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Yr 4 - GOSH > Obstetrics - Corrections pt2 > Flashcards

Obstetrics - Corrections pt2 Flashcards

1
Q

What treatment is offerec to help prevent miscarriage in antiphospholipid syndrome?

A

High-dose aspirin + LMWH

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2
Q

Role of aspirin in preventing miscarriage in antiphospholipid syndrome?

A

Aspirin reduces the risk of thrombosis by inhibiting platelet aggregation and subsequent pregnancy loss in APS.

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3
Q

Role of LMWH in preventing miscarriage in antiphospholipid syndrome?

A

LMWH augments the activity of antithrombin III and prevents the conversion of factor Xa to its activated form.

This results in the prevention of prothrombin to thrombin.

This helps to stabilise fibrin clot.

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4
Q

When is the first dose of anti-D prophylaxis administered to rhesus negative women?

A

28 weeks

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5
Q

What is the most common type of ovarian cyst?

A

Follicular cyst

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6
Q

When do follicular cysts occur?

A

These occur during the menstrual cycle when a follicle does not release an egg in ovulation

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7
Q

Which nutrient is deficient in breast milk?

A

Vitamin K

Vitamin K traverses the placenta poorly and is present in LOW concentrations in breastmilk.

Newborns are prophylactically injected with IM vitamin K immediatley after birth to prevent haemorrhagic disease of the newborn.

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8
Q

What investigation can be carried out to confirm the diagnosis of PROM?

A

Actim-PROM vaginal swab.

This detects IGFBP-1 in vaginal fluid.

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9
Q

What does a ‘boggy’ uterus refer to?

A

Uterus that isn’t contracted

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10
Q

What would you want to test in pre-eclampsia?

A

Reflexes –> can get hyperreflexia in pre-eclampsia.

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11
Q

What PCR indicates pre-eclampsia?

A

> 30

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12
Q

When do the majority of seizures occur in eclampsia?

A

In the postnatal period (44%), but they can also occur in the antepartum (38%) or intrapartum (18%) settings.

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13
Q

What are some high risk risk factors for eclampsia?

A
  • Chronic HTN, pre-eclampsia or eclampsia in previous pregnancy
  • Pre-existing CKD
  • Diabetes mellitus
  • Autoimmune diseases (e.g. SLE, antiphospholipid syndrome)
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14
Q

What is the hallmark feature of eclampsia?

A

A new onset tonic-clonic type seizure, in the presence of pre-eclampsia (new onset HTN and proteinuria after 20 weeks’ gestation).

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15
Q

Clinical presentation of eclampsia?

A
  • Seizures
  • Headache
  • Hyperreflexia
  • N&V
  • Generalised oedema
  • RUQ pain +/- jaundice
  • Visual disturbances e.g. flashing lights, blurred or double vision
  • Change in mental state
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16
Q

What are some maternal complications of eclampsia

A
  • HELLP syndrome
  • DIC
  • AKI
  • Adult respiratory distress syndrome
  • Cerebrovascular haemorhage
  • Permanent CNS damage
  • Death
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17
Q

What are some foetal complications of eclampsia?

A
  • IUGR
  • Prematurity
  • Infant respiratory distress syndrome
  • Intrauterine foetal death
  • Placental abruption
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18
Q

Give 3 differentials for eclampsia

A

Hypoglycaemia
Pre-existing epilepsy
Haemorrhagic stroke

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19
Q

Investigations in eclampsia?

A
  • FBC
  • U&Es
  • LFTs
  • Clotting studies
  • Blood glucose (exclude hypoglycaemia)
  • US: estimate the gestational age and to rule out placental abruption
  • CTG monitoring
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20
Q

What is a reversible cause of seizures?

A

Hypoglycaemia

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21
Q

FBC results in eclampsia?

A

Low Hb & low platelets

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22
Q

U&E results in eclampsia?

A

Raised urea, raised creatinine, raised urate, low urine output

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23
Q

LFT results in eclampsia?

A

Raised ALT, raised AST, raised bilirubin

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24
Q

What are the 5 main principles to address in the management of eclampsia?

A

1) Resuscitation:
- ABCDE
- Patient should lie in the left lateral position

2) Cessation of seizures

3) BP control

4) Prompt delivery of baby and placenta

5) Monitoring

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25
Q

1st line treatment of eclamptic seizures?

A

Magnesium sulphate

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26
Q

What is a CTG sinusoidal trace usually due to?

A

Foetal anaemia e.g. vasa praevia

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27
Q

Causes of prolonged deceleration (>3 minutes)?

A

1) cord prolapse

2) placental abruption

3) uterine rupture

4) uterine hyperstimulation syndrome (by oxytocin or spontaneous increased activity)

5) maternal hypotension (usually 2ary to supine hypotension or epidural top up)

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28
Q

Women who have been treated for CIN require follow up cervical screening.

When should this follow up be?

A

6 months after treatment for a test of cure repeat cervical sample.

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29
Q

Is the IUS affected by enzyme inducers/inhibitors?

A

No

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30
Q

Management of women with a positive pregnancy test and at least one of the following: vaginal bleeding, abdominal, pelvic or cervical motion tenderness?

A

Refer for immediate assessment at the Early Pregnancy Unit

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31
Q

What is the treatment for choice for stage I and II endometrial cancer?

A

Total abdominal hysterectomy with bilateral salpingo-oophorectomy

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32
Q

Steps of PPH management:

A

1) ABCDE

2) 2x peripheral cannulae & commence warmed crystalloid infusion

3) Mechanical:
- uterine fundus compression
- catheterisation to prevent bladder distension and monitor urine output

4) Medical:
- IV oxytocin (slow IV injection followed by IV infusion)
- ergometrine (slow IV or IM) unless history of HTN
- carboprost IM (unless history of asthma)
- misoprostol sublingual

5) Surgical:
- intrauterine balloon tamponade (1st line)
- hysterectomy

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33
Q

In monochorionic twin pregnancies, what is the main pathology that ultrasound monitoring performed between 16 and 24 weeks gestation aims to detect?

A

Twin to twin transfusion syndrome

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34
Q

What is the most reliable test to confirm ovulation?

A

Progesterone level

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35
Q

When is the earliest time you can offer ECV?

A

36 weeks gestation

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36
Q

Sex hormone binding globulin (SHBG) conc in PCOS?

A

Normal to low

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37
Q

What is SHBG?

A

SHBG is a plasma protein that binds the steroid hormones oestrogen, testosterone, and dihydrotestosterone.

Low concentrations of SHBG increase the concentration of unbound, biologically active testosterone and dihydrotestosterone, leading to features of hyperandrogenism associated with PCOS.

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38
Q

Where is the most appropriate place to insert the implant?

A

Subdermal, non-dominant arm

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39
Q

What is the recurrence rate of postnatal psychosis?

A

25-50%

Women needs a specialist referral to a perinatal mental health team.

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40
Q

What weight loss in the first week of life indicates a need for referral to a midwife-led breastfeeding clinic?

A

> 10%

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41
Q

For patients assigned female at birth receiving testosterone therapy, which forms of contraception are contraindicated?

A

Contraceptives containing OESTROGEN only

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42
Q

What are some risk factors for gestational diabetes (that then warrant an OGTT at 24-28 weeks)?

A

1) BMI >30

2) Previous macrosomic baby (>4.5kg)

3) Previous gestational diabetes

4) 1st degree relative with diabetes

5) Family origin with a high prevalence of diabetes (South Asian, black Caribbean and Middle Eastern)

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43
Q

What is the first-line non-hormonal treatment for menorrhagia?

A

Tranexamic acid

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44
Q

1st line maangement of candida (thrush) in pregnancy?

A

Clotrimazole pessary

Note –> oral fluconazole is CONTRAINDICATED due to its association with congenital abnormalities.

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45
Q

What is the most likely location of the ectopic pregnancy?

A

Ampulla of fallopian tube

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46
Q

What is 1ary management of ovarian cancers staged 2-4?

A

Surgical excision of the tumour (may be accompanied by chemo).

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47
Q

What is the only effective treatment for large fibroids causing problems with fertility if the woman wishes to conceive in the future?

A

Myomectomy

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48
Q

What are the 2 SSRIs of choice in breastfeeding women?

A

Setraline & paroxetine

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49
Q

When can an ECV be coffered?

A

From 36 weeks in nulliparous

From 37 weeks in mutliparous

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50
Q

What are the 3 stages of postpartum thryoiditis?

A

1) Thyrotoxicosis

2) Hypothyroidism

3) Normal thyroid function (but high recurrence rate in future pregnancies)

51
Q

What Abs are found in 90% of patients with postpartum thyroiditis?

A

Thyroid peroxidase antibodies

52
Q

How is the thyrotoxic phase of postpartum thyroiditis managed?

A

Propanolol (for symptom control)

Note - not usually treated with anti-thyroid drugs as the thyroid is not overactive.

53
Q

How is the hypothyroid phase of postpartum thyroiditis managed?

A

Treated with thyroxine

54
Q

What are 4 medications that can be used in the management of urge incontinence?

A

Antimuscarinics:
- oxybutynin
- solifenacin
- tolterodine
- darifenacin

55
Q

Is oxybutynin immediate or modified release used in urge incontinence?

A

Immediate release

However, immediate release oxybutynin should be avoided in ‘frail older women’.

56
Q

What is the most important risk factor for developing placenta accreta?

A

Previous c sections

57
Q

Is there a screening programme for ovarian cancer?

A

No

58
Q

What injury is the ‘waiter’s tip hand’ seen in?

A

Erb’s palsy

59
Q

What is required for a diagnosis of pre-eclampsia?

A

New onset BP ≥140/90 after 20 weeks AND ≥1 of proteinuria, organ dysfunction.

60
Q

Management of gestational diabetes if fasting plasma glucose is <7 mmol/l?

A

1) Trial of diet and exercise for 1-2 weeks

2) If targets not met –> add metformin

3) If still not met –> add insulin

61
Q

What does a Bishops score of ≥8 indicate?

A

The cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour

62
Q
A
63
Q

Is lithium safe in breastfeeding?

A

NO

64
Q

In a LSCS, what layers do you cut though to reach the fetus?

A

1) Skin

2) Superficial fascia

3) Deep fascia

4) Anterior rectus sheath

5) Rectus abdominis muscle

6) Transversalis fascia

7) Extraperitoneal connective tissue

8) Peritoneium

9) Uterus

65
Q

What is sometimes referred to as chocolate cysts due to the external appearance?

A

Endometriotic cyst

66
Q

What is the most common ovarian cancer?

A

Serous carcinoma

67
Q

When is a CVS vs amniocentesis performed?

A

CVS: 11-13 weeks

Amniocentesis: from week 15 onwards

68
Q

Where is a swab taken from for TV?

A

Posterior fornix

69
Q

Depending on your local guidelines, for vaginal swabs, you may be expected to take “double swabs” or “triple swabs”.

What does a double swab and triple swab involve?

A

Double swab –> NAAT swab (vulvovaginal) + high vaginal Amies (charcoal) medium swab.

Triple swab –> NAAT swab (vulvovaginal) + high vaginal Amies (charcoal) medium swab + endocervical Amies (charcoal) medium swab.

70
Q

What are the 3 key features of disseminated gonococcal infection?

A

1) tenosynovitis

2) migratory polyarthritis

3) dermatitis (lesions can be maculopapular or vesicular)

71
Q

Azithromycin, erythromycin & clarithromycin in pregnancy?

A

Azithromycin & erythromycin –> most acceptable

Clarithromycin –> less acceptable

72
Q

What is the most acceptable macrolide Abx in pregnancy?

A

Erythromycin

73
Q

What are some potential pregnancy related complications of chlamydia?

A

1) Preterm delivery

2) Premature rupture of membranes

3) Low birth weight

4) Postpartum endometritis

5) Neonatal infection (conjunctivitis and pneumonia)

74
Q

What is Lymphogranuloma venereum (LGV)?

A

A condition affecting the lymphoid tissue around the site of infection with chlamydia.

Caused by a serotype of Chlamydia trachomatis.

75
Q

Who does LGV most commonly present in?

A

MSM presenting with anal discharge and pain, or anyone presenting with rectal chlamydia.

76
Q

Management of LGV?

A

Longer course of doxycycline (21 days)

77
Q

What is a crucial differential diagnosis of Chlamydial Conjunctivitis and should always be tested?

A

Gonoccocal conjunctivitis –> can result in severe complications such as vision loss if the bacteria penetrate further and cause corneal ulceration.

78
Q

Why should a standard charcoal endocervical swab also be taken from the symptomatic area in all patients with symptoms of gonorrhoea?

A

This is to test for sensitivities and monitor patterns of antimicrobial resistance.

NAAT tests only determine if a gonococcal infection is present or not - does not give information about specific bacteria and their Abx sensitivities.

79
Q

1st line management for gonorrhoea?

A

IM ceftriaxone

80
Q

what class of antibiotic is ceftriaxone?

A

Cephalosporin

81
Q

what class of antibiotic is cirpofloxacin?

A

Fluoroquinolone

82
Q

Why should ALL patients with gonorrhoea have a follow up ‘test of cure’ 2 weeks after treatment?

A

Given the high antibiotic resistance.

83
Q

What is disseminated gonococcal infection (GDI)?

A

A complication of untreated gonococcal infection, where the bacteria spreads to the skin and joints:

  • polyarthralgia
  • migratpry polyarthritis
  • tenosynovitis
  • systemic symptoms e.g. fever & fatigue
  • non-specific skin lesions
84
Q

Causative organism of syphilis?

A

Treponema pallidum

85
Q

What is Bechet’s syndrome? What classic triad is seen?

A

A complex multisystem disorder associated with presumed autoimmune-mediated inflammation of the arteries and veins.

Classic triad:
1) Oral ulcers
2) Genital ulcers
3) Anterior uveitis

86
Q

Features of 1ary syphilis?

A
  • Chancre: painless ulcer at the site of sexual contact
  • Local non-tender lymphadenopathy
  • Often not seen in women (the lesion may be on the cervix)
87
Q

Why is 1ary syphilis often not seen in women?

A

Lesion may be on cervix

88
Q

When does 2ary syphilis occur?

A

6-10 weeks after 1ary infection

89
Q

Features of 2ary syphilis?

A
  • systemic symptoms: fevers, lymphadenopathy
  • rash on trunk, palms and soles
  • buccal ‘snail track’ ulcers (30%)
  • condylomata lata (painless, warty lesions on the genitalia )
90
Q

Features of 3ary syphilis?

A
  • gummas (granulomatous lesions of the skin and bones)
  • ascending aortic aneurysms
  • general paralysis of the insane
  • tabes dorsalis
  • Argyll-Robertson pupil
91
Q

What does a negative non-treponemal test + positive treponemal test indicate in syphilis treatment?

A

Successfully treated syphilis

92
Q

What organism causes pubic lice infestation?

A

Parastite –> Phthirus pubis.

93
Q

How is pubic lice treated?

A

Insecticides –> either malathion lotion or permethrin cream.

Both should be applied to the whole body and washed off after 12 hours.

94
Q

Mx of 1ary herpes infection in pregnancy?

A

Elective caesarean section at term is advised if a primary attack of herpes occurs during pregnancy at >28 weeks gestation.

95
Q

Mx of 1ary herpes infection in 3rd trimester of pregnancy?

A

Oral aciclovir 400mg TDS until delivery

96
Q

1st line management of syphilis?

A

IM benzathine penicillin

97
Q

What cells are seen on microscopy in BV?

A

Clue cells

98
Q

Mx of trichomonas vaginalis?

A

Oral metronidazole

99
Q

What is the investigation of choice in genital herpes?

A

NAAT

100
Q

Mx of solitary, keratinised genital wart?

A

Cryotherapy

101
Q

Mx of multiple, non-keratinised warts?

A

Topical podophyllum

102
Q

What infection should be suspected in contact lens associated keratitis?

A

Pseudomonas aeruginosa

103
Q

What should an outbreak of genital herpes be treated with?

A

Oral aciclovir

104
Q

In needle-phobic patients, what is the Mx of gonorrhoea?

A

Oral cefixime + oral azithromycin

105
Q

What is the most sensitive and specific test for the diagnosis of Chlamydia in females?

A

Vulvovaginal swab for NAAT

106
Q

What is acanthamoeba keratitis?

A

A cause of contact lens-associated eye disease commonly associated with contact lens use in bodies of water such as the sea or swimming pools.

107
Q

What is the Jarisch-Herxheimer reaction?

A

Reaction following antibiotic administration for syphilis (benzathine penicillin).

Presents with fever, rash, chills and headache.

In contrast to anaphylaxis, there is no wheeze or hypotension.

108
Q

What is the management of the Jarisch-Herxheimer reaction?

A

no treatment is needed other than antipyretics if required

109
Q

What organism causes BV?

A

Gardnerella vaginalis

110
Q

Pain in genital ulcer caused by syphilis vs herpes?

A

Syphilis –> chancre is painless

Herpes –> painful

111
Q

Does the diagnosis of vaginal candidiasis require a high vaginal swab if the symptoms are highly suggestive?

A

No - can be clinical

112
Q

What can parvovirus B19 infection in pregnant women lead to?

A

Can cross the placenta and cause hydrops fetalis.

113
Q

Which form of emergency contraception should be used with caution in patients with severe asthma?

A

Ulipristal (EllaOne)

114
Q

1ary mechanism of action of the implant?

A

Inhibits ovulation

115
Q

Is trimethoprim in breastfeeding safe?

A

Yes

116
Q

Describe stage 1-4 of ovarian cancer

A

1: confined to ovary

2: tumour outside ovary but within pelvis

3: tumour outside pelvis but within abdomen

4: distant metastasis

117
Q

1st line for infertility in PCOS (after weight loss)?

A

Clomifene

118
Q

What investigations are recommended for all pre-menopausal women with complex ovarian cysts?

A

Serum CA-125, AFP + b-HCG

119
Q

What is b-HCG levels for expectant, medical and surgical management of an ectopic?

A

Expectant: <1000

Medical: <1500

Surgical: >5000

120
Q

Is migraine with aura a contraindication for HRT?

A

No (unlike the COCP)

However, topical preparations are preferred rather than oral.

121
Q

What is the only form of contraception licensed to be used as the progesterone component in HRT?

A

Mirena coil

122
Q

How long is the Mirena coil licensed for as HRT?

A

4 years

123
Q
A

Yr 4 - GOSH (45 decks)

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