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MSRA > Obs gynae > Flashcards

Obs gynae Flashcards

1
Q

Bacterial vaginosis is due to which bacteria?

A

Gardnella vaginalis overgrowth

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2
Q

What is the treatment of bacterial vaginalis?

A

PO metronidazole 5-7days

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3
Q

Which vaginal infection is associated with clue cells on microscopy?

A

Bacterial vaginalis

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4
Q

What BP readings define hypertension in pregnancy?

A

> 140 systolic
90 diastolic

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5
Q

Which antihypertensive agent is used in pregnant patients with history of asthma?

A

Nifedipine

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6
Q

What is Sheehan’s syndrome?

A

Postpartum hypopituitarism due to postpartum hypovolaemic shock

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7
Q

What is the first line treatment for primary dysmenorrhea?

A

NSAIDs eg mefenamic acid (inhibit prostaglandin synthesis)

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8
Q

Which antibiotic for UTI is contraindicated in pregnancy?

A

Trimethoprim (folate antagonist)
Nitrofuranfoin is 1st line (but avoid if near term)

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9
Q

What are the causes of postpartum haemorrhage?

A

4 T’s
Tone (uterine atony)
Trauma (e.g. tear)
Tissue (retained tissue)
Thrombin (clotting disorder)

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10
Q

What is the first line treatment for eclampsia?

A

IV Mg Sulfate
(Neuroprotective for the foetus, monitor for signs of hyperMg eg hypereflexia and respiratory depression)

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11
Q

What is the tumour marker for OvarianCa?

A

CA125

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12
Q

What is the most common cause of a breast abscess in a lactating woman?

A

Staphylococcus aureus

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13
Q

Which emergency contraception pill can be taken up to 5 days after unprotected sexual intercourse?

A

Ulipristal (EllaOne)
Inhibits ovulation
* caution if severe asthma *

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14
Q

What is the mechanism of action of the progesterone only pill except despogestrel?

A

POP: thickens cervical mucous
Desogestrel: inhibits ovulation

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15
Q

What dose of folic acid supplement is recommended in pregnancy?

A

400mcg until 12th week
If higher risk of NTD (obese, diabetes, family history, coeliac, antiepileptic meds) then increase to 5mg

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16
Q

Which antihistamine is first line for hyperemesis gravidarum?

A

Promethazine

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17
Q

What is vasa praevia?

A

When the foetal vessels cross over the inner cervical os
Risk of rupture & foetal distress if also ruptures during artificial membrane rupture eg to induce labour

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18
Q

Would placenta praevia present with painless or painful vaginal bleeding?

A

Painless
(When the placenta implants over internal cervical os)

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19
Q

What is the next steps for a cervical smear which is positive for hrHPV but with normal cytology?

A

Repeat in 12 months
If still hrHPV positive then repeat again at 24 months
If still positive, then colposcopy

(Any smears with abnormal cytology: straight for colposcopy)

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20
Q

How many weeks gestation is the booking visit?

A

8-12 weeks
(General info, BP, urine, BMI, bloods inc hep B, syphilis and HIV)

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21
Q

How many weeks gestation is the Down’s syndrome screening & nuchal scan done?

A

11-13 +6 weeks

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22
Q

How many weeks gestation is the anomaly scan done?

A

18-20+6 weeks

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23
Q

What medication is used to treat hyperthyroidism during pregnancy?

A

Propylthiouracil (PTU) during 1st trimester
Then switched to carbimazole after 1st trimester (due to risk of teratogenicity)

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24
Q

Due to what side effect is chloramphenicol not advised in pregnancy?

A

Bone marrow suppression

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25
Q

What is the recommended management for primary dysmenorrhea?

A

1st line NSAIDs eg mefenamic acid
2nd line COCP

(If secondary dysmenorrhea then advised to refer to gynae for investigation)

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26
Q

What results on a combined test indicate Down’s syndrome?

A

Raised HCG
Low PAPP-A
Thickened nuchal translucency

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27
Q

What is the difference between the combined and the quadruple screening test?

A

Combined
Tests for downs, Edward’s, and patau’s
Done at 11-14 weeks gestation
Tests for nuchal translucency (on USS) and bloods for hCG and PAPP-A

Quadruple
Tests for Down’s syndrome, not as accurate as combined
Done at 14-20 weeks
Blood test

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28
Q

Speculum examination showing multiple punctuate lesions on the cervix (“strawberry cervix”) is seen in which STI?

A

Trichomonas
(Green discharge, treated with metronidazole)

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29
Q

How should a pregnant woman with group B streptococcus (GBS) be managed?

A

Not routinely screened
If picked up, give intrapartum abx (from start of labour through to delivery, due to risk of neonatal sepsis)

30
Q

For how long should contraception be continued for after the menopause?

A

If <50y/o: 24 months
If >50 y/o: 12 months

31
Q

A surge of what hormone causes ovulation?

A

LH (in response to rising oestrogen levels produced by a mature follicle)

32
Q

What is the screening programme for cervical cancer?

A

Age 24-49: smear test every 3years
Age 50-64: smear test every 5 years

33
Q

Post partum haemorrhage is defined as what level of blood loss?

A

> 500 ml within 24 hours of labour

34
Q

What drug is 1st line for PPH?

A

IV oxytocin to stimulate uterine contractions
(Then ergometrine or carboprost)

35
Q

What is the 1st line treatment of gonorrhoea?

A

Single dose of IM ceftriaxone

36
Q

What is the first line treatment for chlamydia?

A

7 days of doxycycline

If pregnant then azithromycin or erythromycin

37
Q

Strawberry cervix is typical of which infection?

A

Trichomonas vaginalis

38
Q

What is the treatment of Trichomonas vaginalis?

A

5 to 7 days oral metronidazole

39
Q

Cervical cancer is associated with which strains of HPV?

A

16, 18, 33

40
Q

Genital warts is associated with which strains of HPV?

A

6 and 11

41
Q

When can the copper IUD be inserted for emergency contraception?

A

Within 5 days of UPSI
Or within 5 days of expected ovulation

42
Q

What should HIV positive women be advised regarding breast-feeding?

A

Advised to not breast feed regardless of viral load

43
Q

What is the routine recall for cervical cancer screening?

A

Every 3 years if aged 25-49
Every 5 years if 50-64

44
Q

When would combined HRT be used rather than oestrogen only HRT?

A

Combined if they still have a uterus (to reduce the risk of endometrial Ca due to unopposed oestrogen)

Oestrogen only can be used if they have had a hysterectomy

45
Q

When would cyclical rather then continuous HRT be used?

A

Cyclical used if last menstrual period less than one year ago

Continuous used if LMP over 1 year ago (or two years of premature menopause)

46
Q

When is anti D immunoglobulin given?

A

If Mum is rheus negative, given routinely at 28 weeks gestation and at north (if baby Rh positive)
Also given if any sensitising event (trauma, bleeding, amniocentesis)

47
Q

How would LH & FSH levels differ in Turner’s syndrome vs Kallmans syndrome?

A

Turners: gonadal dysgenesis, don’t response to LH and FSH do levels remains high due to absence of negative feedback of oestrogen

Kallmanns: abormally functional hypothalamus causes low GnRH so low FSH and low LH

48
Q

When is expectant management of an ectopic pregnancy appropriate?

A

If no foetal heartbeat, bHCG less than 1000, embryo less than 35mm, patient asymptomatic

(Give MTX if bHCG <1500)

49
Q

Women with no additional risk factors are advised to take what supplements during pregnancy?

A

Vitamin D 10mcg throughout
Folic acid 400mcg for first 12 weeks (5mg dose if additional risk factors)

50
Q

What triad does pre eclampsia present with?

A

Proteinuria
Oedema
Hypertension

51
Q

How many days post partum would women require contraception?

A

21 days

52
Q

Which cancers doing taking the COCP increase the risk of?

A

Breast and cervical

53
Q

What investigation must be performed before prescribing aromatase inhibitors for breast Ca?

A

DEXA scan due to risk of osteoporosis

54
Q

After how many days do the POP provide effective contraception?

A

2 days

55
Q

What is the most appropriate imaging for ectopic pregnancy?

A

Transactional USS

56
Q

Which organism is most likely to cause a single painful genital ulcer?

A

Haemophilus ducreyi

(Syphilis usually causes a painless ulcer)

57
Q

When can the COCP be started after emergency contraception?

A

Immediately after levongestrel
5 days after ulipristal acetate

58
Q

Ulipristal acetate should be used in caution if a patient also has what condition?

A

Asthma

59
Q

What advice must be given regarding breastfeeding if a patient has required emergency contraception?

A

No delay if levonorgestrel

Delay for 1 week if Ulipristal

60
Q

What is the mechanism of action of levonorgestrel and Ulipristal acetate?

A

Both inhibit ovulation

61
Q

Mutations of the BRCA1 gene increase the risk of which cancers?

A

Breast and ovarian

62
Q

PCOS increases the risk for developing which type of cancer?

A

Endometrial Ca

63
Q

What are the initial treatment options for endometriosis?

A

1st line analgesia eg mefenamic acid

2nd line is contraceptives (to cause atrophy of the endometriosis lesions)

(Surgical options only if severe)

64
Q

Which strains of HPV are most likely to cause genital warts?

A

6 and 11

65
Q

What is the first line treatment kid genital warts?

A

Topical podophyllum or cryotherapy

66
Q

When is anti D given to rhesus negative women during pregnancy?

A

At 28 and 34 weeks

67
Q

What is the mechanism of action of the IUS?

A

Prevents endometrial proliferation

68
Q

What is the recommended management of a pregnant woman with a fasting glucose >7?

A

Start insulin

(If <7, advise re diet & exercise and recheck in 1-2wks & if still >5.6 then start metformin)

69
Q

What is the first line management of syphilis?

A

IM benzathine penicillin

(Doxycycline alternative)

70
Q

BRCA gene mutations increase a woman’s risk of both breast and which other type of cancer?

A

Ovarian

MSRA (15 decks)

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