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PLABABLE 2.0 > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Methotrexate is indicated for ectopic pregnancy if she can satisfy ALL the following criteria

A

Not in significant pain
Hemodynamically stable
Adnexal mass <35mm with no fetal heart visible
No intrauterine pregnancy
Serum hCG < 5000 IU/L (ideally < 1500 IU/L)
Able to return for follow-up

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2
Q

Emergency contraception of choice within 72 hours of unprotected sex

A

Levonelle Pill

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3
Q

Emergency contraception within 120 hours of unprotected sex

A

IUCS or ellaOne pill

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4
Q

Pregnant exposed to chickenpox

A

Check women’s immunity (previous infection, varicella antibodies)

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5
Q

Pregnant exposed to chicken pox and not immune

A

Administer VZIG (unless more than 20 weeks, in which case pick aciclovir)

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6
Q

IF we suspect that the fetus may have Rhesus hemolytic disease, what investigation should we perform on the pregnant patient? Why?

A

Assess fetal MCA via UTZ

To estimate fetal Hgb concentration -> estimate fetal anemia

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7
Q

Less than 24 weeks AOG
With pain or bleeding or pain and bleeding
UTZ - fetus has fine heartbeat

A

Threatened Miscarriage

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8
Q
  • less than 24 weeks AOG
  • bleeding
  • open cervix
A

INEVITABLE MISCARRIAGE

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9
Q

What PE findings would you appreciate in a patient with missed miscarriage?

A

Less than 24 weeks AOG
Presents with pain, bleeding or pain + bleeding
UTZ does not show fetal heartbeat

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10
Q
  • less than 24 weeks AOG
  • with bleeding
  • history of passing products of conception
  • cervix may be open
  • no fetal heart
  • heterogeneous tissue seen on UTZ
A

Incomplete Miscarriage

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11
Q

A patient presents less than 24 weeks AOG with bleeding and a history of passing products of conception. Ultrasound revealed an empty uterus.

A

COMPLETE MISCARRIAGE

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12
Q

A woman in labor presents with SEVERE ABDOMINAL PAIN and VAGINAL BLEEDING. She is HYPOTENSIVE. Her history is POSITIV FOR A PREVIOUS CS.

A

UTERINE. RUPTURE

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13
Q

What are the features of ectopic pregnancy?

A 
Lower abdominal pain
Missed period
Vaginal bleeding
Shoulder tip pain + Peritonism
Cervical excitation
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14
Q

What is the initial investigation if you are presented a woman of a childbearing age presenting with abdominal pain?

A

Urine pregnancy test

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15
Q

If you are suspecting ectopic pregnancy and patient had a positive urinary pregnancy test, what is the next step?

A

Ultrasound to look for intrauterine pregnancy

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16
Q

What is the value that is needed to consider in a hemodynamically stable patient who tested negative for urinary pregnancy test but no intrauterine pregnancy by ultrasound?

A

Beta hCG of 1400

<1400 - wait and observe
> 1400 - laparoscopy

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17
Q

What is the next most appropriate action for a hemodynamically unstable patient with ectopic pregnancy diagnosed by ultrasound (presenting with severe lower abdominal pain, cervical excitation, shoulder tip pain with peritonism, and missed period)?

A

URGENT LAPAROTOMY

18
Q

39 wks AOG passed clear viscous fluid per vagina 4 days ago.

Now, she is feverish, sweaty and with suprapubic tenderness.

SFH: 35cm
Fetal tachycardia at 175

WBC and PCT both elevated

A

Chorioamnionitis

19
Q

What are the 4T’s of postpartum hemorrhage?

A

Tone - atony
Tissue - retained placenta or clots
Trauma - laceration
Thrombin - DIC

20
Q

Values needed to know in categorizing PPH as to its severity

A

Mild - 500-1000
Moderate 1000-2000
Severe 2000

21
Q

Management for secondary PPH?

What is secondary PPH?

A

Secondary PPH is excessive vaginal bleeding 24 hours after delivery until 12 weeks postpartum

22
Q

A woman at 4 weeks postpartum, did not breastfeed, presents with postpartum hemorrhage. What to do?

23
Q

At 4 weeks postpartum, an exclusively breastfeeding woman was arranged for a high vaginal or endocervical swab. What was significant in her history?

A

Risk factor for infection

24
Q

At 4 weeks postpartum, an exclusively breastfeeding woman was arranged for a pelvic ultrasound. What was significant in her history? What is being ruled out in the ultrasound?

A

SIgnificant is a risk factor for a retained product of conception

Pelvic UTZ to rule out POC

25
Q

IF a postmenopausal woman is a smoker, which HRT should be given?

A

Transdermal as oral route has a higher risk for VTE

26
Q

A postmenopausal woman underwent hysterectomy, which HRT should be given to manage her vasomotor symptoms?

A

Estrogen-only HT (progesterone is given with estrogen to protect the uterus against EM CA, however, since patient has no more uterus, progesterone has no function anymore)

27
Q

SFH at 12 weeks

A

Pubic symphysis

28
Q

SFH reaches the umbilicus. AOG is most likely

29
Q

SFH is at the xiphoid process of the sternum. AOG is estimated at…?

A

36-40 weeks

30
Q

IN any female especially less than 25 y/o with IUS who develop lower abdominal pain and irregular menstrual cycles, what should you suspect first?

31
Q

Differentiate trichomoniasis from bacterial vaginosis and candidiasis.

A

Trichomoniasis

  • caused by Trichomonas vaginalis
  • presents with offensive greenish to yellowish discharge and strawberry cervix
  • with itching
  • pH > 4.5
  • Mgt: Metronidazole

Bacterial Vaginosis

  • caused by Gardenerella vaginalis
  • presents with thin clear grey to white discharge
  • positive for Whiff test, i.e., fishy smell upon addition of KOH to vaginal discharge
  • no itching
  • pH>4.5
  • Mgt: Metronidazole + Clindamycin

Candidiasis

  • caused by Candida albicans
  • presents with thick white discharge
  • pH 4-4.5
  • MGt: local Clotrimazole
32
Q

Consider pre-eclampsia when you have a patient who is pregnant and hypertensive with the following protein valules:

A

24-hour urine protein > 0.3g/24 hrs

OR

PCR (protein: crea ratio) > 30 mg/mmol

OR

ACR (albumin: crea ratio) > 8 mg/mmol

33
Q

Snowstorm appearance on ultrasound

A

Molar pregnancy

34
Q

How do patients with molar pregnancy present?

A

Painless 1st trimester bleeding
Hyperemesis
Uterus large for dates
Markedly elevated serum bHCG

35
Q

Postpartum contraception of choice

36
Q

Why POP and not COCP as postpartum contraception?

A

You do not give COCP in

  1. Breastfeeding less than 6 mos (it decreases milk production)
  2. Less than 6 weeks (risk of thromboembolism)
37
Q

Single Most appropriate IV therapy to prevent further fits for eclampsia

A

Further bolus of MgSO4

Remember:
LD: MgSO4 4g IV over 5-15 mins
Maintenance: 1g/hr IV infusion x 24 hrs
Recurrent seizure: 2-4g MgSO4 IV over 5-15 mins

38
Q

Single MOST appropriate test to perform to assess ovulation in a woman who has 32-day cycle

A

Day 25 progesterone (mid-luteal progesterone level)

39
Q

NICE recommendation for constipation in pregnancy

A

I Love Shit

Ispaghula Husk (bulk-forming)
Lactulose (osmotic laxative)
Senna (stimulant)

40
Q

A hemodynamically stable (normotensive) pregnant woman who is in pain came in with beta-hCG of >1400. Most appropriate next course of action

A

LAPAROSCOPY

Methotrexate would be contraindicated since patient is in pain

41
Q

Diagnostic imaging method of choice for acute pelvic pain in gynecology

A

Ultrasound

For tubo-ovarian abscess, do TVS

PLABABLE 2.0 (33 decks)

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