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XUAN MSRA > Obstetrics and Gynaecology > Flashcards

Obstetrics and Gynaecology Flashcards

1
Q

What is the criteria for a diagnosis of gestational diabetes?

A

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

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2
Q

What is the management of gestational diabetes?

A

(based on fasting)
If < 7mmol/l: trial of diet and exercise for 1-2 weeks
If >7mmol/l: start insulin
If 6-6.9mmol/l and complications: start insulin

If refusing insulin-> metformin

If metformin not tolerated-> glibenclamide

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3
Q

What is the management of pre-existing diabetes in pregnancy?

A

1) Weight loss of if BMI >27
2) Stop all oral meds except metformin and start insulin
Folic acid 5mg/day 12 weeks pre-conception
3) Treat retinopathy as can worsen during pregnancy

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4
Q

What is the commonest type of ovarian cyst?

A

Follicular cyst

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5
Q

What are the two types of benign epithelial tumours?

A

1) Serous cystadenoma
2) Mucinous cystadenoma

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6
Q

What is a type. of germ cell tumour?

A

Dermoid cyst

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7
Q

What are the two types of physiological/functional ovarian cysts?

A

1) Follicular cysts
2) Corpus luteum cystd

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8
Q

What is the most common type of ovarian cancer?

A

Serous carcinoma

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9
Q

What is the treatment of infertility in the context of PCOS?

A

1) weight reduction if appropriate
2) anti-oestrogen therapies e.g. Clomifene
3) Metformin
4) Gondaotrophins

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10
Q

What is the management of pre-eclampsia?

A

1st line: labetalol (if asthmatic nifedipine)

Definitive management is delivery of baby

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11
Q

What is the most common causative organism of early-onset sepsis in neonates?

A

<48hrs since birth:
Group B Streptococcus

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12
Q

What is the most common causative organism of late-onset sepsis in neonates?

A

> 48hrs since birth:
Staphylococcus epidermidis OR Staphylococcus aureus

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13
Q

What is the antibiotic of choice for intrapartum GBS prophylaxis?

A

Benzylpenicillin

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13
Q

Who should have intrapartum GBS prophylaxis?

A

1) If previous GBS
2) If pre-term labour
3) If pyrexia during labour

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14
Q

What medication can be used to suppress lactation when breastfeeding?

A

Cabergoline (dopamine receptor agonist)

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14
Q

What are causes of oligohydramnios?

A

premature rupture of membranes
Potter sequence
bilateral renal agenesis + pulmonary hypoplasia
intrauterine growth restriction
post-term gestation
pre-eclampsia

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14
Q

What are causes of primary ammenorhoea?

A

Constitutional delay i.e. a late bloomer, has secondary sexual characteristics
Anatomical i.e. mullerian agenesis (patient develops secondary sexual characteristics and has variable absence of female sexual organs)
Imperforate hymen (characterised by cyclical pain and the classic bluish bulging membrane on physical examination)
Transverse vaginal septae (characterised by cyclical pain and retrograde menstruation)
Turner syndrome (XO chromosome)
Testicular feminisation syndrome (XY genotype, no internal female organs)
Kallmann syndrome (failure to secrete GNRH)

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15
Q

What are the causes of secondary ammenorhoea?

A

Pregnancy
Patient is using contraception
Menopause
Lactational amenorrhoea
Hypothalamic amenorrhoea (suppression of GnRH due to stress, excessive exercise, eating disorder)
Endocrinological (hyperthyroidism, polycystic ovary disease, Cushing’s syndrome, hyperprolactinaemia, hypopituitarism)
Premature ovarian failure (autoimmune, chemotherapy, radiation therapy)
Asherman’s syndrome (iatrogenic intrauterine adhesions/cervical stenosis)

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16
Q

At how many weeks should you refer if no feral movements?

A

24 weeks

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17
Q

What are safe anti-epileptics in pregnancy?

A

Lamotrigine
Carbamazepine
Levetiracetam

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18
Q

What is the most common benign ovarian tumour in women under the age of 25 years?

A

Dermoid cyst (teratoma)

19
Q

What is the most common cause of ovarian enlargement in women of a reproductive age?

A

Follicular cyst

20
Q

What is the most common type of ovarian pathology associated with Meigs’ syndrome?

A

Fibroma

21
Q

How soon til contraceptives effective ok starting?

A

instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

22
Q

What is Sheehan’s syndrome?

A

Sheehan syndrome describes hypopituitarism caused by ischemic necrosis due to blood loss and hypovolaemic shock.

Features may include:
agalactorrhoea
amenorrhoea
symptoms of hypothyroidism
symptoms of hypoadrenalism

23
Q

What is Asherman’s syndrome?

A

Asherman’s syndrome, or intrauterine adhesions, may occur following dilation and curettage. This may prevent the endometrium responding to oestrogen as it normally would.

24
Q

What is the management of PPROM?

A

Admission to ensure not developing chorioamnionitis
10 days erythromycin should be given to all women with PPROM
Antenatal corticosteroids
Delivery at 34 weeks

25
Q

What are recommended supplements for healthy patient during pregnancy?

A

Folic acid 400mcg OD (12 weeks prior to 12 weeks into pregnancy)
Vitamin D 10mcg OD (throughout pregnancy)

26
Q

Medical management of stress incontinence?

A

Duloxetine

27
Q

Medical management of urge incontinence?

A

antimuscarinics are first-line
1) oxybutynin (immediate release)
2) tolterodine (immediate release)
3) darifenacin (once daily preparation)

28
Q

What to do if pregnant woman unsure of chickenpox history has VZV contact?

A

Check VZV antibodies

29
Q

What is the management of POI in those under 51?

A

HRT or COCP

30
Q

What is the treatment of Trichomonas vaginalis?

A

Oral metronidazole

31
Q

What is the treatment of gonorrhoea?

A

IM Ceftriaxone

32
Q

Which cancers does the COCP increase the risk of?

A

Breast Cancer
Cervical Cancer

33
Q

Which cancers does the COCP protect against?

A

Ovarian Cancer
Endometrial Cancer

34
Q

What are the causes of postpartum haemorrhage?

A

The causes of PPH are said to be the 4 Ts:
1) Tone (uterine atony): the vast majority of cases
2) Trauma (e.g. perineal tear)
3) Tissue (retained placenta)
4) Thrombin (e.g. clotting/bleeding disorder)

35
Q

What is the management of PPH?

A

Mechanical:
1) palpate the uterine fundus and rub it to stimulate contractions (‘rubbing up the fundus’)
2) catheterisation to prevent bladder distension and monitor urine output

Medical:
1) IV Oxytocin
2) Ergometriine slow IV or IM
3) Corborprost IM (unless asthmatic)
4) Carboprost IM
5) Misoprostol sublingual

Surgical:
1st line- Intrauterine balloon tamponade

36
Q

Which strains of HPV cause cervical cancer?

A

HPV 16, 18 and 33

37
Q

What is management of breech baby?

A

<36 weeks- likely to turn spontaneously
>36 weeks- ECV if >36 weeks in nulliparous and >37 weeks in multiparous
if still breech- planned C-section or vaginal

38
Q

What results of combined test suggest Down’s Syndrome?

A

↑ HCG
↓ PAPP-A
thickened nuchal translucency

38
Q

What are the features of congenital rubella syndrome?

A

1) Sensorineural deafness
2) Eye abnormalities
3) Congenital heart disease

39
Q

What is the management of induction of labour?

A

If Bishop score ≤ 6: Vaginal prostaglandins or oral misoprostol

If >6:
Amniotomy and IV oxytocin infusion

Possible methods:
1) Membrane sweep
2) Vaginal prostaglandins E2 (PGE2)
3) Oral prostaglandin E1
Maternal oxytocin infusion
4) Amniotomy (‘breaking of waters’)
5) Cervical ripening balloon

40
Q

What is the first line management for shoulder dystocia?

A

McRoberts manoeuvre (hyperflexion of the maternal legs)

41
Q

What is the management of PMS?

A

Mild: lifestyle advice
Moderate: COCP
Severe: SSRI

42
Q

When is the anomaly scan?

A

18 - 20+6 weeks

43
Q

When is the dating scan/nuchal translucency?

A

11 - 13+6 weeks

44
Q

When are anti-D doses during pregnancy?

A

1st dose: 28 weeks
2nd dose: 34 weeks

45
Q

When is screen for anaemia and atypical red cell alloantibodies?

A

28 weeks

46
Q
A

XUAN MSRA (20 decks)

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