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Fourth Year > Obstetrics and Gynaecology > Flashcards

Obstetrics and Gynaecology Flashcards

1
Q

Features of polycystic ovary syndrome?

PCOS PAL

A

P - polycystic ovaries on ultrasound.
C - cycles are erratic or amenorrhoea.
O - obesity and hirsutism.
S - subfertility.

P - prolactin elevated (mildly).
A - androgens elevated (modestly).
L - LH elevated (significantly).

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2
Q

PCOS is linked to which other medical conditions?

A
  • Insulin resistance.
  • Hypertension.
  • Lipid abnormalities.
  • Increased risk of cardiovascular disease.
  • Acne.
  • Hirsutism.
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3
Q

What (usually) happens to production of GnRH in hypothalamic disease?

A

Decreased GnRH > decreased LH and FSH from anterior pituitary.

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4
Q

Describes FSH serum levels in primary (or premature) ovarian failure?

A

Elevates.

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5
Q

How might you distinguish Cushing’s syndrome from PCOS by blood results?

A

Cushing’s - suppression of LH and FSH.

PCOS - significantly elevated LH.

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6
Q

Hypertension and proteinuria in a pregnant woman?

A

Pre-eclampsia - URGENT ASSESSMENT.

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7
Q

Classical triad of pre-eclampsia?

PRE

A
  • Proteinuria ++.
  • Rising BP - generally >140/90mmHg.
  • Oedema.
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8
Q

Complications of pre-eclampsia?

A 
D - disseminated intravascular coagulation.
R - renal failure.
C - cerebral haemorrhage.
O - oligohydramnios.
G - intrauterine growth retardation.
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9
Q

DDx of vaginal bleeding with a positive pregnancy test?

A
  • Miscarriage.
  • Ongoing pregnancy.
  • Ectopic pregnancy.
  • Cervical pathology (e.g. ectropion, polyp, cancer).
  • Menstrual period (if pregnancy test not yet performed).
  • THREATENED MISCARRIAGE.
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10
Q

DDx of RIF pain with positive pregnancy test?

A
  • Ectopic pregnancy.
  • Ongoing normal pregnancy.
  • Appendicitis with concurrent pregnancy.
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11
Q

DDx of hyperemesis, positive pregnancy test, vaginal spotting and ketones 4+?

A
  • Normal pregnancy with hyperemesis.
  • Miscarriage.
  • Molar pregnancy.
  • Exclude other causes of vomiting.
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12
Q

How is a threatened miscarriage managed?

A
  • Discharge home with safety netting.
  • Bleeding in early pregnancy is not uncommon, though cervix is closed it is impossible to predict what will happen.
  • Offer an early pregnancy contact card if appropriate.
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13
Q

How is a pregnancy of unknown location initially managed in a clinically well patient?

A

Allow home.

  • Safety net regarding seeking urgent help if in pain / faint / unwell.
  • Repeat HCG in 48 hours.
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14
Q

Management of ruptured ectopic?

A
  • ABCDE.
  • Call for immediate help.
  • IV access x 2.
  • Fluid resus.
  • Urgent blood transfusion (O neg If unknown).
  • Immediate theatre for emergency laparotomy / diagnostic laparoscopy.
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15
Q

TVUSS shows enlarged uterus with a multi cystic appearance (bunch of grapes) and enlarged yolk sac for gestation - diagnosis?

A

Molar pregnancy - needs histopathological diagnosis.

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16
Q

How is a suspected molar pregnancy managed?

A
  • Histopathological diagnosis.
  • Surgical evacuation of the uterus.
  • If high suspicion - refer to specialist molar service prior to results for HCG tracking and potentially requiring chemotherapy.
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17
Q

How does molar pregnancy occur?

A

As a result of abnormal fertilisation.

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18
Q

What is a partial molar pregnancy?

A

2 sperm + 1 egg = foetal parts (69 XXX, 69 XXY, 69 XYY).

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19
Q

What is a complete molar pregnancy?

A

Sperm fertilises “empty egg” - 46XX - all androgenic material.

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20
Q

What is choriocarcinoma?

A

A malignant trophoblastic cancer.

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21
Q

Where there is infertility due to oligospermia what is an appropriate treatment?

A

Intracytoplasmic sperm injection (ICSI) - reduces chance of failed fertilisation.

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22
Q

Why should a hormone profile (LH, FSH, testosterone) be carried out in male infertility?

A
  • If FSH is high > spermatogenesis failure.
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23
Q

How might cystic fibrosis or y chromosome deletion contribute to male infertility?

A

Can produce oligospermia / azoospermia.

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24
Q

What impact is PCOS likely to have on menstrual cycles?

A
  • Causes anovulatory cycles.
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25
Q

Treatment options for infertility due to PCOS?

A
  • Weight loss.
  • Clomiphene induction following hysterosalpingogram to ensure tubal patency.
  • ROTTERDAM CRITERIA.
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26
Q

In unexplained fertility, at which point would intervention take place and what would this be?

A

93% will fall pregnant naturally within 2 years.
After 2 years, IVF is recommended.

Not ICSI unless fertilisation fails.

27
Q

In pregnancy, persistent breathlessness or chest pain warrants what?

A

Investigation for cardiac causes.

Cardiac causes account for 23% of maternal deaths and are often overlooked.

28
Q

What steps should be taken when pregnant or post-partum women complain of ill health?

A
  • Red flag: escalate to senior doctors and obstetricians before discharge.

RCOG guidance - pregnant women may look well but can deteriorate rapidly.

29
Q

What steps should be taken for pregnant women who experience their first seizure / worsening epilepsy?

A

Urgent phone referral due to high risk.

NEVER stop meds without seeking expert advice.

30
Q

Explain the term human factors.

A

Describes the interaction between individuals at work, a task and the workplace.

(Seeks to understand how people perform under different circumstances e.g. stress/ fatigue/ time constraints in order to create systems to reduce mistakes.)

31
Q

What is an alternative approach to ABCDE in maternal collapse?

A

Head, heart, chest, abdomen, vagina, legs.

(head - AVPU, heart - CRT / HR / BP / murmur, chest - bilateral air entry / RR / O2 sats / breath sounds / trachea, abdomen - acute rebound or guarding / tenderness uterine or non-uterine / is the foetus alive CTG / need for laparotomy or emergency delivery, vagina - bleeding / what stage is labour / is there an inverted uterus, legs - DVT)?

32
Q

What are contraindications to fluid resuscitation in maternal collapse?

A
  • Pulmonary oedema.
  • Severe pre-eclampsia.
  • Renal failure.
33
Q

What investigations to consider in maternal collapse?

A
  • ABG.
  • Troponin.
  • Blood glucose.
  • Lactate.
  • Blood cultures.
  • ECG.
  • CXR.
  • US abdomen.
  • High vaginal swab.
  • CT / MRI / ECHO.

We want to monitor with continuous ECG, RR, HR, BP, pulse oximetry.
Can consider arterial and CVP lines.

34
Q

What are potential causes of maternal collapse originating in the head?

A
  • Eclampsia (seizures).
  • Epilepsy.
  • CVA.
  • Intracranial haemorrhage.
  • Vasovagal response.
35
Q

What are potential causes of maternal collapse originating in the heart?

A
  • MI.
  • Arrhythmia.
  • Peripartum cardiomyopathy.
  • Congenital heart disease.
  • Dissection of thoracic aorta.
36
Q

What are potential causes of maternal collapse due to hypoxia?

A
  • Asthma
  • PE
  • Pulmonary oedema
  • Anaphylaxis
37
Q

What are potential causes of maternal collapse due to haemorrhage?

A
  • Placental abruption.
  • Uterine atony.
  • Genital tract trauma.
  • Uterine rupture.
  • Rupture aneurysm.
38
Q

What are potential systemic causes of maternal collapse?

A
  • Hypoglycaemia.
  • Amniotic fluid embolism.
  • Sepsis.
  • Trauma.
  • Complications of anaesthesia.
  • Anaphylaxis.
39
Q

Most likely diagnosis?
22 YO F feeling unwell 1 day post SVD with 300ml blood loss at the time.
She has just passed a clot of 200ml and is complaining of faintness. She feels clammy and the uterine fundus is felt above the umbilicus.

A

PPH.
Consider: tone, tissue, trauma, thrombin.

In this case it is most likely tone.

40
Q

How to manage PPH?

A
  • O2.
  • Expel clots and massage uterus.
  • IV access, IV fluids and bloods: FBC, coagulation screen, cross match 4 units.
  • Uterotonics: syntocinon, ergometrine, Carboprost.
  • Tranexamic acid.
  • Urinary catheter.
  • If drugs aren’t improving situation > theatre for intrauterine balloon / interventional radiology / laparotomy - B-Lynch suture, uterine or internal iliac artery ligation / hysterectomy.
41
Q

Likely diagnosis and management?

28 week pregnant F with T1DM who was admitted with vomiting secondary to a UTI collapses.

A

Hypoglycaemia and sepsis.

Hypoglycaemia: if below 3mmol/L give 50ml of 20% or 100ml of 10% glucose solution IV.

Sepsis: sepsis 6.

42
Q

Likely diagnosis?
20 YO F with sudden onset severe abdominal pain radiating to her shoulder. She is around 6 weeks pregnant and is complaining of dizziness. This is her first pregnancy.

A

Ruptured ectopic.

Needs fluid resuscitation and surgical management for acute abdomen.

43
Q

Likely diagnosis?
30 YO F with heavy vaginal bleeding at 10 weeks gestation. The bleeding started 3 hours ago and contains palm sized clots. Approximately 500ml has been lost so far.

A

Miscarriage.

Needs fluid resuscitation and surgical evacuation of the uterus (in cases of haemorrhage).

44
Q

Likely diagnosis. 30 YO F who is acting “oddly” 2 days post emergency lower segment caesarean section (LSCS). She has a Hx of bipolar disorder but was stable throughout pregnancy though her husband feels she is now acting paranoid and is not her usual self.

A

Puerperal psychosis.

Need to diagnosis ASAP to minimise risk to both mother and baby.
Patient needs psychiatry review and transfer to mother and baby unit.

45
Q

Likely diagnosis?
32 YO F on labour ward who the midwife feels is “breathing funny and making funny noises” and is complaining of breathlessness. She went into spontaneous labour and has Group B Strep for which she is receiving Group B Strep as per protocol.

A

Anaphylaxis.

STOP ANTIBIOTICS.

  • Give O2.
  • Adrenaline 500 MICROGRAMS intramuscularly repeated every 5 minutes if necessary.
  • IV fluids.
  • Chlorphenamine 10mg IM or IV.
  • Hydrocortisone 200mg IM or IV.
  • Nebulised salbutamol.
46
Q

Management of sepsis as a result of endometritis / wound infection / UTI?

A

Sepsis 6:

  • Antibiotics.
  • High flow oxygen.
  • Fluid challenge.
  • Measure urine output.
  • Lactate.
  • Blood cultures.
47
Q

Management of retained products of conception and endometritis?

A
  • Antibiotics.

- Surgical evacuation of uterus.

48
Q

How would you manage a para 2 day 1 post SVD with a history of puerperal psychosis?
(currently midwives have no concern).

A
  • Observation.
  • Daily midwife support.
  • Possible elective admission to mother and baby unit.
49
Q

How would you manage a para 3, three days following elective C-section for placenta praevia (EBL 2L) who is now complaining of right calf pain.

  • MEOWS: T36.8, HR 80bpm, BP 120/80, O2 sats 98% air.
A

DDx: DVT.

  • Give treatment dosage of fragmin.
  • Consider prophylactic fragmin in next pregnancy.
50
Q

Differential and management for:
Female day 6 post SVD.
- Admitted 2 days ago with fever and right breast pain.
- Currently breastfeeding.
- Fevers persistently swinging despite antibiotics and continued breastfeeding.

A

DDx: mastitis, breast abscess.

- Provide breast feeding support.

51
Q

Day 3 post elective c-sec complaints of discharging wound growing increasingly red.
- Patient has BMI of 55.
Differential and management?

A

Wound infection.

  • Wound swab.
  • Monitor for sepsis.
  • Inflammatory markers.
  • Risk of VTE - fragmin prophylaxis.
  • Advice regarding risk of future pregnancies e.g. risk of accreta, uterine rupture. Should wait at least one year post delivery to conceive.
  • Weight management advice / referral.
  • Contraception plan.
52
Q

Patient found collapsed on floor with a pool of blood visible between her legs and visibly staining her pyjamas.
- Differential and management.

A

Differential: maternal collapse due to massive PPH.

  • Call 2222 emergency obstetric team declare massive obstetric haemorrhage.
  • ABCDE.
  • Cause of PPH - likely atonic so give uterotonics and tranexamic acid.
  • IV fluids and ask for shock pack.
  • If bleeding ongoing > bimanual compression while transferring to theatre for examination under anaesthetic and possible uterine balloon or laparotomy.
53
Q

What is the TORCH screen?

A
  • Toxoplasmosis.
  • Rubella.
  • Cytomegalovirus.
  • HIV.
54
Q

What is the purpose of amniocentesis karyotyping?

A
  • To detect balanced and unbalanced chromosomes.

- Detect any changes to number of chromosomes.

55
Q

What is HELLP syndrome?

A
  • Haemolysis.
  • Elevated liver enzymes (liver damage).
  • Low platelet count.
    Usually occurs in last trimester or after childbirth associated with pre-eclampsia or eclampsia.
56
Q

Management of an overactive bladder?

A
  • Reduce caffeine intake.
  • Weight loss.
  • Bladder training > refer to incontinence team.
57
Q

Management of lichen sclerosis of the vulva area?

A
  • Discuss vulval skin care.
  • Prescribe soap substitutes and emollients.
  • Dermovate daily for 2 weeks then on alternate days for 2 weeks and then once or twice a week for 2 weeks.
  • GP follow up.
58
Q

Management of suspected dermoid cyst of ovary?

A
  • Need to rule out malignancy.
  • Schedule for outpatient MRI.
  • Tumour markers ca125, HCG, AFP.
  • Refer to gynae for further review.
  • See patient in clinic with results.
  • Dermoid cysts removed surgically.
59
Q

Management of cervical polyp?

A

Remove with polyp forceps and send to histopathology. Patient will receive results in post (obviously in person if malignant).`

60
Q

Investigation of heavy, painful intermenstrual bleeding?

A

Want to rule out any endometrial pathology.

  • Swabs for infection.
  • Endometrial biopsy.
  • Transvaginal US.
  • Review when results available.
61
Q

Management of prolapse (cystocele) in patients who decline surgery?

A
  • Vaginal pessary with review for change in 6 months.

- Provide contact details if any issues with pessary arise.

62
Q

At what gestation should a pattern of foetal movements develop?

A

By 24 weeks.

63
Q

What can cause reduced sensation of foetal movements before 24 weeks?

A

Anterior placenta.

But after 24 weeks the location of placenta has no bearing on movements

Fourth Year (28 decks)

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