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AMK > Obstetrics & gynae > Flashcards

Obstetrics & gynae Flashcards

1
Q

Threatened miscarriage

A

foetus is intrauterine, mild symptoms. Cervical Os is closed.

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2
Q

Complete miscarriage

A

all uterine contents expelled. Cervical Os is closed.

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3
Q

Missed miscarriage

A

dead foetus in the uterus. Cervical os is closed

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4
Q

Inevitable miscarriage

A

Fetus is dead, bleeding. Cervical os is opened

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5
Q

What anti-epileptic drugs are safe for pregnancy?

A

Lamotrigine
Carbamazepine
levacit.

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6
Q

Pre-eclampsia and Mx

A

High blood pressure during gestation
Assoc, with proteinuria, oedema, headaches

Anti-hypertensives e.g. labetalol.
Prevent eclampsia - magnesium sulphate

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7
Q

Symptoms of pre-eclampsia but abnormal creatinine

A

Acute Tubular Necrosis

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8
Q

Symptoms of pre-eclampsia but no proteinuria

A

gestational hypertension

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9
Q

Twin-Twin Transfusion Syndrome
Mx

A

Happens in monochorionic twins. Donor baby begins transferring blood to recipient baby through new vessels.
Both babies are abnormal
Donor baby: more likely to survive
Recipient baby: high cardiac output -> heart failure. increased fluid -> fetal hydrops.

Transect the vessels with lasers

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10
Q

what is the difference between partial and complete molar pregnancy

A

complete mole = 2 sperm, 1 egg with no genetics material
partial mole = 2 sperm, 1 egg with genetic material. makes an unviable fetus

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11
Q

danger of invasive mole

A

metastasise into choriocarcinoma

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12
Q

Dx and Mx of molar pregnancy

A

grape like/cloudy on ultrasound
removal of fetus, follow up with beta hCG testing, don’t get pregnant until 6 months after beta-hCG is normal

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13
Q

Px of placental abruption

A

firm woody uterus
no visible bleeding
painful

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14
Q

Px of placenta previa

A

soft uterus
visible bleeding
no pain

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15
Q

Px of vasa previa

A

rupture of membranes
painless bleeding
fetal bradycardia

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16
Q

Px of HELLP syndrome

A

haemolytic, elevated liver enzymes, low platelets

HTN, DIC, epigastric/RUQ pain, headaches

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17
Q

Px of haemolytic disease of the newborn

A

jaundice, kernicterus
hydrops fetalis

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18
Q

what is cervical ectropion, common cause of ??

A

benign. glandular cells grow outside of the cervix, causing increased levels of oestrogen
common cause of post-coital bleeding

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19
Q

uterus that feels tense/large for dates. hard to palpate fetal parts
Mx

A

polyhydramnios
too much amniotic fluid
indomethacin

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20
Q

sudden gush of fluid and non-reassuring fatal trace

A

cord prolapse

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21
Q

fever, abdo pain, offensive fluid from vagina, preterm rupture of membranes

A

chorioamnionitis

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22
Q

turtle neck sign, failure to progress labour

A

shoulder dystocia

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23
Q

position to relieve shoulder dystocia

A

mcroberts maneuvre

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24
Q

Mx of ectopic pregnancy

A

methotrexate and salphingectomy

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25
Q

common cause of recurrent miscarriage and the Mx

A

anti-phospholipid syndrome
aspirin and LMWH

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26
Q

trimethoprim avoided in the…
and why

A

1st trimester
it is a folate antagonist. contraindicated in 1st ttrimester when the neural tube is developing

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27
Q

nitrofurantoin avoided in the … and why

A

3rd trimester
risk of haemolytic anemia

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28
Q

medical termination of pregnancy

A

oral mifepristone + vaginal misopristol

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29
Q

Px of ovarian torsion

A

sudden 10/10 peri-umbilical pain radiating to the lower back
internal bleeding (from the ovary)
nausea

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30
Q

Mx of confirmed ovarian cancer

A

total abdominal hysterectomy and bilateral salpingo-oophorectomy

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31
Q

difference between salpingotomy and salpingectomy

A

salpingotomy just removes the ectopic pregnancy
salpingectomy removes the ectopic pregancy AND the fallopian tube

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32
Q

first line Ix and gold standard diagnosis for endometriosis

A

first line: transvaginal ultrasound
gs: diagnostic laprascopy

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33
Q

Sheehan syndrome what is it and Px

A

Necrosis of anterior pituitary after post partumhaemorrhage
Low prolactin , so difficulty feeding

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34
Q

Mittelschmerz

A

Ovulation pain

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35
Q

Prolactinoma Px, Mx

A

Prolactinoma is a benign pituitary tumour
Px: galactorrhea, + gonadal dysfunction (amenorrhea, erectile dysfunction,) + neuro (headaches, visual impairment)
Mx: dopamine agonists (cabergoline/bromocriptine) or surgery

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36
Q

cabergoline used for…

A

managing prolactinoma

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37
Q

what are the 4 blood results for DIC

A

prolonged PT and APTT
raised D Dimer
thrombocytopenia
low fibrinogen

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38
Q

1st and 2nd line for managing epilepsy in pregnancy

A
  1. lamotrigine
  2. levetiracetam
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39
Q

suspected varicella in pregnancy, don’t know if immune

A

test varicella antibodies
if not immune, give Ig

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40
Q

how to assess tubal patency (2 methods)

A

hysterosalpingography (no comorbid conditions)

laparoscopy and dye (with comorbid conditions)

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41
Q

commonly used test to test for ovulation

A

day 21 progesterone

42
Q

where is ectopic pregnancy most likely to be

A

ampulla

43
Q

where in fallopian tube is most likely to rupture in ectopic preg

A

isthmus

44
Q

IgG and IgM. What results show immunity from vaccination

A

IgG positive, IgM negative

45
Q

IgG and IgM. What results show immunity from recent infection

A

IgG -ve
IgM +ve

46
Q

what is the combined test and when does it take place

A

PAPP-A, B-HCG, nuchal translucency

10-14 weeks

47
Q

combined test results indicative of down syndrome

A

low PAPP-A
high B-HCG and nuchal translucency

48
Q

how does sheehans syndrome affect cortisol and aldosterone

A

low cortisol
normal aldosterone

49
Q

when to do surgical evacuation or vaginal misoprostol for miscarriage management

A

surgical evacuation if the patient is unstable or bleeding

50
Q

when is methotrexate used in ectopic pregnancy

A

can return for follow up
no pain
no ruptured ectopic pregnancy
serum HCG level 1500 IU/L

51
Q

when is a pregnancy considered viable

A

when fetal heartbeat can be heard

52
Q

what value of crown rump length is fetal heartbeat heard

A

7mm

53
Q

5 requirements for all pregnancies

A

all women have maternal blood grouping and Rhesus D typing

folic acid 5mg

vitamin D

Smoking cessation

exclude alcohol

54
Q

5 features of prolonged pregnancy

A
  • macrosomia
  • oligohydramnios
  • reduced fetal movements
  • presence of meconium (meconium staining on nails)
  • dry flaky skin with reduced vernix (waxy substance on baby’s skin)
55
Q

when does membrane sweep take place in nulliparous and parous women

what is done

what is a requirement

A

after 40 weeks in nulliparous + 41 weeks in parous

insert gloved finger through cervix, separate the chorionic membrane from the decidua

can be done at any bishop score, before IOL

56
Q

when does induction of labour take place in a normal prolonged preganncy

A

41-42 weeks

57
Q

3 indications for IOL

A

premature rupture of membranes

maternal health problems (pre eclampsia)

fetal growth restriction

58
Q

2 methods of IOL

A

vaginal prostaglandin

amniotomy and syntocinon infusion

59
Q

define fetal growth restriction

A

when the fetus is below the 10th percentile in growth

60
Q

when should IOL be done for a baby in fetal growth restriction

A

37 weeks

61
Q

pathophysiology of neonatal hypoglycaemia

A

maternal hyperglycaemia -> fetal hyperglycemia and insulinemia -> B cell hyperplasia in fetal pancreas (more insulin)

when the maternal glucose supply is removed at birth -> the hyperinsulinaemic foetus becomes hypoglycaemic

62
Q

management of neonatal hypoglycaemia

A

feeding within 30-60 minutes of birth
feed at least 3 times hourly
skin to skin
maintain temp 36-37.5

63
Q

4 points for antenatal care of diabetic pregnant women

A

booking appointment: 2hr OGTT

measure CBG 4 times / day

from 28 weeks go a growth scan every four weeks

joint diabetes and antenatal clinic every 2 weeks

64
Q

first line contraception for breastfeeding women

A

anything with progesterone (better to be an implant rather than pill)

65
Q

bishop score of <6

A

vaginal prostaglandin
or
mechanical method (is woman is at risk of uterine hyper stimulation)

66
Q

induction of labour method when bishop score >6

A

amniotomy and syntocinon

67
Q

termination of pregnancy : two options and how to choose

A

oral mifepristone + vaginal misoprostol

surgical evacuation

do surgical evacuation if >14 weeks

68
Q

Mx of pre-existing hypothyroidism in pregnancy

A

increase dose of levothyroxine

69
Q

Mx of PID

A

Im ceftriazone
oral doxy and metronidazole

70
Q

physiology behind breathlessness in pregnancy

A

high levels of progesterone leads to high levels of acidic CO2 so high levels of respiratory drive

minute ventilation and tidal volume increase which cause feelings of breathlessness

71
Q

what can be measured at the start of menopause to verify that it has started

A

FSH

72
Q

how to diagnose Trichomonas

A

wet slide mount from high vaginal swab

73
Q

how many antenatal scans

A

2

74
Q

what and when is the first antenatal scan

A

dating scan
10-14 weeks

75
Q

what and when is the second antenatal scan

A

anomaly scan
17-21 weeks

76
Q

vaginal bleeding. LMP was 9 weeks ago. high bHCG. ultrasound shows intrauterine gestational sac with cardiac activity. cervical os is closed

A

threatened miscarriage

77
Q

Incomplete fusion of paramesonephric ducts?

A

Leads to bicornuate or septate uteri
2nd trimester miscarriage

78
Q

Failure of migration of gonadotropin-releasing hormone (GnRH)-secreting neurones from the olfactory placode

A

Kallmann syndrome, hypogonadotrophic hypogonadism
Primary amenorrhoea

79
Q

Paternal Robertsonian translocation

A

chromosomal abnormality = 1st trimester miscarriage

80
Q

Maternal 45,XO chromosome complement

A

Turner syndrome
Primary amenorhhoea

81
Q

Low maternal serum progesterone, what type of miscarriage

A

1st trimester

82
Q

what is cyclical HRT

A

daily oestradiol
progesterone added on last 14 days
3 month cycles

83
Q

2 causes of post menopausal vaginal bleeding

A

cervical and endometrial cancer

84
Q

histology of the endometrium

A

simple columnar

85
Q

histology of cervix

A

stratified squamous

86
Q

histology of ovary

A

cuboidal

87
Q

histology of vagina

A

glycogen containing stratified sqamous

88
Q

histology of fallopian tubes

A

ciliated columnar

89
Q

what analgesics should breast feeding women avoid

A

aspirin
codeine

90
Q

what should be used in pregnant females with severe allergic rhinitis

A

oral. loratidine

91
Q

where is the lesion in sheehans syndrome
what hormone is deficient

A

anterior pituitary
prolactin

92
Q

how many litres of amniotic fluid is considered polyhydramnios

A

> 2-3

93
Q

what is adenomyosis

A

when the endometrial tissue starts to grow into the muscle wall

94
Q

what is a risk factor for hyperemesis and why

A

trophoblastic disease (molar pregnancy) due to very high bHCG

95
Q

fluid management for hyperemesis gravidarum

A

normal saline with potassium (hypokalemia is common)

96
Q

what is in an antenatal infection screen

A

Hep B
HIV
syphilis

97
Q

when is contraception required post partum?

what r 3 three methods?

A

Women need contraception after day 21 postpartum

LAM (lactational amennorhea method) :

Until 6 months post partum, if she if breastfeeding over 85% she can be covered for contraception under LAM

0-6 weeks: can use POP only, COCP contraindicated

6weeks + : can use COCP

98
Q

what is normal dose of folic acid for all oregnant women

A

0.4mg daily

99
Q

what is the dose of high dose folic acid
what are the indications

A

5mg
sickle cell,
on anti epileptic meds,
obese, diabetes,
history of neural tube defect,
thalassemia trait
celiac disease

100
Q

if fetal movements have not been felt by x weeks then refer to fetal med unit

A

24

AMK (29 decks)

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