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4th year revision > obstetrics and gynae > Flashcards

obstetrics and gynae Flashcards

1
Q

What are the criteria for HELLP syndrome?

A

H - haemolysis (high bilirubin, low serum haptoglobin, anaemia)
EL - elevated liver enzymes (ALT 2x normal)
LP - low platelets (<100)

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2
Q

What are the criteria for hyperemesis gravida?

A
  • <20 weeks gestation

- intractable vomitting + more than 5% pre pregnancy weight loss/ dehydration/electrolyte disturbance/hospital admission

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3
Q

what to do if symptoms of miscarriage and the USS show no heartbeat, gestational sac <25cm and crown rump length <7mm?

A

re-scan in 7-10 days as could just be normal pregnancy that is too early to scan

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4
Q

for how long can you do expectant management of miscarriage before you need to move to medical/surgical?

A

14 days

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5
Q

when is anti-D prophylaxis required in miscarriage?

A

rh -ve mother and more than 12 weeks

rh -ve mother and surgical management at any weeks

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6
Q

what are risk factors for ectopic pregnancy?

A

smoking, previous ectopic, tubal issues, PID

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7
Q

what is the surgical management of ectopic pregnancy?

A

salpingectomy if normal contralateral tube

salpingotomy (but risky for molar)

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8
Q

what is a complete molar pregnancy? what is the management ?

A

2 x paternal genes and no egg
snowstorm appearance
always needs surgical evac + referral to molar centre + no pregnancy for 6 months post negative HCG or 12 months if they had chemo

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9
Q

what is a partial molar pregnancy? what is the management?

A

2x paternal genes + 1 maternal genes
medical management if large foetal tissue + referral to molar centre + no pregnancy for 6 months post negative HCG or 12 months if they had chemo

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10
Q

what are the complications of fibroids?

A

anaemia, degeneration, torsion, infection and very rarely transformation to leiomyosarcoma

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11
Q

what is the investigation of choice for fibroids?

A

TVUSS

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12
Q

what is the managment of fibroids?

A

if under 3cm and no distortion of cavity

  • 1 = mirena
  • 2 = tranexamic and mefenamic acid
  • 3 = COC/POP

if over 3cm

    1. tranexamic acid + mefenamic acid
  • 2 = mirena
  • 3 = COC/POP
  • 4 = myomectomy
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13
Q

what should you do prior to a myomectomy?

A

GnRH analogues for 3 months prior to myomectomy

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14
Q

How do you manage simple ovarian cysts in a pre menopausal woman?

A
  • no need for ca125
  • if asymptomatic : less than 5mm discharge, 5-7mm repeat USS in 1 year, if more than 7mm surgery
  • if symptomatic: surgery
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15
Q

how do you manage complex ovarian cysts (multilobed, solid parts) in a pre-menopausal woman?

A
  • ca125
    (if less than 200 then benign issue, if more than refer to gynae onc MDT)
  • AFP, bHCG, LDH if under 40 years old and if abnormal then refer to gynae onc MDT
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16
Q

how do you manage ovarian cysts in a post menopausal woman?

A

calculate the RMI (USS features x menopausal status x ca125

If <200 then low risk. If <5cm and simple then repeat USS in 3 months. If complex cyst then surgery.

If >200 then high risk. Gynae MDT and CT chest, abdo, pelvis

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17
Q

what are the ultrasound features counted in an RMI

A

multilobulated cysts, solid areas, mets, ascited, bilateral lesions

1 feature = 1 point
2-5 features = 3 points

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18
Q

how do you score for menopausal status in a RMI

A

pre menopausal = 1

post menopausal = 3

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19
Q

what ages are HPV test offered (cervical smear)

A

25-64

20
Q

what is the criteria for menopause?

A

cessation of menstruation for more than 1 year

21
Q

what HRT do you need if you have a uterus? how about if you don’t have a uterus?

A

uterus = oestrogen and progesterone

no uterus = oestrogen only

22
Q

what is a cystocele?

A

prolapse of anterior wall of vagina

23
Q

what is a rectocele?

A

prolapse of the posterior wall of the vagina

24
Q

what is a vaginal vault prolapse?

A

top of vagina prolapses following a hysterectomy

25
Q

what is the most common symptom of a prolapse?

A

feeling of heaviness and dragging

26
Q

what examinations should be done in a suspected prolapse?

A

abdo exam ( to look for any masses) then vaginal exam

27
Q

what are the management options for prolapse?

A
  • conservative (lifestyle, pelvic floor exercises, vaginal oestrogen)
  • pessaries
  • surgical (anterior repair, posterior repair, sacrospinous fixation, laparoscopic sacrohysteroplexy, colposclesis)
28
Q

what is a requirement for colposcleisis?

A

need to be sexually inactive

29
Q

what is the staging criteria for prolapses?

A 
0 = no prolapse
1 = leading edge is -1cm from introitus 
2 = leading edge is -1cm - +1 from introitus (bascially at hymen) 
3 = leading edge is +1cm or below (outside the vagina)
4 = complete vaginal eversion (procidentia)
30
Q

what is the management for stress incontienence?

A
  • conservative (pelvic floor)
  • surgery (bulking agents, fascial slings, colposuspension)
  • medical - duloxetine
31
Q

what is the management for urge incontinence?

A
  • lifestyle (caffeine reduction, smoking)

- medical ( tolterodine, mirabegron, desmopressin)

32
Q

what is the common presentation of lichen sclerosis?

A
  • post menopausal lady with extremely itchy vagina with white rash in figure of eight pattern.
  • 40% will have another autoimmune condition
33
Q

what is the management of lichen sclerosis?

A

dermovate (highly potent steroid)

34
Q

what are the most likely complications 0-24hrs post op?

A
  • haemorrhage

- pre-existing infection ie UTI, penumonia

35
Q

what are the most likely complications 24hr - 5 days post op?

A
  • infection
  • thrombosis
  • direct injury (ureters commonly in gynae surgery)
36
Q

what are the most likely complications 7-14 days post op?

A
  • infection
  • thrombosis
  • indirect injury (AVN secondary to diathermy)
37
Q

what is the differences and similarities between BV and trichomonas vaginalis?

A 
BV = white thin discharge + clue cells 
trichomonas = frothy yellow/green discharge + strawberry cervix

Both = vaginal ph >4.5, smelly discharge, managed with metronidazole

38
Q

when is the booking appointment?

A

8-12 weeks (ideally 10) where they do initial bloods, BP, urine dip

39
Q

when is the dating scan?

A

10-14 weeks (usually 12)

40
Q

when is down’s screening?

A

11-14 weeks

41
Q

when is the anomaly scan?

A

18-21 weeks (usually 20)

42
Q

when is anti-D prophylaxis given?

A

28 weeks

43
Q

when is presentation of baby checked and external cephalic version offered?

A

36 weeks

44
Q

at what gestation should all women with a BMI over 30 be offered screening for gestational diabetes?

A

24-28 weeks

45
Q

what is the order of methods for induction of labour?

A 
1st = membrane sweep 
2nd = vaginal prostaglandins 
3rd = amniotomy + oxytocin
46
Q

what does tamoxifen increase your risk of

A

Venous thromboembolism

4th year revision (32 decks)

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