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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
What is the recommended management for primary dysmenorrhea?
1st line NSAIDs eg mefenamic acid 2nd line COCP (If secondary dysmenorrhea then advised to refer to gynae for investigation)
26
What results on a combined test indicate Down’s syndrome?
Raised HCG Low PAPP-A Thickened nuchal translucency
27
What is the difference between the combined and the quadruple screening test?
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
28
Speculum examination showing multiple punctuate lesions on the cervix (“strawberry cervix”) is seen in which STI?
Trichomonas (Green discharge, treated with metronidazole)
29
How should a pregnant woman with group B streptococcus (GBS) be managed?
Not routinely screened If picked up, give intrapartum abx (from start of labour through to delivery, due to risk of neonatal sepsis)
30
For how long should contraception be continued for after the menopause?
If <50y/o: 24 months If >50 y/o: 12 months
31
A surge of what hormone causes ovulation?
LH (in response to rising oestrogen levels produced by a mature follicle)
32
What is the screening programme for cervical cancer?
Age 24-49: smear test every 3years Age 50-64: smear test every 5 years
33
Post partum haemorrhage is defined as what level of blood loss?
> 500 ml within 24 hours of labour
34
What drug is 1st line for PPH?
IV oxytocin to stimulate uterine contractions (Then ergometrine or carboprost)
35
What is the 1st line treatment of gonorrhoea?
Single dose of IM ceftriaxone
36
What is the first line treatment for chlamydia?
7 days of doxycycline If pregnant then azithromycin or erythromycin
37
Strawberry cervix is typical of which infection?
Trichomonas vaginalis
38
What is the treatment of Trichomonas vaginalis?
5 to 7 days oral metronidazole
39
Cervical cancer is associated with which strains of HPV?
16, 18, 33
40
Genital warts is associated with which strains of HPV?
6 and 11
41
When can the copper IUD be inserted for emergency contraception?
Within 5 days of UPSI Or within 5 days of expected ovulation
42
What should HIV positive women be advised regarding breast-feeding?
Advised to not breast feed regardless of viral load
43
What is the routine recall for cervical cancer screening?
Every 3 years if aged 25-49 Every 5 years if 50-64
44
When would combined HRT be used rather than oestrogen only HRT?
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
When would cyclical rather then continuous HRT be used?
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
When is anti D immunoglobulin given?
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
How would LH & FSH levels differ in Turner’s syndrome vs Kallmans syndrome?
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
When is expectant management of an ectopic pregnancy appropriate?
If no foetal heartbeat, bHCG less than 1000, embryo less than 35mm, patient asymptomatic (Give MTX if bHCG <1500)
49
Women with no additional risk factors are advised to take what supplements during pregnancy?
Vitamin D 10mcg throughout Folic acid 400mcg for first 12 weeks (5mg dose if additional risk factors)
50
What triad does pre eclampsia present with?
Proteinuria Oedema Hypertension
51
How many days post partum would women require contraception?
21 days
52
Which cancers doing taking the COCP increase the risk of?
Breast and cervical
53
What investigation must be performed before prescribing aromatase inhibitors for breast Ca?
DEXA scan due to risk of osteoporosis
54
After how many days do the POP provide effective contraception?
2 days
55
What is the most appropriate imaging for ectopic pregnancy?
Transactional USS
56
Which organism is most likely to cause a single painful genital ulcer?
Haemophilus ducreyi (Syphilis usually causes a painless ulcer)
57
When can the COCP be started after emergency contraception?
Immediately after levongestrel 5 days after ulipristal acetate
58
Ulipristal acetate should be used in caution if a patient also has what condition?
Asthma
59
What advice must be given regarding breastfeeding if a patient has required emergency contraception?
No delay if levonorgestrel Delay for 1 week if Ulipristal
60
What is the mechanism of action of levonorgestrel and Ulipristal acetate?
Both inhibit ovulation
61
Mutations of the BRCA1 gene increase the risk of which cancers?
Breast and ovarian
62
PCOS increases the risk for developing which type of cancer?
Endometrial Ca
63
What are the initial treatment options for endometriosis?
1st line analgesia eg mefenamic acid 2nd line is contraceptives (to cause atrophy of the endometriosis lesions) (Surgical options only if severe)
64
Which strains of HPV are most likely to cause genital warts?
6 and 11
65
What is the first line treatment kid genital warts?
Topical podophyllum or cryotherapy
66
When is anti D given to rhesus negative women during pregnancy?
At 28 and 34 weeks
67
What is the mechanism of action of the IUS?
Prevents endometrial proliferation
68
What is the recommended management of a pregnant woman with a fasting glucose >7?
Start insulin (If <7, advise re diet & exercise and recheck in 1-2wks & if still >5.6 then start metformin)
69
What is the first line management of syphilis?
IM benzathine penicillin (Doxycycline alternative)
70
BRCA gene mutations increase a woman’s risk of both breast and which other type of cancer?
Ovarian

MSRA (15 decks)

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