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FRCEM SBA > Obs & Gynae > Flashcards

Obs & Gynae Flashcards

1
Q

What are 4 physiological changes expected in pregnancy? (4)

A
  1. HR increased 10-20bpm
  2. BP increased 10-15mmgHg by 20 weeks but should be normal by delivery
  3. Alk Phos x3-4 increase
  4. Non-specific ST/T changesand LAD secondary to diaphragm
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2
Q

What is the advantage of VQ over CTPA in pregnancy?

A

Decreased radiation to maternal lung and breast tissue

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3
Q

What is a CXR radiation dose equivalent to?

A

1 week in London

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4
Q

Which antibiotics are c/i in pregnancy?

A

Trimethoprim and tetracyclines (doxy)

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5
Q

When should NSAIDs be avoided in pregnancy?

A

3rd trimester

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6
Q

Which opiate is preferred in pregnancy?

A

DH118

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7
Q

What anti-hypertensives should be avoided in pregnancy?

A

Ace inhib/ ARBS

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8
Q

Which anti-epileptics should be avoided in pregnancy?

A

Sodium valporate

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9
Q

When are pregnant women at increased risk of aortic dissection?

A

3rd trimester

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10
Q

What is the increased risk of ACS in pregnancy?

A

3-4 x

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11
Q

What symptoms is suggestive of physiological breathlessness of pregnancy and how common is it?

A

SOB improves on mild exertion
75 % women

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12
Q

What is posterior reversible encephalopathy syndrome (PRES)?

A
  • 3rd trimester headache, with pre-eclampsia
  • headaches/seizures/corticul blindness
  • vasogenic brain oedema
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13
Q

How do you treat Posterior Reversible Encephalopathy Syndrome (PRES)? (2)

A
  1. Anti-hypertensives
  2. Magnesium
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14
Q

What is Reversible Cerebral Vasoconstriction Syndrome (RCVS)?

A

Post partum headache
Severe HTN and thunderclap headache
Multifocal segmental cerebral artery vasoconstriction

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15
Q

How do you treat Reversible Cerebral Vasoconstriction Syndrome (RCVS) ?

A

Nimodopine

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16
Q

When does acute fatty liver of pregnancy occur?

A

3rd trimester

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17
Q

Abnormal LFTs in pregnancy and pruritis are suggestive of which disorder?

A

Intrahepatic cholestasis of pregnancy

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18
Q

What is HELLP syndome?

A

Haemolysis
Elevated Liver enzyems
Low Platelets

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19
Q

A pregnant women < 6/40 with bleeding and no concerning features what should be advised? (3)

A
  1. Home and return if increased bleeding or pain
  2. Repeat pregnancy test 7-10 days and if negative miscarriage and postive EPAU < 24hours
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20
Q

When 2 BHCGs are taken 48 hours apart by what value should it increase if the pregnancy is likely to be viable and what should be offered?

A
  1. more than 63% increase
  2. US 7-10days (sooner if >1,500 IU/L)
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21
Q

What decrease in BHCG between two samples taken 48 hours apart would you expect in a miscarriage? If this is the case what should be advised?

A
  1. more than 50% decrease
  2. Pregnancy test in 2 weeks - if negative confirmed, if positive EPAU <24 hours
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22
Q

If BHCG decreases by less than 50% or increases by less than 63% in 48 hours what should be done?

A

EPAU review < 24 hours

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23
Q

What should women with threatened miscarriage be advised?

A
  • If bleeding continues past 14 days or increases then represent
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24
Q

If women with threatened miscarriage have had a previous miscarriage what medication should be offered?

A

Progesterone 400mg BD

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25
Q

What is first line management for miscarriage?

A

Expectant - 7 to 14 days wait for bleeding to stop.
Repeat BHCG 3 weeks after bleeding stops to confirm
If no bleeding needs US

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26
Q

What is used to manage a miscarriage medically?

A

800mcg misoprostol (vaginal best, oral if not)
Then pregnancy test 3 weeks later to confirm

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27
Q

Under what conditions can a tubal ectopic be managed expectantly? (3)

A
  1. Stable and painless
  2. <35mm
  3. BHCG <1000
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28
Q

If expectant management of tubal ectopic is not acceptably what medical tx is used?

A

Methotrexate

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29
Q

Under what conditions can methotrexate be used in managing an ectopic? (3)

A
  1. Stable and painless
  2. <35mm
  3. BHGC <5000
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30
Q

Following expectant or medical management of tubal ectopic how often should BHCG be performed and how much should it drop by?

A
  1. Day 2,4,7 and then weekly until normal
  2. 15% every time
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31
Q

How is an ectopic managed surgically? (2)

A
  1. Salpingectomy if no risk for decreased fertility
  2. Salpingolectomy if risk factors for decreased fertility
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32
Q

Under what conditions should anti-resus D be used in women who have had surgical management of miscarriage or ectopic and what dose?

A
  1. Resus negative women
  2. 250 IU
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33
Q

Which women with bleeding in pregancy should get anti-resus D and at what dose?

A
  1. All
  2. 250 IU if < 20 weeks
  3. 500 IU if > 20 weeks
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34
Q

What is the Kleihauer test?

A

Gives indication of feto-maternal haemmorhage

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35
Q

In gestational HTN over what value should we aim for and what value should we admit for?

A
  1. Less than 135/85
  2. Over 160/110
36
Q

What is 1st, 2nd and 3rd line for gestational HTN?

A
  1. Labetalol PO 1st
  2. Nifedipine PO 2nd line
  3. Methyldopa PO 3rd line
37
Q

What are the diagnostic criteria for pre-eclampsia?

A

2 of the following:
1. BP >140/90
2. Proteinurea (++ protein)
3. Oedema

38
Q

What are the symptoms of pre-eclampsia? (5)

A
  1. Frontal headache
  2. RUQ pain
  3. Visual symptoms
  4. Oedema
  5. N/v
39
Q

What are the signs/symptoms of severe pre-eclampsia? (5)

A
  1. Ongoing headache
  2. Visual schotomata
  3. Epigastric pain
  4. Oliguria and severe HTN
  5. Progressive worsening biochem
40
Q

What signs suggest pre-eclamptic patients are moving towards eclampsia? (3)

A
  1. Confusion
  2. Tremor/twitching
  3. Hyper-reflexia
41
Q

What is the medical management of eclampsia (3)

A
  1. 4 g Mg2+ IV 5-15 mins followed by:
  2. 1g/hr for 24hours
42
Q

If a patient has a further seizure whilst on treatment for eclampsia what should be done medically? (2)

A
  1. Further 2-4g IV magnesium
  2. Extend infusion 1g/hr for further 24hours
43
Q

What anti-hypertensive should be used in eclampsia? (3)

A
  1. Labetalol (PO/IV)
  2. Nifedipine (PO)
  3. Hydralazine (IV)
44
Q

What is the definitive management of eclampsia?

A

Delivery

45
Q

What is gestational trophoblastic disease?

A

Spectrum of benign hydatid mole to invasive choriocarcinoma - fertilised ovum forms trophoblastic tissue

46
Q

What does gestational trophoblastic disease present like? (5)

A
  1. Vaginal bleeding 12-16/40
  2. Tissue resembles frog spawn
  3. Uterus ++ for date
  4. Can have pre-eclampsia/eclampsia
  5. BCHG +++
47
Q

What does ‘snowstorm’ appearance of US suggest

A

Gestational trophoblastic disease

48
Q

What is placental abruption?

A

Premature separation of placenta

49
Q

What are the risk factors for placental abruption? (6)

A
  1. Pre-eclampsia
  2. Previous abruption
  3. Trauma
  4. Smoking
  5. Cocaine
  6. Multi-parous
50
Q

What can placental abruption lead to? (3)

A
  1. Concealed haemorrhage
  2. DIC
  3. Labour
51
Q

What is placenta praevia?

A

Placenta partly/completely lies over lower uterine segment + os

52
Q

What are risk factors for placenta praevia? (5)

A
  1. Over 35 years
  2. Increased parity
  3. Previous placenta praevia
  4. Twins
  5. Uterine abnormalities including previous c-section
53
Q

How does placenta praevia present?

A

Painless, bright red bleeding in 3 rd trimester

54
Q

What is the treatment of placenta praevia?

A

C-section

55
Q

What is vasa praevia?

A

Abnormal fetal blood vessels attach to membranes over cervical os below presenting fetal part

56
Q

How does vasa praevia present?

A

Rupture of membranes with massive bleeding which can lead to fetal exsanguination

57
Q

What should you give a mother following delivery of baby?

A

Oxytocin 5U IM + syntometrine 500mcg IM (unless maternal HTN)

58
Q

What is the Brandt-Andrews technique?

A

To remove placenta - given pull on cord whilst exerting upward pressure on uterus to prevent inversion

59
Q

How should cord prolapse be managed? (4)

A
  1. Minimal handling
  2. Elevate presenting part either manually or by filling urinary bladder
  3. Knees to chest or left lateral position
60
Q

How is shoulder dystocia managed? (3)

A
  1. McRoberts position - hyperflex hips (knees to ears)
  2. Then try and apply gentle suprapubic pressure to try to rotate shoulder
  3. Can attempt finger into anterior shoulder axilla to bring it down
61
Q

What are the features of trichomonas vaginalis? (2)

A
  1. Malodorous
  2. Sexually transmitted
62
Q

How do you treat trachomonas vaginalis?

A

7 days metronidazole 400mg BD
Treat sexual partner

63
Q

What is the most common cause of vaginal discharge?

A

Bacterial vaginosis

64
Q

What is bacterial vaginosis?

A

Increase in normal flora - Gardenlla vaginalis most common

65
Q

What are Amsels criteria?

A

For diagnosising bacterial vaginosis
1. Thin, white discharge
2. ‘clue cells’ on wet mount
3. PH >4.5
4. ‘Fishy odour’ when adding alkali

66
Q

How is bacterial vaginosis treated?

A

7 days 400mg metronidazole or 2g STAT

67
Q

What does Gonorrhea look like on microscopy?

A

Gram negative diplococci

68
Q

What are the indications for treatment of gonorrhoea? (4)

A
  1. Gram -ve diplococci on microscopy
  2. +ve culture
  3. +ve NAAT
  4. Sexual partner with gonorrhoea
69
Q

What is the treatment for gonorrhoea? (3)

A
  1. 1 IM ceftriaxone single dose if no sensitivity
  2. If sensitive 500mg ciprofloxacin single dose
70
Q

If a patient with sexually transmitted disease has PID or epididymo-orchitis what should be added to tx?

A

STAT dose ceftriaxone followed by normal regime for that disease

71
Q

What is the investigation for chlamydia?

A

NAAT

72
Q

What is the treatment for chlamydia? (2)

A
  1. Doxycycline 100mg BD 7 days (not pregnant)2
  2. Azithromycin 1g PO then 500mg OD for 2 days
73
Q

When can Levenogestrel be used as emergency contraception and when is it most effective?

A
  1. <72 hours
  2. <12 hours
74
Q

When should the dose of leveogestrel by doubled?

A

Obese women

75
Q

When can Ulipristal acetate be used as emergency contraception

A

< 5 days (120 hours)

76
Q

What are the contraindications for ulipristal acetate? (4)

A
  1. severe asthma
  2. severe liver failure
  3. gynae cancers
  4. breastfeeding women should pause feeding for one week as it is excreted in milk
77
Q

When can the copper coil be used as emergency contraception?

A

< 5days (120 hours)

78
Q

What is the most effective form of emergency contraception?

A

Copper coil

79
Q

What are the contraindications for the copper coil?

A
  1. Pregnancy
  2. PID
  3. Uterine fibroids or disruption to uterine anatomy
  4. Undiagnosed vaginal bleeding
80
Q

What are two outpatient treatment protocols for PID recommended by BASSH

A
  1. 1g IM cefrtiaxone + doxy PO 100mg BD for 14 days + metronidazole 400mg BD PO for 14 days
  2. PO ofloxacin 400mg BD for 14 days + PO metronidazole 400mg BD for 14 days
81
Q

When should magnesium be given in pre-eclampsia?

A

Any of the severe features

  1. Ongoing or recurring severe headaches
  2. Visual schotomata
82
Q

What is the most common organism in PID?

A

Chlamydia

83
Q

What is Fitz-Hugh-Curtis Syndrome

A

PID complication - infection spreads to the liver capsule causing peri-hepatitis and right upper quadrant pain. Rare, associated with Chlamydia

84
Q

What is the initial treatment for mastitis?

A

Breast feeding advice -mainly needs better milk expression.
If fails then abx

85
Q

Which pregnant women should get oral aciclovir if they have chicken pox?

A
  1. Present < 24hours onset of rash
  2. Over 20/40
86
Q

What causes Trichomoniasis

A

Flagellated protazoan

87
Q

What are the symptoms of Trichomoniasis?

A

Women: ‘frothy discharge’, occasionally ‘strawberry cervix’
Men: Asymptomatic

FRCEM SBA (12 decks)

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