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MBBS V > Obs & Gynae > Flashcards

Obs & Gynae Flashcards

1
Q

Management of pre-eclampsia ?

A

CTG fetal monitoring. Call obsetrician for advice.

Asymptomatic, incidental finding, no severe features: Close outpatient monitoring. Labetalol. IOL at 37 weeks

If rural, send to Adelaide for monitoring

Symptomatic or any features of HELLP: hospitalisaion and IOL

Future pregnancies need prophylacic aspirin

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2
Q

Invetigation for suspected polyhydramnios?

A

AFI (Amniotic Fluid Index) >24 cm

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3
Q

Risk factors for preterm labour?

A

Smoking, alcohol use, illicit drug use

Previous preterm labour

Twins

Previous cervical surgery

Chorioamnionitis

Preeclampsia + placental abruption

Placenta previa

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4
Q

Management of PCOS?

A

Non med: weight loss, mx metabolic syndrome (lipids, glucose, HTN)

If not concerned about infertility:

Med: OCP (or Metformin if OCP contraindicated)

If concorned about infertility:

Med: Ovulation induction wth clomiphene

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5
Q

Pre-menopausal bleeding, clots, open oss. Ix, Dx, Mx?

A

Doppler US + transvaginal USS

Incomplete abortion

Expectant management +/- misprostol (prostagladin) + Anti-D (625 IU)

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6
Q

Investigation (2) and Mx (1) of prolactinoma?

A

Visual fields

MRI head

Dopamine agonists (cabergoline)

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7
Q

Clinical features pre-eclampsia (8)?

A

High BP + proteinuria

RUQ Abdominal pain (vasospasm to liver)

Blurred vision (raised ICP and vasospasm to retinal artery)

Peripheral swelling (d/t proteinuria)

SOB (pulmonary oedeam d/t proteinuria)

Headaches (raised ICP from cerebral oedema amd HTN)

Hyperreflexia + Clonus

Eventually cerebral oedema (from severe proteinuria) causes seizures

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8
Q

Screening tests in 3rd trimester?

A

Morphology scan 20 weeks

Oral GTT 24 weeks

GBS swab 36 weeks

(Give Anti-D at 28 and 34 weeks for Rh- mother)

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9
Q

Normal CTG (cardiotocography)?

A

HR normal range is 110-160 bpm

Variability of HR is normal (5-25 bpm)

Accelerations (>15bpm for 10 minutes) reflects fetal movement

Early deceleration (decline of >15 bpm) during contractions

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10
Q

When can you have vaginal birth after C section ? When contraindicated? Risk of what?

A

Indicated: After low transverse incision C section

Contraindicated: Classical (vertical) incision, multiple gestation

Risk of uterine rupture

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11
Q

Features of HELLP syndrome?

A

Hemolysis (H)

Haemolysis: low Hb, low haptoglobin, high LDH, high unconjugated bilirubin

Elevated Liver (EL) enzymes

Low Platelet (LP) count

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12
Q

Late deaccelerations reflect what?

A

Deaccelerations after contraction curve

Reflect placental inufficiency and hypoxia. Problem!

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13
Q

How’s this CTG? What does it represent?

A

Late deaccelerations during labour. Low variability, deaccelerations occur after contraction finish. Indicates Placental insufficiency, hypoxia + Problem!

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14
Q

Chlamydia mx?

A

Doxycycline 100mg PO, BD 7 days

OR

Azithromycin 1g PO, stat

Contact tracing back 6 months. Notifiable

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15
Q

When to use tocolytics?

A

Tocolytics (nifidipine/calcium channel blocker)

Indicated in pre-term labour when wanting to allow steroids to work (<34 weeks) or transfer to tertiary hospital

Contraindicated:

Haemodynamic instability in abuptio placentae

Cervical dilation > 4cm

Chorioamnionitis

Nonreassuring fetal signs

Cord prolapse

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16
Q

Uncomplicated genital gonorrhoea mx?

A

STAT IM ceftriaxone and oral azithromycin

Contact tracing back two months. Notifable

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17
Q

Main mechanism of action for progesterone implant?

A

Inhibits ovulation

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18
Q

Investigation of bleeding during pregnancy?

A

Resuscitate if needed

Abdominal examination: SFH, fetal lie

Bloods – CBE, group and save, Kleihauer, coagulation studies

CTG for fetal distress

Tranvaginal USS to assess position of placenta

NO digital vaginal exam

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19
Q

Mx of placenta previa ?

A

If Rh-ve give Anti-D

If bleeding stopped and HD stable –

Lives <20 minutes from hospital and have supports can go home

Lives >20 minutes stay in hospital until no bleeding for 24 hours

If still bleeding and HD stable –

Admit and monitor, send for group and hold

Conider steroids if <34 weeks

Will ultimately need C-section when mature fetus

If not stable -> emergency C-section

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20
Q

Investigations for suspected molar pregnancy? Mx?

A

B-HCG ++++++

USS: snowstorm

Chest CXR + LFTs to check for haematogenous spread of invasive disease (or choriocarcinoma)

Dilation and curettage. Normal reproduction after, higher risk of molar pregnancy

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21
Q

New onset rash in pregnancy. Diff Dx (4)?

A

Pruritic urticarial papules and plaques of pregnancy (PUPPP)/ Polymorphic eruption of pregnancy (PEP)

Atopic eruption of pregnancy

Potentially harmful to fetus:

Pemphigoid gestationis (self limiting)

Obsetetric cholestasis (very itchy on hands and feet) (IOL or ursodeoxycholic acid)

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22
Q

Risk factor for ovarian cancer (1)?

A

HPV 16/18

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23
Q

How to establish labour?

A

Regular contractions (3 every 10 minutes) and cervical dilitation

Can test for premature labour with fetal fibronectin if <35 weeks

Cervical USS to see if effacement if occuring (normal >3cm)

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24
Q

When should a pregnant lady be offered high dose folate supplementation (6)?

A

BMI >35

On anti-epileptics

On methotrexate

Diabetes

Inflammatory bowel disease

Family history of neural tube defects

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25
Q

Risk factors for endometrial cancer? (3)

A

Unopposd oestrogen exposure

Tamoxifen (oestrogen stimulator in endometrium, inhibits in breast)

PCOS

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26
Q

Mx of preterm labour?

A

Admit and consider transfer to tertiary centre with NICU

Steroids if <34 weeks – betamethasone

Tocolysis (nifedipine) unless contraindicated (infection or bleeding) to delay labour for 48 hours to allow steroids to work

MgSO4 for neuro protection (reduce risk of cerebral palsy) <32 weeks

ABx prophylaxis for GBS penicillin G

Treat chorioamnionitis (Ampicillin + Gentamicin + Metronidazole) or abruption (Fluid resuscitation and blood transfusion)

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27
Q

Free fluid in Pouch of Douglas? (2)

A

Ruptured Ovarian cyst

PID

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28
Q

Missed OCP today, last OCP taken 2 days ago. Had unprotected sex last night. At start of active pills (ended start sugar pills 2 days ago). How to manage?

A

Take missed pill now (2 in one day). As >48 hours since last pill, use condoms for 7 days

As just finished sugar pills, consider emergency conaception.

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29
Q

Gonorrhoea dx?

A

Men: first pas urine NAAT

Women: endocervical swab NAAT

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30
Q

Post menopausal bleeding differential diagnosis (3)?

A

Endometrial cancer

Endometrial polyp or hyperplasia

Atrophic vaginitis

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31
Q

Clamydia dx?

A

First pass urine NAAT

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32
Q

Screening tests in 2nd trimester?

A

2nd trismester chromosomal abnormality screen (if missed first): HCG + Alpha fetoprotein + estriol + inhibin A) (14-20 weeks)

Asymptomatic bacteuria screen (12 weeks)

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33
Q

Pre-menopausal bleeding, no clots, closed oss. Ix, Dx, Mx?

A

Doppler US + transvaginal USS

Threatened abortion

Reversible, watch and wait. Anti-D (625 IU)

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34
Q

What is the best test for ovulation?

A

Progesterone 7 days before expected menstruation

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35
Q

Contraindications to OCP (4)

A

Women over 35 who smoke

Previous VTE

Migraines with aura

Previous stroke, CVD

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36
Q

Pre-exising HTN vs Gestational HTN vs Pre-eclampsia?

A

Pre-existing HTN (>140/90) prior to 20 wk GA, persisting >7 wk postpartum

Gestational HTN: sBP >140 or dBP >90 developing after 20th wk GA in a woman known to be normotensive before pregnancy

Preeclampsia: pre-existing or gestational hypertension with new onset proteinuria

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37
Q

Pre-menopausal bleeding, no clots, open oss. Ix, Dx, Mx?

A

Doppler US + transvaginal USS

Inevidable abortion

Expectant management +/- misprostol (prostagladin) + Anti-D (625 IU)

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38
Q

Investigation of urge incontinence? (2)

A

Bladder diary

Urodynamic testing

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39
Q

Differentials for SGA fetus?

A

Symmetrical (small head=body): Chromosomal, TORCH infection
Asymmetrical (big head>>body): Placental dysfunction: abruption, infarction, previa, chorioamnionitis, matenal issue leading to insufficient nutrients or O2, smoking, alcohol

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40
Q

Complications of pre-eclampsia? (9)

A

Maternal: ARDS, placental abruption, cerebral heamorrhage

Fetal: IUGR, pre-term birth

Long term: HTN, ischemic heart disease, stroke, venous thromboembolism

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41
Q

In developing females, what order of changes during puberty? (4)

A

Boobs, Pubes, Grow & Flow

Breasts (8)

Axillary hair (9)

Growth spurt (10)

Menache (11)

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42
Q

Hyperemesis gravidarum dx?

A

Loss of weight

Ketouria

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43
Q

Routine screening at start of pregnancy? (5)

A

Blood type (for Rh- and APO incompatability, may need blood transfusion in future)

CBE (anaemia) and iron studies

Viral immunology (esp. Rubella)

Viral serology (HIV, Hep C, Hep B, Syphillis, TORCH infections, STIs)

Cervical screen

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44
Q

Main mechanism of action for intrauterine progestrrone device?

A

Prevents endometrial proliferation

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45
Q

When is the OCP effective?

A

If taken in first 5 day of menstrual cycle (from first day of bleed) -> effective immediately

If not, takes 7 days

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46
Q

Test for premature ovarian failure?

A

FSH/LH (will be increased), FSH:LH ratio >1.0

CVD screen

Bone density screen

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47
Q

Causes of polyhydramnios + investigations

A

Twins

Maternal diabetes

Reduce fetal swallowing (oesophagial atresia, duodental atresia)

Amniotic Fluid Index >25cm

Fetal wellbeing CTG, Morphology USS

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48
Q

Ectopic pregnancy haemodynamicaly unstable. Mx? (2)

A

Rupture: salpingectomy (tube removal)

If contralateral fallopian tube not viable: salpinostomy (tube preserving) (+ Rh- mothers need Anti-D 625 IU)

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49
Q

When does cervical screening start?

What tests does it involve (2)?

Pathways?

A

At age of 25 years or 2 years after the last pap smear (whatever is later)

HPV testing

If 16/18 deteced -> Liquid Based Cytology + referral (colposcopy)

If 16/18 not detected -> Liquid Based Cytology

High grade lesion -> referral (colposcopy)

Low grade lesion or negative LBC -> repeat HPV testing in 12 months

If after 12 months had repeated positive HPV (any type) -> referral (colposcopy)

50
Q

Investigations for preeclampsia?

A

Urine dipstick. urinalysis + 24 urine collection + urine protein-creatine ratio

EUC for renal function

CBE – haemolysis bloods, anaemia, platelets (HELLP)

LFTs (HELLP)

US – foetal growth restriction (complication)

51
Q

Milky fishy odor discharge from vagina. Dx, Mx?

A

Bacterial vaginosis

Metronidazole

52
Q

Dysmenorrhea differential dx (3)?

A

PID

Endometrisosis

Adenomyosis

53
Q

What is Kleihauer test used for?

A

The amoutn of maternal-fetal blood expure during a pregnancy bleed

Helps determine how much Anti-D is needed.

54
Q

Big fundal height compared to gestational weeks + bHCG++++. Next investigation, dx?

A

Transvaginal USS (snowstorm appearance)

Molar pregnancy

55
Q

Bishop’s score cut offs?

A

<5 needs cervical ripening (misoprostol or sweeping of membranes)

<6 not ready for vaginal birth (not ready for IOL)

56
Q

Variable deaccelerations reflect what?

A

Reflect cord compression: change maternal position

57
Q

Colicky lower abdominal pain during pregnancy differentials?

A

Preterm labour
Braxton Hicks contractions
Placental abruption
UTI, appendicitis

58
Q

Diff dx of bleeding during pregnancy?

A

Placental abruption

Placenta previa

Preterm labour

Miscarriage

Cervical pathology – cancer, ectropion, STI

59
Q

Diagnosis of PCOS?

A

Needs 2/3:

Clinical or lab evidence of hyperadrogenism (increased testosterone, 3:1 LH:FSH)

Anovulation

Polycystic ovaries on USS

60
Q

Contraindications for HRT (4)?

A

>60 or >10 years since LMP

Established cardiovascular disease

Previous VTE

Suspicion for endometrial cancer or breast cancer

61
Q

Which are cancerous HPV strains?

A

16 and 18

62
Q

Atrophic vaginitis mx (1)?

A

Topical oestrogen

63
Q

Risk factors for umbilical cord prolapse (5)?

A

Breech

Multiple pregnancies

Premature birth

Polyhydramnios

64
Q

What is the Rh- protocol?

A

For Rh- mothers (assuming Rh+ infants):

Anti-D given routinely at 28, 34 and post birth

Any bleeding during 2nd and 3rd trimesters

Any surgical intervention (ie miscarriage, ectopic pregnancy, D&C, termination)

65
Q

HPV 16/18 came up on cervical screening. Next step?

A

LBC and referral for colpscopy

66
Q

Follow up of Molar pregnancy?

A

Esure no invasive disease (CXR)

Serum BHCG 48 hours after surgery, every 1–2 weeks while this value is elevated, and then monthly for 6 months.

67
Q

Mx of urge incontinence (2)?

A

Referral to incontinence nurse

Anticholingergics (oxybutynin)

68
Q

Investigations for SGA fetus?

A

Serial USS + plot growth

Amniotic fluid index (AFI <5 Oligohydramnios)

Umbilical artery doppler

MCA doppler

Waveform

TORCH screen

Karyotyping

69
Q

Calculating estimated date of delivery:

What do you need to know?

How to do it?

A

Need to know:

1) LMP? 2) Regular cycle? 3) How long is cycle?

Calculate using Naegele’s rule: Date of LMP + 7 days (+ x days) - 3 months + 1 year

‘x’ days is amount over normal 28 day cycle. Ie if 35 day cycle:

Date of LMP + 14 days - 3 months + 1 year.

If LMP not known or irregular cycle: need US scan between 7-14 (8-11) weeks (max growth time so most accurate results).If more than 5 day discrepency, use USS

70
Q

Thick, white, adherent non offensive vaginal discharge in diabetic, post Abx steroid user.

Dx?

Mx?

A

Candidal vulvovaginitis

Topcial antifngal (clotrimazole, miconazole)

71
Q

Causes and mx of post partum haemorrhage?

A

Tone (uterine atony)

Trauma (perineal tears)

Tissue (retained placenta, placenta accreta)

Thrombin (coagulation disorders)

Turned inside out (uterine eversion)

ALS and Fluid resuscitation -> Check cause (high SFH for uterine atony, trauma of vagina)

Bimanual uterine massage + ocytocin + tranexamic acid -> intrauterine balloon tamponade -> Uterine artery Embolisation

72
Q

Contraception options if on anticonvulsant?

A

Use Mirena, Copper IUD or barrier

All hormonal mehtods interacts with anticonvulsants

73
Q

Mx of normal vomiting in pregnancy?

A

Dietary changes: small frequent meals + avoid spicy, odorous, high-fat, and acidic foods

Ginger +/- pyridoxine (B6) +/- doxylamine (H1-receptor antagonist)

74
Q

TORCH infections?

A

Toxoplasmosis

Others (including Syphillis, Listeria, Varicella Zoster, Parvovirus B19),

Rubella virus

Cytomegalovirus (CMV)

Herpes simplex virus (HSV)

75
Q

Complication of PCOS?

A

Higher risk of endometrial cancer

Infertility

Metabolic syndrome: T2DM, CVD

OSA

76
Q

Causes of menorrhagia or abnormal uterine bleeding (9)?

A

Menorrhagia = heavy bleeding

PALM (structural) COEIN (physiological)

Polyps

Adenomyosis

Leiomyoma (fibroids)

Malignancy (endometrial cancer)

Coagulopathy

Ovulation dysfunction

Endometrisosi

Iatrogenic

Not classified

77
Q

Complaints about prolapse (7)?

A

ADD B2 + S2

Asymptomatic

Discomfort (dragging)

Dysfunction (Bladder + Bowel)

Sexual issue

pSychiatric concerns (afriad of cancer)

78
Q

What are the screening tests for chromosomal abnormalities ?

A

First trimester: Pregnancy Associated Plasma Protein (PAPP-A) + b-hCG + nucheal translucency USS

Second trimester: Alpha feto-protein + HCG + ucongugated estriol

Confirm with CVS or amniocentesis

79
Q

Copious thin white, discharge with fishy odour. >4.5 pH. Dx? Ix? Mx?

A

Bacteial vaginosis

Clue cells on wet prep from vaginal swab

Metronidazole

80
Q

Karyotype of Turner’s syndrome + other features (5)

A

45XO

Widely space nipples

Webbed neck

Hypergonadotropic hypogonadism (low oestrogen, low androgens, high FSH/LH) + Primary amenorrhoea

Coarctation of aorta

Short stature

81
Q

Indications for induction of labour (6)

A

Matenal:

Mild preclampsia after 37 weeks (severe at any time, consider steroid before 34 weeks)

Maternal request

Gestational diabetes at 39 weeks (reduce risk of shoulder dystocia)

Fetal:

Post term pregnancy

Prelabour prterm rupture of membranes

Chorioamnionitis

82
Q

Benefits to HRT? (3)

A

Reduce menopausal symptoms

Cadioprotective (if no current CVD)

Protects against osteoporosis

83
Q

What contraception contraindicated with carbemazapine?

A

Systemic hormonal (COCP, implanon, POP)

84
Q

Main mechanism of action for COCP?

A

Inhibits ovulation

85
Q

Post coital bleeding young women differential dx? (4)

A

Cervical ectropian (new OCOP use)

STI

Hormonal contraception

Cervical malignancy

86
Q

Missed OCP today, last OCP taken 24 hours ago. Had unprotected sex last night. How to manage?

A

As <48 hours since last pill, the pill is still working.

Take missed pill now (2 in one day) and continue regular cycle

87
Q

A 57-year old post-menopausal woman is referred to the gynaecology clinic by her general practitioner following the incidental discovery of an ovarian cyst on ultrasound. She is otherwise completely well. The ultrasound report describes “a 5cm left sided ovarian cyst with solid components. Right ovary normal.” She has had bloods performed and her CA-125 level is 25. Management?

A

3 for post menopausal x 1 for one US finding x 25 CA-125 level

RMI: 75 (3 x 1 x 25)

Moderate risk of RMI (25-200) -> laparoscopic salpingo-oophorectomy

High risk (>200) -> staging laparotomy

88
Q

Mx of PID?

A

Ceftriaxone, metronidazole, doxycycline

89
Q

Complicatons of PID (3)?

A

Infertility

Ectopic pegnancy

Fitz-Hugh-Curtis syndrome: adhesions that cause chronic pain

90
Q

How’s this CTG? What does it represent?

A

Norml CTG showing early deaccelerations during labour (head compression)

91
Q

Which HPV strains cause warts?

A

6 and 11

92
Q

Goals of therapy in PCOS? (4 +1)

A

Reduce irregular menses (OCP, Metformin)

Reduce endometrial hyperplasia + risk of endometrial cancer from unopposed oestrogen (OCP)

Reduce androgen production (OCP)

Control metabolic syndome (weight loss, metformin)

Induce ovulation if wanting pregnancy: letrozole

93
Q

How’s this CTG? What does it represent?

A

Variable deaccelerations. Demonstrates cord compression.

94
Q

Pre-menopausal bleeding, no clot, closed oss. No fetal heart beat, Dx, Mx?

A

Missed abortion

Misprostol (prostagladin) + Anti-D (625 IU)

95
Q

Mx of Hyperemesis gravidum? (7)

A

Urine dipstick (for ketones). EUC to check for AKI. Urine MCS for pyelonephritis

Ultrasound on admission -> higher risk of IUGR

IV Fluids. consider thiamine + glucose for prolonged vomiting (prevent Wenicke’s encephalopathy)

Pharmacological:

1st line: Metoclopramide or doxylamine

2nd line: Ondansetron for severe hyperemesis gravidarum

96
Q

Features of endometriosis (4)?

A

Dysmenorrhoea

Dyspareunia

Pelvic pain

Infertility

97
Q

Posterior vaginal labial swelling differentials (2) and mx?

A

Bartholin gland cyst or abscess

Abscess: I&D

Cyst: Marsupialisation

98
Q

Screening tests in 1st trimester?

A

Dating USS 8-12 weeks

Serology screen (HIV, Hep B, Hep C, Syphillis, TORCH)

Blood type

1st trimester chromosomal abnormalities screen: b-HCG, PAPP-A + nuchal translucency scan (11-14 weeks)

99
Q

Risk factors for ovarian cancer?

A

BRCA + Lynch syndrome

Factors that lead to increased number of ovulation cycles:

Nulliparity

Early menarche, late menopause

COCP adds protective effect!

100
Q

Previous cervical screening 12 months ago showed LSIL. Now HPV testing shows HPV11. Mx?

A

LBC and referral for colpscopy

101
Q

Thin, frothy, yellow, malodourous, strawberry cervix, >4.5 pH. Dx, Mx?

A

Trichomonas vaginalis

Single dose 2g tinidazole or 2g metronidazole

102
Q

Approximate fundal heights per gestational week (3)?

A

12 weeks palpable above pubic bone

20 weeks palpable at umbilicus

36 weeks palpable at sternum

103
Q

Investigations for suspected pre-term labour?

A

Abdominal palpation

CTG

Do not perform vaginal examination (infection risk, unsure if low lying placenta)

US for cervical length (ie start of cervical effacement). If <3cm, high risk of delivery in next 7 days. Needs hospitalisation

GBS status

CBE and CRP to check for infection

Midstream urine

High and low cervical swab

Amnistick or ferning

Fetal fibronectin test (if <35 weeks)

104
Q

Missed OCP today, last OCP taken 2 days ago. Had unprotected sex last night. At end of active pills (about to start sugar pills tomorrow). How to manage?

A

Take missed pills now (2 in one day). As >48 hours since last pill, use condoms for 7 days

As about to start sugar pills, change to new cycle and start active pills

105
Q

Mx of shoulder dystopia?

A

Ask for help

Perform McRobert’s manoeuvre (flex and abduct hips)

Apply suprapubic pressure

Attempt to manually rotate the anterior shoulder (Rubin manoeuvre)

106
Q

Pre-menopausal bleeding, clots, closed oss. Ix, Dx, Mx?

A

Doppler US + transvaginal USS

Complete abortion

Anti-D (625 IU)

107
Q

Complications of IUD insertion? (4)

A

Device expulsion (usually next period)

PID

Device migration to peritoneal cavity

Uterine perforation

108
Q

Ectopic pregnancy haemodynamicaly stable. Mx?

A

Methotrexate (+ Rh- mothers need Anti-D 625 IU)

109
Q

Causes of oligohydramnios (3) + investigations? (2)

A

Placental insufficiency (dugs use, smoking, placental abruption)

Decreased fetal urination: renal agenesis, posterior urethral valves

Amniotic Fluid Index <5cm

Fetal CTG, Fetal morphology US

110
Q

Risk factors ovarian cancer (2)?

A

BRCA mutations

Lynch syndrome (CEO = colorectal, endometrial, ovarian)

111
Q

Causes of increased SFH compared to gestational age?

A

Wrong gestational age/ EDD

Multiple pregnancies (twins)

Polyhydramnios: Fetal abnormality (structural causing difficulty swallowing), TORCH infection

LGA (from gestational diabetes)

If early in pregnancy with no USS -> Gonadotrophic hyadid/Molar pregnancy

112
Q

Is warfarin safe in breast feeding? Does it cross the plaenta?

A

Yes and yes (not safe in pregnancy)

113
Q

Risks to HRT ? (3)

A

Breast cancer risk if for more than 4-5 years (needs oestogen+progesterone)

Endometrial cancer risk if uterus + oesotrogen alone

Stroke and ischemic heart disease if established VTE or coronary artery disease

114
Q

Previous cervical screening 12 months ago showed LSIL. Now negative HPV. Mx?

A

Back to 5 yearly screen

115
Q

How’s this CTG? What does it represent?

A

Normal CTG during labour.

Normal HR,normal variability, normal accelerations associated with contractions.

116
Q

Post menopausal bleeding investigation (3)?

A

Transvaginal USS (>4mm has high risk)

Endometrial biopsy

Hystoscopy

117
Q

What pathogen are we worried about in gastroenteritis in pregnancy? What’s more common (2)?

A

Listeria

More common: rotavirus + norovirus

118
Q

Causes of seconday ammenorrhoea? (7)

A

Pregnancy

Meds: Anti-psychotics + metoclopramide (dopamine antagonists -> nothing opposes prolactin -> inhibits GnRH)

Hypothalamus issue: Physiological stress, anorexia, excssive exercise

Pituitary issue: Hypothryoidism (TRH+++ stimulates prolactin -> inhibits GnRH), Prolactinaemia (prolactin inhibits GnRH), Sheehan’s syndrome

Ovarian issue: PCOS, premature menopause

Endometrial issue: Ashemann’s syndrome post procedure

119
Q

Contraindication to Neagles rule? (2)

Alternative?

A

Irregular cycle, hormonal contraception in last 12 weeks.

Crown-rump ratio by USS 7-14 weeks

120
Q

Milky fishy odour with alkalotic pH, smear shows clute cells. Dx and Mx?

A

Bacterial Vaginosis

Metronidazole, must be treated in pregnancy, higher risk of fetal complicaitons (miscarriage, preterm labour)

MBBS V (6 decks)

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