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obs n gyne Flashcards

1
Q

gestatonal diabetes

A

5678

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2
Q

pregnancy induced hypertension definition

A

htn after 20weeks gest
no protenuria no oedema

resolves after birth

in risk of future pre eclampia or htn later in life

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3
Q

on acei for htn before pregnancy

A

stop and give labetolol while awaiting review

labetolol CI = nifedipine and hydralazine

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4
Q

pre eclampsia

A

preg induced htn w proteinuria (>0.3g/24hrs)

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5
Q

abx avoid in breastfeeding

A

ciprofloc
tetracylines
chloramphen
sulphonamides

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6
Q

psych drugs avoid in breastfeeding

A

Lithium benzo

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7
Q

drugs to avoid in breastfeading

A

aspirin
carbimazole
methotrex
sulfonyurea
cytotoxic dx
amiodarone

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8
Q

placeta acreta

A

attacthment of placenta to myometrium
doesnt properly seperate in labour there is a risk of PPH

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9
Q

placenta acreta, increta, percreta

A

chorionic villi attached to myometrium

invade myometrium

invade thru perimetrium

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10
Q

postpartum thyroiditis

A

immune attack of thyroid within 6 mths of giving birth

3 phases
thyrotoxicosis
hypothyroidism
normal thyroid function in 12 ths (high rate of recurrence in future pregnancies

hyperthyroid phase = propanolol
hypo = thyroxine

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11
Q

postpartum thyroiditis abs

A

thyroid peroxidase

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12
Q

ssri breastfeeding

A

sertraline paroxetine

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13
Q

folic acid

A

women 400mcg OD 3 months before conception until 12 weeks gestations

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14
Q

risk factors gestational diabetes

A

bmi>30kg
previous big baby 4.5kg+
prev gest diabetes
1st degree relative diabtes
family origin w high prev ie south asian, black cariibean, middle eastern.

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15
Q

NOACs in pregnancy

A

CI therefore change to LMWH ie enoxaparin

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16
Q

retinopathy of prematurity

A

visaul impairment in premmie <32 weeks

contributing fx is overoxygenation eg bc venilation == prolif retinal blood vessels (neovascurlisation)
loss of red reflex
screening done in at risk groups

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17
Q

airtravel in preg

A

not recommended post 37 wks in uncomp singlton preg

32wks if uncomplicated multiple preg

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18
Q

symphysis fundal height

A

top of pubic bone to uterus in cm

should match gest age in weeks
within 2cm after 20 weeks

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19
Q

fetal movements

A

start 18-20 weeks and increase until plataue after 32 weeks

16-18 weeks in multiparous

should be established by 24 weeks

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20
Q

what fetal position may make movement less noticable

A

anterior fetal position

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21
Q

causes of oligohydramnios

A

prom
pottor sequence
interauterine growth restriction
post term gestation
pre eclampsia

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22
Q

Group b strep proph

A

benzylpeniciliin

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23
Q

high risk factors for preeclampsia

A

htn in prv preg
CKD
autoimmune ie SLE or antiphosphollipid
type 1 or 2 diabetes
chronic htn

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24
Q

mod risk factors for preclampsia

A

1st preg
40+ or preg interval 10 yrs
bmi>35kg at first visit
fam hx preclampsi
multiple preg

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25
Q

reducing risk of hypertensive disroders

A

1+ high rf
2+ mod rf

= aspirin 75-150mg daily from 12 weeks gestation until birth

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26
Q

when need 5mg folic acid

A

either partner NTD, prev preg w NTD, Fam hx NTD
women taking antiepileptic
coeliac disease
diabetes
thalassaemia trait
obese bmi>30

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27
Q

drug cuases folate deficiency

A

Phenytoin
methrotrexate
pregnancy
alcohol excess

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28
Q

gestational diabetes in previous pregnancy

A

offer OGTT asap after booking
and at 24-28 weeks

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29
Q

antiepileptics in pregnancy

A

usually all safe except barbituates

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30
Q

phenytoin in pregnancy

A

associated w cleft palate

if taking in preg = take vit K last month of pregnancy to prevent clotting disorders in newborn

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31
Q

what to monitor w pt on mg sulphate

A

urine output
reflexes
resp rate
o2 saturations

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32
Q

abruption risk factors

A

ABRUPTION

A abruption prev
B blood pressure (HTN/preclampsia_
R ruptured membranes (premature or prolonged)
U uterine injury (trauma to abdo)
P polyhydramnios
T Twins or multiple gestation
I infection in uterus ep chorioamionitis
O older (>35)
N Narcotic use ie cocaine and amphetamines

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33
Q

nausea and vomiting in pregnancy

A

natural : ginger and p6 point acupuncture on wrist

1st line antihistamines ie promethazine

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34
Q

mx of pprom

A

admission
regular observation to see chorioamnionitis
oral erythromycin
corticosteriods (to reduce risk of resp distress)

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35
Q

criteria for surgical management of ectopic
which one

A

Size >35mm
ruptured or not
pain
fetal heartbeat
hCG >5000
(fine if theres another intrauterine preg)

salpingectomy 1st line if no other RF for infertility

otherwise salpingotomy

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36
Q

medical management criteriaof ectopic

n what is it

A

<35mm
unruptured
no signifcant pain
no heartbeat
hCG<1500

Methotrexate
(not suitable if another intrauterine preg)
Only done if pt willing to attend follow up

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37
Q

tx herpes simples genital ulcers tx

A

primary infection = Valaciclovir 10 days

recurrence = 3 days

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38
Q

risk factors umbilical cord prolapse

A

prematurity
multiparity
polyhydramnios
twin pregnancy
cephalopelvic disproportion
abnormal presentations e.g. Breech, transverse lie

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39
Q

oestrogen secreted

A

theca granulosa cells in ovaries

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40
Q

progesterone produced by

A

corpus luteum

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41
Q

HRT w uterus

A

oestrogen and progesterone

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42
Q

HRT no uterus

A

oestrogen only

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43
Q

combined hrt risk

A

breast cancer

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44
Q

oestrogen only hrt risk

A

endometrial cancer (thats why do not give if have uterus)

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45
Q

risk of vte w hrt

A

increased when prog as well
transdermal doesnt inc risk

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46
Q

risk of IHD w HRT

A

only 10 years after menopause

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47
Q

risks of hrt overall

A

cancers etc
vte
stroke
IHD

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48
Q

rotterdam criteria PCOS

A

2 of 3

  • Oligoovulation/anovulation – irregular, absent periods
  • Hyperandrogenism – hirsutism, acne
  • Polycystic ovaries on USS
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49
Q

pcos path

A

Insulin resistance – insulin = higher levels of androgens and suppresses SHBG
which suppresses androgens usually

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50
Q

pcos blood findings

A

Raised LH, raised LH:FSH ratio, raised testosterone

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51
Q

ovarian cysts
 Functional cysts –
 Corpus luteum cysts –
 Dermoid cysts/germ cell tumours –

A

harmless, disappear

often early pregnancy

teratomas, may contain skin/teeth/hair/bone

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52
Q

ashermans syndrome

path

causes

sx

A

adhesions connecting areas of uterus that wouldnt usually be connected
because of damage to it

ie D&C, uterine surgery, endometritis

painful lighter periods (2ndry amen)

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53
Q

cervical ectropian path

A

Columnar epithelium of endocervix extended out to ectocervix (stratified
squamous epithelium)
bc elevated oestrogen

= exposed to erosion

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54
Q

cervical ectropian sx

A

post coital bleeding
vaginal discharge

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55
Q

pelvic organ prolapse

Uterine prolapse –
 Vault prolapse –

A

uterus into vagina

hysterectomy – vault into vagina

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56
Q

pelvic organ prolapse

Rectocele –

Cystocele –

A

posterior vaginal wall defect – rectum prolapses into vagina –
constipation, urinary retention, lump

anterior vaginal wall defect – bladder into vagina

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57
Q

organ prolapse grading

A

Grading
- 1 = lowest part >1cm above introitus
- 2 = lowest part within 1cm of introitus
- 3 = lowest part >1cm below introitus
- 4 = full descent

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58
Q

endometrioma

A

chocolate cysts in endometriosis
if rutpure

= sudden intense pain

USS = free fluid in pelvis

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59
Q

oestrogen only HRT and breast cancer ?

A

doesnt increase risk if used for less than 10 years

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60
Q

uterine fibroids mx in meantime of op

A

GnRH agonst - triptorelin
only short term

to shrink fribroids

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61
Q

oesteoporosis RF

A

glucorticoid
RA
Alcohol excess
hx of parental hip frac
low bmi
current smoking

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62
Q

long term complications PCOS

A

Subfertility
Diabetes mellitus
Stroke & transient ischaemic attack
Coronary artery disease
Obstructive sleep apnoea
Endometrial cancer

complications inc in pts who are obese

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63
Q

acute urinary retention causing meds

A

anticholinergics, tricyclic antidepressants, antihistamines, opioids and benzodiazepines.

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64
Q

cause of necrotising facitis in pt w chicken pox

A

b haemolytic group a steptociccus

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65
Q

uterine fibroid <3cm
not distorting uterurine cavity tx

A

medical treatement

MIrena coil (IUS) tranxemic acid
cocp
pop

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66
Q

risk malignancy index (RMI) in ovarian ca components

A

CA125
menopausal status
US findings

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67
Q

rubella in pregnancy when is biggest risk

A

1st 8-10 weeks risk of damage to fetus v high
damage rare after 16 weeks

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68
Q

congenital rubella sx fx

A

sensorineural deafness
congen cataracts
congen heart disease (PDA)
growth retardation
hepatosplenomeg
purpuric skin lesions
salt and pepper chorioretinitis
microphthalmia
cerebral palsy

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69
Q

vaginal prostaglandin

A

dinoprostone

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70
Q

oral prostaglandin e1

A

misoprostol

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71
Q

what to moniter if given mg sulpate

A

reflxes and resp rate

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72
Q

bishop score 0 points
Cervical position
Cervical consistency
Cervical effacement
Cervical dilation
Fetal station

A

Cervical position - posterior
Cervical consistency - firm
Cervical effacement - 0-30%
Cervical dilation - <1cm
Fetal station - (-3)

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73
Q

bishop score things that score 1

A

Cervical position = intermediate
Cervical consistency = intermediate
Cervical effacement = 40-50%
Cervical dilation = 1-2cm
Fetal station = -2

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74
Q

bishop scores 2

A

Cervical position - Anterior
Cervical consistency - soft
Cervical effacement - 60-70%
Cervical dilation - 3-4cm
Fetal station -1, 0

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75
Q

bishop score 3

A

Cervical position -
Cervical consistency -
Cervical effacement 80%
Cervical dilation >5cm
Fetal station +1,+2

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76
Q

bishop score >6

A

amniotomy and IV oxytocin

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77
Q

stage 1 labour

A

onset of true labour to full dilation

latent= 0-3cm takes 6 hrs
active = 3-10cm dilation, 1cm/hr

78
Q

most likely place to rupture ectopic

A

isthmus

79
Q

antenatal visit booking visit

A

8-12 weeks

diet, alcohol, smoking, folic, vitD, classes

BP urine dip BMI

Bloods= fbc, group, rhesus status, hep b, syhphyllys
HIV
Urine culture for asympotmatic bacteriuria

80
Q

11-13+ 6 weeks antenatal visit

A

early scan confirm dates
excluse multple preg
downsyndrome nuchal scan

81
Q

16 weeks antenatal visit

A

bp and urine drip
routine

82
Q

18-20+6 week antenatal scan

A

anomaly scan

83
Q

25 weeks only if primip

A

bp
urine dip
symphysis fundal height

84
Q

28 week scan

A

Routine care: BP, urine dipstick, SFH

Second screen for anaemia and atypical red cell alloantibodies. If Hb < 10.5 g/dl consider iron

First dose of anti-D prophylaxis to rhesus negative women

85
Q

down syndrome preg testing results

A

low afp
low oestriol
high bHCG
low PAPP-A
thickened nuchal translucency

86
Q

risk factors for ovarian ca

A

many ovulations ie

early menarche
late menopause
nulliparity

87
Q

implant contraceptive ie nexplanon
adverse effets

A

irregular/heavy bleeding (coprescribe COCP)

‘prog effects’ ie headache, nausea, breast pain

88
Q

risk factors for hyperemesis gravida

A

inc leveks of bHCG ie
- multiple gest
- trophoblastic disease

nulliparity
obesity
family or personal hx of n&V of pregnancy `

89
Q

hyperemeisis gravida ddx criteria triad

A

5% pre preg wt loss
dehydration
electrolyte imbalance

90
Q

4 Ts - causes of PPH

A

Tone (uterine atony): the vast majority of cases
Trauma (e.g. perineal tear)
Tissue (retained placenta)
Thrombin (e.g. clotting/bleeding disorder)

91
Q

when are pregnant women screened for anaemia

A

booking visit 8-12 wks
28 weeks

92
Q

oral iron therapy cut off in pregnancy

and tx

A

1st tri if <110

2nd/third <105

postpartum <100

oral ferrous sulphate or fumarate
contin for 3 mths after corection to replenish stores

93
Q

cocp inc risk and dec risk of what

A

increased risk of breast and cervical cancer

protective against ovarian and endometrial cancer

94
Q

puerperal pyrexia def and cause

A

temp>38 in 14 days postpartum

endometritis: mc cause
uti
wound infections (tear/c section)
mastitis
VTE

95
Q

endometritis tx

A

admit iv abx clindamycin and gentamicin until afebrile 24 hrs

96
Q

women for gest diabetes rf screening

A

booking scan
and 24-28 weeks

97
Q

pcos hirsutism and acne tx

A

cocp

no response
= topical eflotnithine

spironolactone flutamide and finasteride under specilaist

98
Q

nexplanon implant time back to normal fertility

A

4 weeks

99
Q

contraception in pt w gastric sleeve/bypass/duodenal switch

A

never oral again

100
Q

cervical canvcer epid type and virus

screening

A

under 45 yo
squamous cell
HPV16&18

3yrs 25-49
5 yrs 50-64

101
Q

cervical ca RF

A

hpv 16 18
smoking
early first intercourse, many partners
high parity
cocp
low socioecon status

102
Q

cervical ca staging

A

FIGO

1a only cervix not visible
1b only cervix but visible

2 beyond cervix but not pelvic wall

3 reached pelvic wall (hydronephrosis)

4 beyond pelvic wall ->blader n rectum

103
Q

endometrial cancer type

A

adenocarcinoma

104
Q

rf endmetrial ca

A

unapposed oestrogen
older
early menarch
later menopause
obesity
diabetes

105
Q

ovarian ca type

A

epithelial usuall serous carcinoma

germ cell tumor = high afp and hcg

106
Q

ovarian ca why does cocp help

A

risk caused by more ovulations

cocp = lowers ovulations

107
Q

where can ovarian ca spreas

A

paraaortic lymph nodes

108
Q

vulval cancer type

A

scc

109
Q

vulval Ca Rf

A

age
hpv
immunosupression
lichen sclerosis

110
Q

features vulval Ca

A

lump or ulcer on the labia majora
inguinal lymphadenopathy
may be associated with itching, irritation

111
Q

Benign breast conditions
 Duct ectasia
 Papilloma
 Galactorrhoea
 Nodularity

A

– yellow/green, thick, maybe bloody. Expectant management.

– bloody/clear. Microdorchectomy.

– milky

– normal – cyclical

112
Q

breast cysts

A

40-60 – aspirate
 Infection – S. aureus
- Lactational/peripheral – fluclox
- Non-lactational / central – fluclox and metro

113
Q

progest only contraception n SEs

A
  • Implant – 3 years, hormonal SEs
  • Injection – 12 weeks, SEs hormonal, weight gain, reduced bone density
  • POP – daily (breast ca risk)
  • IUS – 6 years, hormonal SEs
114
Q

Ulipristal
when
types
works when
breastfeeding?
CI?

A

within 120 hours. Pill, patch, ring – start 5 days after. If breastfeeding,
wait 1 week. Not in severe asthma

115
Q

Postpartum contraception
- Anytime if no risks

A

POP, implant, injection

116
Q

Postpartum contraception
3 weeks / 6 weeks breastfeeding

A

COCP, patch, ring

117
Q

Postpartum contraception
48 hours/4 weeks

A

IUD/IUS

118
Q

POP missed pills

A

Desogesterel/cerazette
 Less than 12 hours late – no action
 More than 12 hours late – take missed pill ASAP and next one at usual
time – extra cautions for 48 hours

Others
 Same as above but 3 hours

119
Q

miscarriage medical mx missed

A

oral mifepristone. 48hrs later misoprostol unless gestational sac has
passed.

(preg test after 3 weeks)

120
Q

miscarriage medical mx incomplete

A

single dose misopristol

(preg test after 3 weeks)

121
Q

when is combined test done

what tested

A

11-14 weeks

PAPP-A
BHCG
nuchal translucency

122
Q

when quadruple test done

A

up to 20 weeks

123
Q

when is chronioc villois sampling done

A

10-13wks

124
Q

amniocentisis timw

A

15-20wks

125
Q

Causes of oligohydramnios (AFI<5)

A
  • Renal agenesis
  • Placental insufficiency
  • ROM
  • Pre-eclampsia
126
Q

Causes of polyhydramnios (AFI>24)

A
  • Maternal DM
  • Multiple GIT
  • CNS issues
127
Q

lithium in preg =

A

ebsteins anomaly

128
Q

SSRI complication in preg

A

tri 1 congenital heart defects / tri 3 pulmonary
HTN

129
Q

induction of labour

A

Vaginal PGE2  reassess at 6 hours  oxytocin infusion  amniotomy 
cervical ripening balloon

130
Q

shoulder dystocia

A

Help
 Episiotomy
 Mcrobert’s – hyperflexion of mother at hip

 Suprapubic pressure – pressure to anterior shoulder

 Rubin’s – pressure of posterior aspect of anterior shoulder

 Woodscrew’s – same time as above – pressure anterior aspect

 Replace head – zavanelli manoeuvre
 LCSC

131
Q

PPH mx

A

ABC -> palpate uterus -> catheterise -> IV oxytocin -> IM carboprost ->
intramyometrial carboprost -> rectal misoprostol -> balloon tamponade

 Secondary – up to 12 weeks

132
Q

conditions to take 5mg folic acid

A

if epilepsy, coeliac disease, DM, high BMI, neural tube defect risks

133
Q

CTG rate

A

110-160

<100/>180 = abnormal

134
Q

ctg decelerations

A
  • Early = head decompression
  • Variable = cord compression
  • Late = hypoxia
135
Q

hellp syndrome features

A

haemolysis
elevated liver enzymes
low plts

136
Q

mc benign ovarian tumour in women under the age of 25 years

A

dermoid cyst (teratoma)

137
Q

meigs syndrome

A

benign ovarina tumor (fibroma)
associated w ascites and pleural effusion

138
Q

androgen insensitovity syndrome (AIS)

A

x linked
resistance to testoesterone
= 46XY but phenotype female

extra androgen converted to oestrogen may have breast development
lumps in groinundescended testes = ca risk

139
Q

how to check if 2ndy amen is primary ovarian failure

A

high FSH

4 weeks amenorhea
2 samples 4 weeks apart

140
Q

indications for HRT

A

vasomotor sx ie flushing, headaches, insomnia
premature menopause

141
Q

reasons for hrt in younger women

A

prevent osteoporosis

142
Q

other hrt benefits

A

reduce risk of colorectal ca

143
Q

hrt if risk VTE

A

transdermal

144
Q

se hrt

A

nausea
breast tenderness
fluid retention and weight gain

145
Q

cylical combined hrt

A

perimenopausel (ie period in last 12 mths)

given 10-14 days per month
monthtly breakthru bleed

can swtitch to combined after 12mths if >50 and 24 mths if<50

146
Q

continuous hrt

A

for post menopausal

no period 12 mths >50yo
no period 24mth < 50yo

147
Q

primary ovarian insufficiency

A

menopause before 40

hypergonadotropic hypogonadism

(Under-activity of the gonads (hypogonadism) means there is a lack of negative feedback on the pituitary gland, resulting in an excess of the gonadotropins (hypergonadotropism))

hormones =
raised LH and FSH (gonadotropins)
low oestradiol

148
Q

autoimmune causes of primary ovarian insuff

A

coeliac
adrenal insufficiency
type 1 dm
thyroid

149
Q

risk of what w primary ovarian insuff

and tx

A

dementia
parkinsons
OP
stroke
svd

either HRT till 51
or cocp

150
Q

emergency contra

A

copper iud - 5 days or ovulation

levenogestrel - 72hrs restart cocp asap

ulipristal - 120 hrs

151
Q

cervical/endometrial ca avoid which contra

A

mirena

152
Q

breast ca contraception

A

avoid hormonal

barrier or copper coil

153
Q

wilsons contraception

A

avoid copper coil

154
Q

monochorionic diamniotic twins

A

t sign

155
Q

dichorionic diamniotic

A

twin peak sign

156
Q

monochorionic USS

A

every 2 weeks from 16 wks

157
Q

dichorionic USS

A

2 weekly from 20 wks

158
Q

planned birth for twins

A

32 MCMA

36 MCDA

37 DCDA

159
Q

obstetric cholestasis

A

uro acid

calamine lotion
antihistamine

PTT deranged = water soluble vit K

160
Q

HELLP Syndrome

A

haemolysis
elevated liver enzymes
low plts

161
Q

causes of polyhydramnios

A

maternal DM
multiple gest
CNS issues

162
Q

kleihauser test

A

see how much fetal blood mixed in maternal

163
Q

BV in pregnancy

A

metronidazole 400mg bd 7 days

164
Q

tocolytic

A

relax uterus

ie in prolapse b4 c section

165
Q

disseminated gonococcal infection

micro

and triad

A

gram -ve diplocci

tenosynovitis
migratory polyarteritis
dermatitis (maculopap or vesicular)

166
Q

syhphyllis ulcer

A

painless and lymphade

167
Q

lymphogranuloma venerum

A

tender swollen inguinal LNs

167
Q

Haemophilus ducreyi

A

painful ulcer

168
Q

antepartum haemorrhage def

A

bleeding from genital tract after 24 wks before delivery of baby

169
Q

fetal lie presentation in abruption

A

normal ie

longitudinal lie and cephalic presentation

170
Q

why may shock be out of keeping with visual loss in abruption

A

bleed is retropalcental ie doesnt escape from uterus

171
Q

clotting studies post major abruption

A

low fibrinogen

placental damage = thromboplastin release in circulation

= DIC bc all clotting factors esp fib used up

172
Q

sx and signs of ectopic

A

abdo pain
shoulder pain
vag bleeding
tachy
hypotension
amenorhea

cervical excitation adnexal mass

173
Q

bedside tests for suspected ectopic

A

urine bhcg

174
Q

ectopic rf

A

PID
prev ectopic
pop
intrauterine
emdometriosis
prev tubal surgery

175
Q

where may fertilised ovum implant

A

follopian tubes
ovary
cervix
peritoneum
liver

176
Q

hyperemesis gravid rf

A

high levells of bhcg

1st pregnancy
young age
multiple preg
molar preg
hypethyroid
pre hx motion sickness

177
Q

bedside test in hyperemesis gravid

A

urine dip for ketones

suggesting starvation and ketosis

178
Q

complications of hypermesis

A

aki
wernickes enceph (give thiamine)
oesphagitis, mallory weiss tear
VTE

179
Q

signs on exam suggesting malignancy

A

visible mass
ulceration
inflammation
bleeding

180
Q

bv rf

A

excessive vag douching
smoking
multiple partners
copper coil
recent abx

181
Q

apgar categories

A

color
tone/activity
resp effort
pulse
reflex irritability

182
Q

first tri markers

downsyndrome

A

PAPP-A hCG Nuchal trans

low high increased

183
Q

triple test markers

A

hcg AFP estriol

184
Q

what test added if quad test 2nd tri

A

inhibin A

185
Q

triple test markers downs

A

in hcg

dec afp

dec estriol

(inc inhibin a)

186
Q

how does gest dm lead ro macrosomia

A

inc foetal Blood glusose

= feotal hyperinsulinaemia
= inc fat deposition

187
Q

reassuring CTG

A

feotal hr 110-160
accelerations
variability of greater than 5 beats per min
absence of deceleraions

188
Q

how do women inc o2 intakein oreg

A

tidal volume

189
Q

normal feotal ph

A

7.25

190
Q
A

finals (28 decks)

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