Obs And Gynae

Question 1

Indications for c section

Answer 1

Maternal reasons e.g infections such as herpes or eclampsia, cervical ca. Or previous uterine surgery. Cardiac disease, high HIV viral load over 1000 copies Foetal indications such as distress, position, cord prolapse or congenital anomalies Maternal-foetal implications such as rupture, placenta previa and failure of labour to progress.

Question 2

What is the success rate of vaginal delivery after previous Caesarian (vbac)

Answer 2

60-80% with a 0.5-1% increased risk of rupture

Question 3

Factors associated with decreased success of trial of labour after previous Caesarian section

Answer 3

Body mass index of 40 or more 2 or more previous c sections Previous c section for failure to descend into second stage of labour Infant weight over 4000g Maternal age over 35

Question 4

What is placenta previa

Answer 4

Placenta previa is when the placenta is covering the cervix And can be categorised by: Complete - completely covering the cervix Partial - a portion is covering the cervix Marginal - extends just to the edge of the cervix

Question 5

Incidence of finding placenta previa on 20 week scan

Answer 5

4% of 20 scans have an incidental finding of placenta previa. Most of which resolve by term and therefore follow up uss at x weeks is best in the absence of bleeding. 0.4% of pregnancies have placenta previa at term

Question 6

Types of uterine incisions for c section

Answer 6

low segment Transverse - through non contractile portion of the uterus. The bladder must first be dissected off the uterus. Classic - vertical incision through the contractile fundus of the uterus. Higher risk of bleeding and adhesions as well as rupture with VBAC

Question 7

Complications of a c section in order of most common to least common

Answer 7

Haemorrhage Infection Visceral injury Thrombosis

Question 8

Types of breech position

Answer 8

Non cephalic Tranverse Footling

Question 9

Assessment of breakthrough bleeding with women on OCP

Answer 9

Insert picture

Question 10

Characteristics of trichomonas

Answer 10

Wet saline mount shows flagellated, motile organisms, pmns and WBC’s

Question 11

Most common cause of spontaneous abortion

Answer 11

Aneuploidy

Question 12

Signs and symptoms of trichomonas

Answer 12

Yellow green malodorous discharge 25% asymptomatic Petechiae on vagina and cervix

Question 13

Signs and symptoms of candidiasis

Answer 13

White cottage cheese discharge Intense pruritus Swollen inflamed genitals Vulvar burning, dysuria, dyspareunia

Question 14

Signs and symptoms of bacterial vaginosis

Answer 14

Grey thin diffuse discharge 50-75% asymptomatic Fishy odour especially after coitus Absence of vulval/vaginal irritation

Question 15

How to prevent breast engorgement post partum

Answer 15

Frequent nursing 8-12 a day Optimal nursing position Satisfactory latch No breastfeed skipping during the first several weeks Avoidance of formula feedings in the first several weeks Can also try warm compress before feedings and cool compress in between

Question 16

Highest maternal mortality rates are associated with which cardiac condition

Answer 16

Eisnmengers syndrome - where there is a communication between systemic and pulmonary system, with increased pulmonary resistance (right to left shunt) 50% risk of dying Fatal mortality also reaches 50%

Question 17

Most common histology of cervical Ca

Answer 17

Squamous cell carcinoma

Question 18

Differential for postmenopausal bleeding

Answer 18

Endometrial cancer until proven otherwise Endometrial polyps - treated with polypectomy Vaginal atrophy

Question 19

Definition of menorhagia

Answer 19

Menstruation at regular cycle intervals but with excessive flow and duration

Question 20

Differential for abnormal uterine bleeding

Answer 20

Polyp Adenomyosis Leiomyoma Malignancy Hyperplasia Coagulopathy Ovulatory disfunction Endometrial Iatrogenic Not yet classified PALM COEIN

Question 21

Treatment of mild menorrhagia

Answer 21

NSAIDS Antifibrinolytics Combined ocp Progestin son d10-14 of each month More a IUD danazol

Question 22

Contraindications to mirena use

Answer 22

Presence of pregnancy Uterine cancer or fibroids Uterine malformations Acute liver disease or liver tumors Breast carcinoma Existing pelvic inflammatory disease Uterine bleeding not previously diagnosed

Question 23

Common acid base status in hyperemesis gravidarum

Answer 23

Metabolic alkalosis early on from vomiting but as vomiting becomes chronic you develop a mixed metabolic acidosis and metabolic alkalosis due to a higher anion gap which is usually due to the ketoacidosis which develops with startvation.

Question 24

Most appropriate antibiotic from prophylaxis of post c section endometritis

Answer 24

Cefazolin

Question 25

How does post c section endometritis present

Answer 25

Postpartum fever, uterine tenderness, foul smelling Lothian and leucoytosis.

Question 26

post partum thyroiditis

Answer 26

variation of hashimotos and presents in a variety of ways. begins 1-4 months after delivery and can last 2-8 weeks. can be transient or become permanent. treatment is not usually necessary unless significant symptoms develop.

Question 27

uterine inversion

Answer 27

severe abdominal pain, shock and uterine tissue outside the cervix. Give oxygen, crystalloids, stop oxytocin infusion and leave placenta in place. This is a life threatening complication of third stage of labour.

Question 28

degrees of uterine inversion

Answer 28

1. fundus is partially turned out 2. fundus passes through cervix but not outside vagina 3. fundus is prolapsed outside of the vagina 4. the uterus cervix and vagina are outside and visible

Question 29

risk factors for developing DVT post delivery

Answer 29

BMI\>30 emergency C section cesarian hysterectomy previous DVT known thrombotic disorder age\>35 parity\>3 current infection major illness immobility \> 4 days prior to surgery pre eclampsia gross varicose veins

Question 30

absolute contraindications for HRT

Answer 30

severe liver disease undiagnosed vaginal bleeding venous thrombosis known or suspected breast or uterine cancer

Question 31

relative contraindications include

Answer 31

hypertriglyceridemia uncontrolled hypertension migraine headaches history of uterine fibroids history of breast cancer atypical ductal hyperplasia of the breast active gallbladder disease

Question 32

risk factors for endometrial cancer

Answer 32

long term exposure of non opposed oestrogen high cumulative doses of tamoxifen estrogen producing tumors obesity nulliparity diabetes hypertension thyroid or gallbladder disease older age history of infertility late age of natural menopause early age of menarche menstrual irregularities white race

Question 33

risks of having intrahepatic cholestasis during pregnancy

Answer 33

prematurity fetal distress increased perinatal mortality

Question 34

intrahepatic cholestasis of pregnancy

Answer 34

rare, presents in 3rd trimester - usually as itching can become jaundice. Usually have elevated Bilirubin with relatively normal transaminases. total bile acids are most specific and sensitive test

Question 35

most common cause of jaundice during pregnancy

Answer 35

acute viral hepatitis

Question 36

Bishops score

Answer 36

Question 37

lichen sclerosis

Answer 37

benign chronic inflammatory progressive dermatological condition found in the anogenital region

Question 38

cervical insuffieciency

Answer 38

inability of the uterine cervix to retain a pregnancy in the second trimester in the absence of contractions tranvaginal USS from 12 weeks is recommended to assess cervix length \<25mm is considered short

Question 39

management of cervical insufficiency

Answer 39

cervical clervage hydroxyprogesterone caproate weekly from 16 weeks up to 36 weeks gestation

Question 40

diagnositic criteria for severe pre eclampsia

Answer 40

systolic BP greater than 160 on 2 occassions 6 hours apart proteinuria greater than 5g in 24h collection or 3+ on 2 random urine samples oliguria less than 500ml in 24h persistent headache or visual disturbances pulmonary oedema or cyanosis concerning abdominal pain impaired LFTs thrombocytopenia oligohydraminos decreased fetal growth placental abruption

Question 41

FIGO Staging

Answer 41

staging for endometiral cancer Ia cancer has invade less the myometirum Ib cancer has invaded greater than half the myometrium II cervical involvement without sread outside uterus III regional spread to adenexa/serosa, lymph nodes etc IV cancer in bladder, rectum and outside the pelvis

Question 42

types of endometrial cancer

Answer 42

Type 1 - low grade estrogen related Tyoe 2 - high grade not estrogen related

Question 43

How is cervical ripening performed

Answer 43

prostaglandins or special devices