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

Obs and Gynae 4 Flashcards

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1
Q

What layers are cut through in lower segment Caesarian section (8)

A
  1. Superficial fascia
  2. Deep fascia
  3. Anterior rectus sheath
  4. Rectus abdominis muscle (not cut, rather pushed laterally following incision of the linea alba)
  5. Transversalis fascia
  6. Extraperitoneal connective tissue
  7. Peritoneum
  8. Uterus
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2
Q

What strains of HPV cause cervical cancer?

A

16, 18

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3
Q

If a patient has the IUD fitted and wants HRT what key info can you give?

A

The progesterone in the IUD is enough to protect against endometrial cancer risk so they can have just oestrodiol, they do not need combind HRT

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4
Q

State the Rotterdam Criteria

A

2/3 from:
1. infrequent or no ovulation (usually manifested as infrequent or no menstruation)
2. clinical and/or biochemical signs of hyperandrogenism (such as hirsutism, acne, or elevated levels of total or free testosterone)
3. polycystic ovaries on ultrasound scan (defined as the presence of ≥ 12 follicles (measuring 2-9 mm in diameter) in one or both ovaries and/or increased ovarian volume > 10 cm³)

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5
Q

Catagories of PPH

A

minor (500–1000 ml)
major (more than 1000 ml)

Major:
- moderate (1000–2000 ml)
- severe (more than 2000 ml)

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6
Q

Abx prophylaxis for GBS, whats given and when?

A

IV intrapartum Benzylpenecillin to mum only!

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7
Q

Name the risk factors for GDM (5) and if they have 1 when should they be screened?

If they have previously had GDM when should they be screened?

A
  1. BMI > 30
  2. First degree relative with type 1 diabetes
  3. previous GDM
  4. previous macrosomic baby (> 4.5kg)
  5. High prevalence ethnicity

screen OGGT at 24-28 weeks

If have previous GDM- screen at booking and 24-28 weeks

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8
Q

If you seen female genital mutilation what should next step be to do?

A

if < 18 report this to the police

if > 18 still police

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9
Q

If someone is suffering from vasomotor menopausal symp and dont want any HRT what can you giv them?

A

SSRI - fluoxetine

Clonidine is also licensed for the treatment of vasomotor symptoms in menopause,

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10
Q

What in the history and exam would mae you think urinary overflow incontinance?

A

Bladder still palpable after urination, think retention with urinary overflow

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11
Q

monochorionic twin pregnancy- at week uss are you checking for twin-twin transfusion?

A

TTTS usually occurs in early or mid-pregnancy, thus USS 16 and 24 weeks focus on detecting this condition

After 24 weeks the main purpose of ultrasound examinations is to detect fetal growth restriction.

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12
Q

trans male on testosterone (female at birth) what contraception do you give them?

A

Copper coil!!
- hormonal are CI

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13
Q

Snow storm appearance
- complete =

A

molar preg

  • complete hydatidiform mole = no foetal parts present and snowstorm appearance is seen on ultrasound
  • bleeding early in preg is common
  • incomplete hydatidiform mole = NO SNOW STORM and Parts SEEN!
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14
Q

features of Complete hydatidiform mole (4)

A
  1. vaginal bleeding
  2. uterus size greater than expected for gestational age
  3. abnormally high serum hCG
  4. ultrasound: ‘snow storm’ appearance of mixed echogenicity
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15
Q

primary PPH time -
secondary PPH time -

A

primary PPH time - < 24 hours
secondary PPH time - 24 hours - 6 weeks

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16
Q

PPm categories

Normal vaginal
minor =
major - mod =
major - severe =

c-section must be …

A

minor =500-1000ml
major - mod = 1000-2000ml
major - severe = > 2000ml

c-section must be …
Postpartum haemorrhage (>1000ml)

17
Q

VBAC
- if going for C-section you must be counselled on subsequent vaginal

A
  1. 1/200 uterine scar rupture
  2. small increased risk of placenta praevia +/- accreta in future pregnancies, and of pelvic adhesions.
  3. success rate of planned VBAC is 72–75%, however this is as high as 85-90% in women who have had a previous vaginal delivery.
  4. All women undergoing VBAC should have continuous electronic fetal monitoring by CTG in labour as a change in fetal heart rate can be the first sign of impending scar rupture.
  5. Risks of scar rupture is higher in labours that are augmented or induced with prostaglandins or oxytocin.
18
Q

Hyperemisis gravidarum

admit if 1/3 from:

A
  1. Continued nausea and vomiting and is unable to keep down liquids or oral antiemetics
  2. Continued nausea and vomiting with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics
  3. A confirmed or suspected comorbidity (for example she is unable to tolerate oral antibiotics for a urinary tract infection)
19
Q

Hyperemesis gravidarum
for diag

Pregnancy-Unique Quantification of Emesis (PUQE) score for severity

A
  • 5% pre-pregnancy weight loss
  • dehydration
  • electrolyte imbalance
20
Q

Hyperemesis gravidarum
management

Conservative (3)

  1. Admit if warrant

Medical
First line
- class
- 2 eg’s

Second line
- class
- eg and SE

or

  • Class
  • Eg and SE therefore only use for…
A
  1. Admit if warrant
    Conservative
    - avoid triggers/ odours
    - ginger
    - P6 acupressure

Medical
1. first line- anti-histamine ie. cyclizine or promethazine

  1. second line
    oral ondansetron (5-HT3 antagonist)
    - slight increase of cleft palate
    oral metoclopramide
    or
    domperidone (DA Agonist!)
    or metoclopomide might cause EPSE so \DONT USE FOR > 5 days!!
  2. IV hydration +/- K+ hydration
21
Q

complications of Hyperemesis gravidarum (5)

A
  1. acute kidney injury
  2. Wernicke’s encephalopathy
  3. oesophagitis, Mallory-Weiss tear
  4. venous thromboembolism
    5 fetal outcome
22
Q

painful periods - dysmenorrhoea mx

first-line

second-line

A

first-line = NSAID (mefenamic acid or ibuprofen)

second-line = combined oral contraceptive pills

23
Q

painful periods - dysmenorrhoea mx

first-line

second-line

A

first-line = NSAID (mefenamic acid or ibuprofen)

second-line = combined oral contraceptive pills

24
Q

Primary dysmenorrhoea =
- when?

Features (2)

Secondary dysmenorrhea =

STEM clue on timing!

Causes (4)

management? (1)

A

Primary dysmenorrhoea =
- no underlying pelvic pathology
- 50% of menstruating women and usually appears within 1-2 years of the menarche.
Features (2)
1. pain typically starts just before or within a few hours of the period starting
2. suprapubic cramping pains which may radiate to the back or down the thigh

Secondary dysmenorrhea =
develops many years after the menarche and is the result of an underlying pathology

STEM- usually starts 3-4 days

Causes include: Endometriosis, Fibroids, adenomyosis, PID, IUD (copper)

ALL GET REFFERRED!

25
Q

MMR vaccine in preg?

A

Dont give to anyone preg or trying to get preg
- avoid getting preg for 28 days after MMR

Year 4 PassMed Incorrect Qs (37 decks)

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