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Specialty PACES > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

1
Q

what is the tissue sample in CVS?

A

placenta

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2
Q

what are the two surgical approaches to CVS?

A

transabdominal or transcervical

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3
Q

what is the timeframe for CVS

A

11 - 14 weeks

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4
Q

what is the CSV risk of miscarriage?

A

1%

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5
Q

what is the next step following inconclusive result from CVS in antenatal diagnosis?

A

wait for a few weeks until amniocentesis is possible

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6
Q

what information is gained at the first trimester USS?

A
  1. multiplicity (and chorion/amnion status)
  2. gestational age
  3. viablility of pregnancy
  4. gross anatomical abnormalities
  5. nuchal translucency
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7
Q

what information is gained at the 20 week structural abnormality scan?

A
  1. further examines foetal anatomy
  2. site of placenta
  3. sex of foetus
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8
Q

what pre-natal diagnoses require amniocentesis?

A
  1. inborn errors of metabolism
  2. foetal infection
  3. rhesus isoimmunisation
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9
Q

is anti-D given during amniocentesis?

A

yes

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10
Q

what serum markers are involved in the triple test?

what is added for the quadruple test?

A

triple = AFP, uE2, beta-HCG

quad = + inhibin

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11
Q

what is roughly the false positive rate for triple/quadruple screen?

A

5%

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12
Q

when during pregnancy is foetal echo performed?

offered to all mothers?

A

second trimester

only in cases with high risk for cardiac abnormality

  • diabetes type 1
  • congenital heart disease
  • epilepsy
  • teratogenic medication
  • previous child with cardiac abnormality
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13
Q

when is uterine artery doppler performed?

A

20 - 24 weeks

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14
Q

high resistance with notching on uterine artery doppler suggests higher risk for which conditions?

A

pre-eclampsia and growth restriction

enhanced monitoring is indicated

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15
Q

what are the indication for antenatal foetal blood sampling?

A

investigation of

  1. foetal hydrops
  2. parvovirus infection
  3. bloodtyping prior to transfusion
  4. haemolytic disease/alloimmune thrombocytopenia
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16
Q

which NSAID is particularly useful in dysmenorrhoea?

A

mefenamic acid

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17
Q

what hormonal options are available for treatment of dysmenorrhoea?

A

COCP, oral/depot progestogens, Mirena coil

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18
Q

what is/was the classical definition of menorrhoea ?

A

> 80 mL blood loss per period

difficult to quantify so dianosis now made more on history given

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19
Q

what is the risk of malignancy index? (equation)

A

RMI = U x M x CA125

U = USS score

M = menopause score

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20
Q

what factors contribute to the USS score in the risk of malignancy index?

A

multiloculation

solid areas

ascites

bilateral lesions

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21
Q

a simple, unilateral, unilocular cyst on USS is seen

likely diagnosis?

what should the follow up be? advice to patient?

A

simple ovarian cyst

supportive management, pain relief

USS follow up in 3-4 months, where we expect 50% to resolve on their own

risk of torsion! red flags, advise to attend A&E

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22
Q

what is the earliest a CTG can be used?

A

32 weeks (confidently)

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23
Q

what are maternal indications for CTG?

A

pain, PET, diabetes, antepartum haemorrhage

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24
Q

what are foetal indications for CTG?

A
  • IUGR
  • prematurity
  • oligohydramnios
  • multiple pregnancy
  • breech presentation
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25
Q

what is normal range for foetal HR on CTG?

A

110 - 160

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26
Q

foetal tachycardia on CTG suggests what?

A
  1. hypoxia/foetal distress
  2. maternal infection
  3. beta-agonist use
    4.
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27
Q

what is the serious concern with baseline bradycardia on CTG?

what are some other causes?

A

severe foetal distress from placental abruption or uterine rupture

hypotension, maternal sedation, post-maturity, hypoxia

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28
Q

prolonged HR <90 bpm on CTG suggests what?

A

known as ‘prolonged deceleration’ = impending foetal demise

should be acted on without delay

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29
Q

normal reduced variability lasts how long? what is the aetiology?

A

<40 mins, foetal sleep

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30
Q

after how long does reduced variability become a problem?

A

>90 mins

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31
Q

what is the physiological mechanism of early decelerations?

A

reflection of increased vagal tone in response to elevated foetal intracranial pressure during contractions

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32
Q

‘shouldering’ of variable decelerations refers to what?

worrying or reassuring?

A

aceleration on either side of variable decelerations

reassuring

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33
Q

typical variable decelerations are a reflection of what physiolocial process?

A

cord compression during uterine contraction

especially in oligohydramnios

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34
Q

what is the criteria for atypical/late decelerations to become non-reassuring?

A

present >50 % of contractions for >30 mins

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35
Q

with FBS during labour, what are the important values and their impact on management?

A

pH > 7.25 = normal. Labour should continue

pH 7.20 - 7.25 = borderline. Repeat pH in 30 - 60 mins

pH < 7.20 = abnormal. Needs delivery

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36
Q

what is the treatment for vaginal candidiasis?

A

topical imidazole and oral fluconazole

Canesten duo

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37
Q

treatment of trachomoniasis?

A

metronidazole

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38
Q

what factors contribute to the increased risk of cholestasis in pregnancy?

A

progesterone - biliary stasis

oestrogen - increases cholesterol:bile salt ratio (lithogenicity)

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39
Q

in acute pyelonephritis during pregnancy, what worrying symptom may the woman complain of that can be cautiously dismissed?

A

uterine tightening

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40
Q

what is a usual treatment for UTI in pregnancy?
consult local guidelines…

A

cephradine, amoxicillin

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41
Q

what are the best biochemical descriminants of acute fatty liver of pregnancy from HELLP syndrome?

A

high uric acid

hypoglycaemia

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42
Q

what is the maternal mortality rate of acute fatty liver of pregnancy?

A

20%

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43
Q

what is the classic localisation for pruritis in obstetric cholestasis?

A

palms and soles

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44
Q

what are the treatments of obstetric cholestasis?

what do each of them do?

A

chlorphenamine - anti-itch

ursodeoxycholic acid - reduse serum bile acids

vitamin K - correct any clotting abnormalities before labour

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45
Q

what are the 4 main malpresentations in descending order of frequency?

A

breech, shoulder, face, brow

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46
Q

what is done post-natally for women with GDM?

A

further OGTT 6 weeks later to make sure it’s not become T2DM

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47
Q

what is the additional vitamin requirement for pregnant women with pre-existing T2DM?

A

5 mg/day folic acid, rather than 0.4 mg/day

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48
Q

what are the indications for 5 mg/day folic acid?

A

preexisting T2DM, epilepsy (& relevant medication), previous FH NTDs, coeliac diseaes, sickle cell anaemia

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49
Q

what diabetic medications is allowed in pregnancy?

A

ONLY insulin and metformin

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50
Q

are statins safe in pregnancy?

A

no

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51
Q

are ARBs safe in pregnancy?

A

no

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52
Q

what is the advice for babies following GDM?

A

feed as soon after delivery as possible

every 2-3 hours thereafter

keep warm

monitor capillary glucose before feeds that shouldn’t fall below 2 mmol/L

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53
Q

other than symptomatic relief, what are the benefits of HRT?

A

bone protection

reduces risk of developing CRC

delay in onset of Alzheimer’s

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54
Q

what are the risks of HRT?

A

increases risk for breast and endometrial CA, ovarian CA

VTE and stroke

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55
Q

what are the absolute contraindications for HRT?

what are the relative contraindications?

A

absolute: CA endometrium, suspected pregnancy, liver disease, thrombophilia

relative: HTN, personal/family history of VTE, breast CA

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56
Q

what are the symptoms of menopause?

A

hot flushes, night sweats, sleep disturbance

vaginal dryness/atrophy, UTIs, menstrual disturbance

loss of libido

headache and palpitations

mood disturbance and loss of temper

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57
Q

what is the HRT for perimenopausal women with uterus in situ?

A

cyclical COCP at the lowest dose possible for the shortest time possible

cyclical: oestrogen for 28 days, with progestogen for last 12 days of cycle
they will have post-P2 withdrawal bleed

maximum duration of treatment = 5 years

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58
Q

what are the indications for moving a woman from cyclical HRT to continuous HRT?

A

whichever comes first:

  • not bleeding for more than one year (completion of menopause)
  • reaching 54 years old
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59
Q

what is the HRT for a woman who has been amenorrhoeic for >1 year?

A

continuous combined replacement therapy

oestrogen and progesterone together all the time

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60
Q

how frequently is the review for women on HRT?

A

6 monthly

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61
Q

what is the HRT indicated for a woman who has had a hysterectomy?

what is the benefit in terms of risk profile versus normal treatment?

A

oestrogen-only HRT

?testosterone for libido

reduced risk of breast CA versus combinded HRT

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62
Q

what medication is given in preterm labour to reduce risk of cerebral palsy and protect gross motor function?

A

magnesium sulphate

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63
Q

what is the first line tocolytic?

what is the second line tocolytic?

class of drugs and an example for each

A

calcium-channel blocker - nifedipine

oxytocin receptor agonist - atosiban

do not offer beta-adrenoceptor agonists

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64
Q

what is the dose for antenatal steroids in preterm labour?

A

12 mg betamethasone IM

two doses 24 hours appart

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65
Q

when is it appropriate to consider/offer antenatal steroids

A

24(0) - 35(6)

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66
Q

which antibiotic should not be given in P-PROM due to its association with NEC?

A

co-amoxiclav

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67
Q

which antibiotic should be given as prophylaxis in P-PROM?

A

PO erythromycin 250 mg QDS

up to 10 days or until labour is established

evidence from ORACLE trial show short-term respiratory function, chronic lung disease and major neonatal cerebral abnormality were all reduced with this course of antibiotics

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68
Q

what are the signs of chorio-amnionitis in P-PROM women?

A

maternal pyrexia, offensive smelling discharge, foetal tachycardia (CTG)

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69
Q

treatment for simple lactational mastitis is conservative

what are the indications for antibiotics?

what are the antibiotics?

A

infected nipple fissure, symptoms not improving after 12-24 hours following effective milk removal, positive breast milk culture

PO flucloxacillin 250 mg QDS

penallergic: PO erythromycin 250 mg QDS

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70
Q

in the combined test, along with NT what are the blood markers measured routinely?

A

PAPP-A and beta-HCG

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71
Q

what are the cut off values for anaemia in pregnancy by trimester?

A

1st - 110 g/L

2nd - 105 g/L

3rd - 100 g/L

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72
Q

when are pregnant women screened for aneamia?

A

booking bloods and 28 weeks

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73
Q

what is the prescription for a woman presenting with primary genital herpes in the last 6 weeks of pregnancy?

A

PO aciclovir 400 mg TDS until delivery

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74
Q

what are the main risks of VBAC?

A
  • uterine rupture (c. 1 in 200)
  • blood transfusions and endometritis
  • vaginal injury
  • maternal mortality (2-3 in 10,000)
  • hypoxic ishaemic encephalopathy (8 in 10,000)
  • early PPH
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75
Q

what are the maternal risks of elective repeat cesaerian section?

A
  • infection, bleeding, damage to adjacent structures
  • less likely to succeed at VBAC next time
  • placenta praevia/accreta in subsequent pregnancy
  • longer hospital stay
  • less in control of your birth, longer wait for skin-to-skin and breastfeeding
  • pain and immobility
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76
Q

what are the foetal risks for elective repeat cesaerian section?

A
  • foetal respiratory morbitidy
  • lacterations
  • ?bonding/breastfeeding affected
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77
Q

what is a topical medication that can be given for hirsuitism?

A

eflornithine

contraindicated in pregnancy and breastfeeding

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78
Q

what medication should be avoided during breast feeding?

A
  • aspirin
  • sulphonylureas
  • carbimazole
  • ciprofloxacin
  • benzodiazepines
  • lithium
  • sulphonamides
  • tetracyclines
  • amiodarone
  • cytotoxic drugs
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79
Q
  • painless vaginal bleeding occurring before 24 weeks, but typically occurs at 6 - 9 weeks
  • the bleeding is often less than menstruation
  • cervical os is closed
  • complicates up to 25% of all pregnancies

classification?

A

threatened miscarriage

80
Q
  • a gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion
  • mother may have light vaginal bleeding / discharge and the symptoms of pregnancy which disappear. Pain is not usually a feature
  • cervical os is closed
A

missed (delayed) miscarriage

81
Q
  • heavy bleeding with clots and pain
  • cervical os is open
A

inevitable miscarriage

82
Q
  • not all products of conception have been expelled
  • pain and vaginal bleeding
  • cervical os is open
A

incomplete miscarriage

83
Q

what is the differential for PMB?

A

endometrial adenocarcinoma until proven otherwise

then: tamoxifen, T2DM, PCOS, late menopause, high oestrogen levels

84
Q

cottage-cheese vaginal discharge means…

A

candida albicans vaginitis

Thrush

85
Q

what is a short-term management strategy for control of menorrhagia?

A

norethisterone 5 mg tds

rapidly stops menstrual bleeding

86
Q

when should a serum progesterone be taken when investigating subfertility?

A

7 days before the expected start of the next period

87
Q

abdominal ultrasound reveals a boggy uterus with subendometrial linear striations

A
88
Q

prescription for c. trachomatis or n. gonorrhoeae urogenital infection?

A

ceftriaxone 500 mg IM as a single dose

azithromycin 1 g PO as a single dose

89
Q

which is more likely to be malignant:

  • simple, unilocular ovarian cyst
  • complex multilocular ovarian cyst?
A

complex

90
Q

what is the management of a <35 y/o woman with a simple, 3mm ovarian cyst on USS?

A

repeat USS in 8-12 weeks

it should have regressed on its own by then but if it persists then consider referral to gynae

91
Q

how do you classify PPH?

A

500-1000 mL = minor haemorrhage

>1000 mL = major haemorrhage

92
Q

what is the age definition of premature ovarian failure?

A

younger than 40 years old

93
Q

what is the counselling for HRT effect on breast CA?

A
  • in the Women’s Health Initiative (WHI) study there was a relative risk of 1.26 at 5 years of developing breast cancer
  • the increased risk relates to duration of use
  • breast cancer incidence is higher in women using combined preparations compared to oestrogen-only preparations
  • the risk of breast cancer begins to decline when HRT is stopped and by 5 years it reaches the same level as in women who have never taken HRT
94
Q

does magnesium sulphate just prevent or prevent and treat seizures?

A

prevent and treat

if termination is not achieved with MgSO4 then consider BZD (midazolam) for termination of acute seizure

95
Q

is trimethoprim safe in breastfeeding?

A

yes

96
Q

what are the antibiotics indicated for puerperal endometritis?

A

IV clindamycin and gentamicin until afebrile for >24 hours

97
Q

are systemic corticosteroids safe in breastfeeding?

A

yes

98
Q

A 28 -year-old is found to have an ectopic pregnancy at 10 weeks gestation. She undergoes surgical management of the ectopic with a salpingectomy. She is known to be rhesus negative. What is the recommendation with regard to anti-D?

A

anti-D should be given

In surgical management of an ectopic pregnancy then Anti-D immunoglobulin should be administered.

Anti-D is not required in circumstances where a medical management (methotrexate) of the ectopic has been used, nor for treatment of pregnancy of unknown location.

99
Q

at what stage post partum can you offer intrauterine devices for contraception?

A

minimum 4 weeks post partum

100
Q

what is the first line therapy for a symptomatic fibroid?

A

Mirena - levonorgestrel-releasing intrauterine system

other options: TXA, COCP

101
Q

what medication is used short term before myomectomy to treat symptoms and shrink the size of the tumour?

A

GnRH analogue (continuous)

102
Q

how long after starting copper IUD can it be relied upon for for contraception?

A

immediately

103
Q

how long after starting progesterone-only pill can it be relied upon for contraception?

A

2 days

104
Q

how long after starting COCP can it be relied upon for contraception?

A

7 days

105
Q

does hydatidiform mole usually present with abdominal pain?

A

no

106
Q

what are the stages of ovarian cancer?

A

1 - tumour confined to ovary

2 - tumour within pelvis

3 - tumour outside pelvis but within abdomen

4 - distant metastasis

107
Q

what is the normal course of blood pressure in pregnancy?

A
  • blood pressure usually falls in the first trimester (particularly the diastolic), and continues to fall until 20-24 weeks
  • after this time the blood pressure usually increases to pre-pregnancy levels by term
108
Q

what should be measured in the blood to monitor therapy with LMWH in pregnancy?

A

anti-Xa activity - not aPTT

109
Q

what is the prinicple pathology being monitored for on USS between 16 and 24 weeks of a MCDA twin pregnancy?

A

twin-to-twin transfusion syndrome

110
Q

what is the principle pathology being monitored by USS after 24 weeks of a MCDA twin pregnancy?

A

IUGR

111
Q

a woman with ischaemic heart disease asks for COCP..

what is the recommendation?

A

COCP is absolutely contraindicated

112
Q

what are the symptoms of hyperemesis gravidarum?

A

nausea, vomiting, hypersalivaition, dehydration, weight loss, anorexia

try to quantify impact on quality of life

113
Q

what differentials should you consider with hyperemesis gravidarum?

A

molar pregnancy

UTI

acute abdomen

thyrotoxicosis

gastroenteritis

medication/drugs

114
Q

what investigations should you order in hyperemesis gravidarum?

A
  • urine - quantify ketones, MSU
    • ’+ ketones’ = ketonuria
  • Blood - U&E, FBC, glucose, betaHCG
  • USS - viable, intrauterine pregnancy, exclude molar pregnancy

consider TFTs, LFTs, amylase, ABG

115
Q

what are the admission criteria for hyperemesis gravidarum?

A

unable to keep food/water down

ketonuria and/or weight loss >5% despite antiemetics

potential/confirmed comorbidity

116
Q

what are the antiemetics effective in hyperemesis gravidarum?

A

cyclizine, prochlorperazine, ondansetron, metaclopramide

117
Q

what are two CAM therapies that can be offered in mild cases of hyperemesis gravidarum?

A

ginger and acupuncture

118
Q

other than antiemetics, what medication should be considered in hyperemesis gravidarum?

A

ranitidine

anti-WE: thiamine, slow NaCl 0.9% infusion

severe: corticosteroids

119
Q

what is the main differentiating factor in the history between placenta praevia and placental abruption?

A

abdominal pain

120
Q

what are the components of the bishop score?

what is the interpretation of the bishop score?

A

cervix - position (0-2), consistency (0-2), effacement (0-3), dilatation (0-3)

foetal station (0-3)

bishop <5 - will need induction
Bishop >9 - labour will occur spontaneously

121
Q

what medication is used in the symptomatic management of obstetric cholestasis?

A

ursodeoxycholic acid to bind to bile satls in circulation

induction typically at 37 weeks

122
Q

what are the indications for continuous CTG monitoring during labour?

A
  1. sepsis or severe chorioamionitis, temp >38 degC
  2. severe hypertension >160/110 mmHg
  3. oxytocin induction
  4. new vaginal bleeding
  5. presence of significant meconium
123
Q

what are the medications given in major PPH?

A

ergometrine, syntocinon (together as syntometrine)

carboprost

124
Q

COCP, 1 missed pill at any time in cycle

A

take the last pill even if it means taking 2 pills in one day

continue as normal

no additional/emergency contraception needed

125
Q

COCP missed 2 pills in week 1

sex in the pill-free period

A

take last pill even if it means taking 2 pills in one day and carry on normal cyclinc

emergency contraception will be needed

use condoms until you have taken pill for 7 consecutive days

126
Q

COCP missed 2 pills in week 2

sex in the pill-free period

A

take the last missed pill even if it means taking 2 pills in one day

condoms should be used until she has taken the pill for 7 consecutive days

no emergency contraception is required

127
Q

COCP missed 2 pills in week 3

sex in the pill-free period

A

take the last missed pill even if it means taking 2 pills in one day

when this packet finishes, skip the break and continue to the next packet without a break

use condoms until she has taken the pill for 7 consecutive days

no emergency contraception is required

128
Q

after what gestation should the SFH match the gestational age?

A

20 weeks

129
Q

during LCSC, what are the layers between skin and uterus?

A
  • Superficial fascia
  • Deep fascia
  • Anterior rectus sheath
  • Rectus abdominis muscle
  • Transversalis fascia
  • Extraperitoneal connective tissue
  • Peritoneum
130
Q

menorrhagia in a woman who requires contraception..

what are the options?

A
  1. levonorgestrel-releasing intrauterine system
  2. COCP
  3. depo-provera injection (or equivalent)
131
Q

can zopiclone be given to breastfeeding mothers?

A

no - present in breast milk

132
Q

which antiepileptics are best in pregnancy?

A

lamotrigine, carbemazepine and levetiracetam

133
Q

what is the mangement of cord prolapse?

A
  1. tocolysis
  2. patient on all fours
  3. push presenting part back into uterus, do not move the cord
  4. immediate caesarian section
134
Q

what is the schedule for delivering depo-provera?

A

injection every 12 weeks, can extend to 14 weeks without the need for extra precaution

135
Q

what is the effect of COCP on different cancer risks?

A

increased - breast and cervix

decreased - ovarian and endometrial

136
Q

how do you give carboprost in PPH?

A

1st i.m.

2nd intramyometrial

137
Q

what comes after syntometrine and carboprost (intramyometrial)

A

misoprostol PR

138
Q

what is the target blood pressure antihypertensive therapy in PET?

A

systolic <150 mmHg

diastolic 80-100 mmHg

139
Q

what is the pattern of serum markers seen with downs syndrome on antenatal scren?

A

NT and bHCG elevated

everything else reduced (PAPP-A, uE2, AFP)

140
Q

what is the contraindication for ergometrine in 3rd stage labour?

A

hypertension

141
Q

A 33-year-old primigravida woman of 32 weeks gestation presents to the Emergency Department with premature rupture of membranes. There have been no complications of the pregnancy so far and the woman is normally fit and well. How is she best managed?

A

admit for 48 hours

antibiotics (erythromycin, or penicillin and clindamycin if GBS +ve)

steroids for lungs to develop as this is premature

142
Q

what is the treatment for multiple, non-keratinized genital warts?

A

topical podophyllum

2nd line - imiquimod

143
Q

at what gestation is serum betaHCG detectable?

A

8 days

144
Q

what is the first thing to do in a pregnant woman exposed to VZV?

A

check immunity with VZV Ig

145
Q

how long post-exposure do you have to administer VZIG if required?

A

10 days

146
Q

in what time period is aciclovir useful n VZV ?

A

up to 24 following onset of rash

147
Q

what features (other than painless bleeding) would suggest vasa praevia versus placenta praevia?

A

rupture of membrane and foetal bradycardia

148
Q

what gestation is normal for head to engage with pelvis?

A

37 weeks

though with nulliparous woman can occur right before labour

149
Q

at what gestation is same day delivery for pre-eclampsia become an available option?

A

after 34 weeks

150
Q

how long does the implant last?

what is the PEARL index?

A

3 years

0.7 in 100 women-years

151
Q

what is the advice for women on COCP with a planned upcoming surgery?

A

stop the pill 4 weeks before and start 2 weeks after surgery to prevent thromboembolic disease

152
Q

how early following birth can you insert Cu-IUCD?

why?

A

28 days postpartum

increased risk of uterine perforation

153
Q

is smoking a risk factor for PET?

A

no

154
Q

what is the time course for putting in Cu-IUCD following termination/miscarriage?

A

1st or 2nd trimester can be placed immediately

must wait 4 weeks pootpartum in 3rd trimester/at term

155
Q

what is the grading of placenta praevia?

A

I - in lower segment

II - partially covers internal os

III - covers internal os only before dilation

IV - completely covers internal os

156
Q

what is the radical procedure for late cervical cancer?

A

Wertheim hysterectomy

removal of uterus, parametrium, upper 1/3 vagina and pelvic node clearance

157
Q

what are the complications of PET?

A

eclampsia

foetal -
prematurity and IUGR

maternal -
bleeding: intracranial/intraabdominal, abrupto placenae, DIC, HELLP
cardiac failure, multi-organ failure

158
Q

how many antenatal visits should a woman expect during pregnancy?

A

nulliparous - 10

subsequent pregnancies - 7 (if uncomplicated)

159
Q

what is the timeframe for Down’s screening with NT available?

A

11 - 13+6 weeks

160
Q

what antenatal visits are only for nulliparous women?

A

25, 31 and 40 weeks

nothing special done at these visits, just check on patient

25 week measure SFH for first time, at 40 weeks discuss postdate induction potentially

161
Q

what is the brand name of combined contraceptive patch?

A

Evra (only patch licenced in UK)

162
Q

is metronidazole safe for use in pregnancy?

A

yes

but when treating BV, avoid 2g stat dose and offer 400 mg BD for 5-7 days

163
Q

what are the two things you should council when starting depo provera?

A

fertility can take >1 year to retun after stopping

small but significant decrease in bone density which will recover after stopping

164
Q

what social factor is associated with a decreased risk of HG?

A

smoking

165
Q

what is a sensible medication to be given first line for HG?

A

promethazine (antihistamine)

166
Q

what is the biggest risk of TOP?

A

infection, that can occur in up to 10% of cases

antibiotic prophylaxis should be given around the procedure

167
Q

what is the typical presentation of vulval intraepithelial neoplasia?

A

VIN - single whilte plaques that may be itchy but do not ulcerate

168
Q

what is the WHO definition of perinatal mortality?

A

stillbirth from 22 weeks gestation plus neonatal death until 7 days postpartum

169
Q

what are the causes of hyperechogenic bowel on antenatal scan?

A

cystic fibrosis

down’s syndrome

CMV infection

170
Q

what are the long term complications of PCOS?

A

subfertility

metabolic - T2DM, CAD, stroke & TIA
associated obstructive sleep apnoea

endometrial CA

171
Q

which method of contraception is most proven to be associated with weight gain?

A

depo provera

172
Q

what is the schedule for booking visit and dating scan?

A

booking visit between 8-12 weeks, ideally before 10 weeks

dating scan between 10-13+6 weeks

down’s screening is 11-13+6 weeks (inc measuring NT)

173
Q

what are the contraindications for the medication in atonic uterus + PPH?

A

ergometrine - hypertension

carboprost - asthma

oxytocin & misoprostol have no contraindications in this scenario

174
Q

do you give anti-D for PV bleed before 12 weeks gestation?

A

only if heavy, persistent or painful

175
Q

what is the most specific physical sign for PET?

A

brisk tendon reflexes

176
Q

what are the indications for surgical management of ectopic pregnancy?

A

gestational sac >35 mm

bHCG >1,500 IU/L

pain

177
Q

what are the conditions for medical management of ectopic pregnancy?

A

ectopic <35 mm

bHCG <1,500 IU/L

pregnancy is excluded from uterus

no pain

must be willing to attend follow-up

178
Q

for COCP, what history with regards to breast CA are cautions and contraindications?

A

current Hx breast CA - UKMEC 4

carrier of known gene mutations associated with breast CA - UKMEC 3

179
Q

what is the treatment for vaginal candidiasis?

A

LOCAL - co-trimoxazole 500 mg PV stat

SYSTEMIC - fluconazole 150 mg PO stat; or
itraconazole 200 mg PO bd for 1 day

if pregnant, can only use local therapy

180
Q

what are the associations with increased nuctal translucency?

A

Down’s syndrome

congenital heart defects

congenital abdominal wall defects

181
Q

what is the indication for Kleihauer test?

A

any sensitising event after 20 weeks

always give anti-D dose empirically

182
Q

do you eventually get regular bleed with progesterone implant (nexplanon)?

A

less than 1/4 women eventually get regular bleeding

183
Q

what is done at the 28 week antenatal visit?

A

second screen for anaemia and alloimmunisation

first dose prophylactic anti-D

(give iron is Hb <10.5)

184
Q

what is done at the 34 week antenatal visit?

A

second dose prophylaxic anti-D

information on labour and birth plan to be given

185
Q

which is the POP that has extended cover if she missed the pill?

A

Cerazette - desogestrel

up to 12 hours late she doesn’t have to take action

186
Q

what is the screening programme for ovarian cancer?

A

there is none

187
Q

what happens to resp rate during pregnancy?

A

nothing

188
Q

what happens to ESR and CRP during pregnancy?

A

ESR up, nothing to CRP

189
Q

what is the consideration of a woman with hypertension asking for contraception?

A

uncontrolled HTN - COCP UKMEC 4

controlled HTN should consider other options rather than COCP

190
Q

what are the rules for anti-D in early pregnancy?

A

miscarriage alone before 12 weeks does not need anti-D

miscarraige + ERPC before 12 weeks needs anti-D

threatened miscarriage after 12 weeks needs anti-D

termination (medical or surgical) at any point needs anti-D

191
Q

what is the dose of anti-D ?

when should it be given?

A

before 20 weeks - 250 IU

after 20 weeks - 500 IU

give as early as possible, definitely within 72 hours

192
Q

what is the frequency of induction of labour in UK?

A

15-25% of all labour

193
Q

what must be done for a woman at 42 weeks who refuses IoL or C section?

A

returns to labour ward for 2x weekly CTG monitoring and USS looking for:
AFI & uterine artery doppler

194
Q

what is the rate of progression for the first stage of labour?

A

at least 2 cm every 4 hours

195
Q

what are the two options for failure to progress in the first stage of labour?

A

AROM (using small hook on VE)

or oxytocin infusion

196
Q

what are the complications of augmentation/induction of labour?

A

failure

uterine hyperstimulation (>7 contractions in 10 mins)

N&V

uterine rupture

Specialty PACES (3 decks)

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