At birth - 0.5ml of HepB IG within 12 hours of birth
3. Further vaccine at 1-2 months
4 further vaccine at 6 months (maybe 12 months)

28
Q

Management of pre-term labour (NOT PPROM!) therefore membranes are intact

1.
2. Give… 3/5 examples
3.

A
  1. Admit for observations (obvs check if membranes have ruptured)
  2. Give tocolytic such as Nifedipine, MgSO4, Terbutalinem Indomethacin, Atosiban (oxytocin antag)
  3. Give steroids to help fetal lungs mature

Don’t need to give abx if membranes haven’t ruptured

29
Q

KNOW THE DIFFERENCE IN MANAGEMENT FOR STRESS AND URGENCY INCONTINENCE!

Stress: From coughing
1. First-line:
2. Second-line: Med and MOA
3. Surgery-

Urgency: Over-active bladder
1. First-line:
2. Med (first line med = ) BIG CI!
eg 2
eg 3
eg 4 if they are frail

A

Stress

  1. First-line: 6 weeks pelvic floor exercises 8 contractions performed 3 times a day for 3 months at least
  2. Second-line: Duloxetine (SNRI) increase in SE and NA in pudendal nerve, stims urethra striated muscle in sphincter enhanced.
  3. Surgery- retropubic mid-urethral tape procedures

Urgency: Over-active bladder

  1. First-line: Bladder retraining min 6 weeks
  2. First line med = antimucarinic - Oxybutynin (AVOID IN ELDERLY FRAIL WOMEN)
    eg 2. tolterodine
    eg 3 darifenacin
    eg 4. If frail… mirabegron (a beta-3 agonist)
30
Q

Investigations for any urinary incontinence:
1
2
3
4

A
  1. bladder diary for at least 3 days
  2. Urine dip MC + S
  3. Pelvic exam for any prolapse using a Sims’ speculum
  4. Urodynamic studies
31
Q

-

A
  • If > 50yo Women using non-hormonal methods of contraception can be advised to stop contraception after 1 year of amenorrhoea
  • If < 50yo stop after 2 years of amenorrhoea
32
Q

Explain the different criteria for Categories of C-sections

C1- Criteria
Baby delivered within…

C2- Cause
Baby delivered within…

C3- Cause
Baby delivered within…

C4

A

C1- immediate threat to the life of the mother or baby
Examples:
- suspected uterine rupture
- major placental abruption
- cord prolaps
- fetal hypoxia
- persistent fetal bradycardia
Baby delivered within… 30 mins

C2
- maternal or fetal compromise which is not immediately life-threatening

Baby delivered within… 75 minutes

C3
delivery is required, but mother and baby are stable
Baby delivered within… 24 hours/that day

C4
elective caesarean

Year 4 PassMed Incorrect Qs (37 decks)

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