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AMC Key > Obstetrics & Gynaecology > Flashcards

Obstetrics & Gynaecology Flashcards

1
Q

HMB/AUB
Best for later conception

A

Mirena (LNGIUS) 1st
Cocp 2nd
Pop: no, causes irregular 🩸

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2
Q

Patient ectopic pregnancy, wants to continue contraception.
Best choice

A

LARC
POP/ COCP : small risk of ectopic

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3
Q

Most important factor for Labor progress

A

Uterine contractions
1st phase: latent : irregular contractions/cervical efface and dilation
Active: regular contractions, cervix 3-4cm, descent of head

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4
Q

Abd pain following cough /sneeze
Tender and
CTG normal

A

Rectus sheath hematoma
*Diastasis rectus: painless , swelling at any pt midline ,📈 on abd pressure

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5
Q

PV 🩸 with suspected ectopic,which is very important sign for emergency

A

Shoulder tip pain
: irritated phrenic nerve by blood in peritoneal cavity

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6
Q

Dysmenorrhoea 1° mngt

A

NSAIDs 1st
OCP: given if contraception is planned or NSAIDs contraindicated

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7
Q

CTG information

A

Baseline heart rate
Variable heart rate
Acceleration
Deceleration : early/variable/prolonged/late

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8
Q

Abnormal CTG

A

HR outside range
Poor variability
Deceleration are variable/prolonged

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9
Q

Pregnancy loss, keen for conception

A

Immediately

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10
Q

ITP pregnancy
Steroid or ivIG

A

If platelet<30,000 or symptomatic>30,000

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11
Q

ITP

A

Advised 70-100,000 plt count for safe regional anaesthesia
* gestational thrombocytopenia occurs 10%but plt count usually
70,000

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12
Q

Girls puberty development

A

Order:
Breast bud>growth spurt>axillary/pubic hair>menses

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13
Q

Tanner female
General

A

1: none
2: boobs and pubes
3: acne,axilla, height
4.menses
5. Adult

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14
Q

Tanner breast

A

|-No : none
||-Body : bud
|||-Elevates : breasts elevated
|V-2 mountains in : secondary mound
V-Adulthood : adult size

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15
Q

HMB/AUB

A

Ovulatory: regular, structural;fibroids, endometriosis,polyp
Anovulatory : hormonal; PCOS, hypo or hyperthyroidism, hyperprolactinemia, Cushing

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16
Q

Best Ix for Ovulatory HMB

A

TVS

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17
Q

Non reassuring CTG Mx

A

Call help
O2
Left lateral
IV fluids bolus
Stop oxytocin infusion
Continuous CTG monitoring
Kiv tocolysis
If all done : still not improving
Fetal scalp sampling
Finally: Urgent Lscs

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18
Q

Reassuring CTG

A

Normal fhr :110-160
Good variability:6-25bpm
Age appropriate acceleration
No late or variable deceleration

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19
Q

Female infertility

A

Hormonal
Blocked tubes
Adhesion uterine
Thick cervical mucus

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20
Q

Male infertility

A

Semen abnormality
Obstructive causes
Ejaculatory failure

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21
Q

Ocp protection

A

Cool : colon
OCP : ovary
protects
U: uterine

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22
Q

Ocp risk

A

Be : breast
careful : cervical

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23
Q

Atrophic vaginitis Sx

A

5 years post menopause
Dyspareunia: atrophic vaginal epithelium
Dysuria: chronic, thinning of bladder and urethral epithelium due to low estrogens

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24
Q

Tx atrophic vaginitis

A

Lubricant
Estrogen cream

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25
Q

COCP
contraindications

A

Active breast ca
Smoker age> 45
DVT
Migraine
Thrombophilia
HPT BP> 160/110
DM with nephropathy
Liver disease
SLE
APS
IHD

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26
Q

Cord prolapse CTG finding

A

Variable deceleration
Fetal brady

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27
Q

Risk of PE in pregnancy

A

Highest: past PE
Chronic HPT

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28
Q

Most common cause of low milk production

A

Decreased frequency of breastfeeding

(-)!peptide increased when reduced feeding,so reduced synthesis of milk production

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29
Q

Prolonged deceleration in CTG in induced labor

A

Syntocinon causing uterus hyperstimulation is common cause. Cease syntocinon if no improvement with other measures

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30
Q

Fetal bradycardia
Vs prolonged deceleration

A

PD: drop in fhr from baseline >90s to 5 minutes
FB: fhr <90/min for > 5minutes

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31
Q

Lichen sclerosis vagina

A

Clobetasone 1st line
Calcineurin (-)

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32
Q

Varicella contact in pregnancy
Unknown immune status

A

Check IgG level
Give ivIG if negative

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33
Q

Post coital bleeding
Patient on high estrogen phase during ovulation/on OCP cause?

A

Cervical ectropion

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34
Q

Listeriosis in food to avoid in pregnancy

A

Soft cheese

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35
Q

1.Premature ovarian failure
Diagnostic?
2.Keen for conception tx

A

1)2 FSH levels 1 month apart
High (in menopausal range )
Serum estradiol Low

2) Tx: MRT

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36
Q

Autoimmune oophoritis causing premature ovarian failure

A

LH will be high

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37
Q

Premature ovarian failure keen for contraception
Rx?

A

OCP

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38
Q

2° amenorrhea
Causes

A
  1. PCOS
  2. Premature ovarian failure
  3. Hyperprolactinemia
  4. Functional/exercise induced
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39
Q

PPROM 26wk-35wk
Aim

A

For fetal maturity:
Steroid given in 24 hours
Tocolysis in that period
NICU back-up
USG: liquor adequacy
Abx: IV erythromycin
WBC/CRP:2-3 days
CTG: 2-3 days
All okay 👍»> discharge with advise

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40
Q

Ix for PPROM

A
  1. Speculum:fluid at fornix
  2. CTG
  3. High &low vaginal swab
  4. USG : liquor adequacy
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41
Q

Chorioamnionitis ∆
Criteria

A

Maternal fever
+ 2 of the following
Maternal tachycardia
Uterine tenderness
Foul smell discharge 🤢
Fetal tachycardia
WBC >15,000
CRP> 40

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42
Q

Measles infected pregnant women

A

Observation only
MMR contraindicated

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43
Q

Exposed to Measles patient in pregnant women

A

If no symptoms, give NHIG !

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44
Q

Measles pregnant women

A

Notify and contact tracing
Observation of patient

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45
Q

Measles complications

A

Preterm Labor
Spontaneous abortion
Maternal morbidity
Pregnancy loss

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46
Q

Abruptio placenta most common finding

A

PV 🩸 bleeding 80% of cases
Abd pain 70%

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47
Q

PROM after intercourse

A

Pooling of fluid at posterior fornix
Nitrazine
Amnisure

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48
Q

PROM> 18 hours

A

Start Abx !!!
Prevent chorioamnionitis !!!

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49
Q

Rubella exposure to pregnancy 1st trimester

A

Check serology IgG and IgM stat
If IgG> 10 : no further action

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50
Q

Rubella incubation period
14-23 days

A

Early testing before 7 days or within 21 days need repeat IgM testing for susceptible ones

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51
Q

Once serology IgM+

A

Termination of pregnancy

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52
Q

Maternal tachycardia and hypotension with disproportionate small amount PV 🩸

A

Abruptio placenta

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53
Q

Unstable abruptio

A

ABC
Cross match
USG

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54
Q

Dysmenorrhoea not relieved with NSAIDs or OCP
Ix

A

TVS 1st choice
TAS: virgin

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55
Q

Post coital bleeding
Normal cervical screening

A

<30 yrs
OCP: cervical ectropion
Cervicitis: chlamydia + discharge
>30y yrs
Polyp

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56
Q

Primary amenorrhea presentation
Ix

A

+ secondary sexual character : USG
- secondary sexual character: hormonal studies

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57
Q

Ovarian dysgenesis
(Turners)

A
  1. No /abnormal breast
  2. Poor streak ovaries
  3. FSH 📈
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58
Q

Mullerian

A
  1. Normal breast /pubic/ axillary
  2. FSH LH normal
  3. Abnormal uterus/vagina/cervix
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59
Q

Androgen insensitive

A

Normal breast
Absent pubic and axillary hair
Absent uterus

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60
Q

The following tests are considered basic for all patients with primary amenorrhea
* priority based on presentation

A

:

Pregnancy test (to exclude pregnancy prior to first menstruation)
Pelvic ultrasound (complementary to physical exam)
FSH (and LH)
Thyroid stimulating hormone (TSH)
Prolactin

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61
Q

Decision for which test in 1 amenorrhea based on Tanner

A

Breasts are an endogenous assay for estrogen. Breast development consistent with a Tanner stage of II or greater indicates the presence of estrogen and ovarian function (although it could be insufficient or prematurely failed). With breasts present, the next step is always checking for the presence or absence of a uterus, its anatomy and possible defects, vagina, and hymen. If there is no breast development, FHS (and LH) comes first

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62
Q

Incarcerated uterus

A

Cervix stuck between pushed upwards pushing on bladder & urethra»> voiding issue
USG for ∆

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63
Q

Reassuring CTG

A

Observe and continue monitoring

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64
Q

Non reassuring CTG / abnormal CTG

A

Fetal scalp blood sampling

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65
Q

Non reassuring CTG

A

Variability of FHR <3 bpm ( N: 6-25)
HR: 100-109/min
Variable deceleration non complicated

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66
Q

Abnormal CTG

A

FHR<100/min or > 170/min
Variability<3 or absent
Deceleration>3 mins/ late/complicated variables

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67
Q

Hematoma at episiotomy site

A

<3cm: ice pack & analgesia
> 3 cm: evacuate under Anesthesia

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68
Q

VZIG passive immunization

A

Within 96 hrs of exposure

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69
Q

Acyclovir in pregnancy

A

As prophylaxis in 2nd term pregnancy / developed sx

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70
Q

Otosclerosis

A

Avoid OCP,give IUCD

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71
Q

Emergency contraceptive , most important q?

A

Date of last unprotected Si

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72
Q

Women contraindicated for COCP needs med for menopausal SX

A

SSRI: fluoxetine

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73
Q

Bright red spot pv , tender uterus, fever Day5 post partum

A

Retained POC

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74
Q

Fever, tender uterus, malodorous and green discharge of lochia

A

Endometritis ( Day 5 onwards)

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75
Q

HSIL (CIN 2/3) In 3rd trimester

A

Colposcopy now ( safe)

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76
Q

Invasive cervical cancer

A

Viable fetus, steroid for lung maturity and expedite delivery
Previable : mother decides to forego pregnancy, tx m mother

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77
Q

Colpocopy : no abnormality but smear CIN 2 ( HSIL)

A

Cone biopsy

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78
Q

High dose folic acid 5mg

A
  1. Patients on anti epileptic
  2. Family history / personal HX of NTD
  3. Type1 or 2 DM
  4. BMI> 35
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79
Q

Uterine bleeding> step wise approach

A

Determine ovulatory vs anovulatory:
1. FBC
2. USG : TVS preferred
3. Endometrial thickness+: sampling

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80
Q

Cervical motion tenderness

A

PID
Ectopic pregnancy

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81
Q

PID
Mx

A

Cervical swab
Abx

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82
Q

Ovarian teratoma

A

Solid mass <10 cm
Young woman
Asymptomatic or mild symptoms
Adnexal mass

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83
Q

OCP with high BP

A

Stop OCP and reassess BP, estrogen cessation might bring down BP

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84
Q

Gardnerella Vaginalis

A

MCC bacterial vaginosis
Thin, greyish, malodorous discharge

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85
Q

Calendar method contraception

A

Abstinence
-6 days from earliest day of ovulation
+2 days after last day of ovulation
Ovulation: always 14th day

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86
Q

Cycle 26- 30 days

A

Abstinence start: 12 -6 =day 6
Ends: day 18

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87
Q

Previous Lscs + prolonged active phase of 1st phase risk

A

Uterine rupture

88
Q

Unstable lie

A

Multipara

89
Q

GDM post delivery monitoring

A

2 yearly OGTT

90
Q

Yaz/Yasmin tablet

A

Estrogen + Drospirenone (helps with wt loss esp water retention)

91
Q

EBV in pregnancy

A

Reassure, TCA if SX develops
Small risk to foetus, early Labor,SGA

92
Q

Migraine with Vomiting

A

Mild: pcm
Mod to severe: codeine+ metoclopramide (Vomiting 🤮 part)

93
Q

Sudden pain getting up chair/sneeze

A

Round ligament pain
Common in 2md trimester

94
Q

Amenorrhea after gynae procedure

A

Adhesions
TVS 1st Ix

95
Q

USG done in PV 🩸 mainly

A

To find out cause of bleeding
Not for fetal viability

96
Q

Pregnant, frontal headache, hypotension diplopia

A

Pituitary apoplexy
(Adenoma hemorrhage,sudden)

97
Q

Abnormal lie at term

A

1st : USG TRO placenta Previa/polyhydramnios/ multiple gestation
Attempt ECV

98
Q

Patient with primary pulmonary hypertension wants conceive

A

Contraindicated, mother risk

99
Q

DVT treatment post partum
and safe for BF

A

Warfarin

100
Q

Warfarin in 1st trimester

A

Fetal Warfarin Syndrome :
Facial anomalies,
Nasal hypoplasia
Chondrodysplasia punctata
Short fingers, hypoplasia finger nails
Intellectual disability
Low birth weight

101
Q

Warfarin 2nd trimester

A

Mental retardation
Optic atrophy
Dandy Walker

102
Q

DVT on LMWH nearing term

A

Switch to unfractioned heparin
(safe for regional anaesthesia)

103
Q

Duration to restart LMWH/Unfractioned heparin post SVD and LSCS in DVT patient

A

SVD: 4-6 hrs
LSCS: 6-12 hrs

104
Q

If epidural catheter removed, when can restart LMWH?

A

24 hours after removal

105
Q

Reason for DVT in pregnancy

A

Reduced protein S and protein C
And
Increased activity factor V and VII

106
Q

PE in pregnancy
Best Ix

A

V/Q perfusion scan

107
Q

Hypothyroidism in pregnancy
Frequency to check?

A

•Requirement increase by 30%
•Check 4-6weeks 1st half pregnancy
1x 26-32 weeks

108
Q

Mom insist on LSCS despite no indication

A

Refer obstetrician for 2nd opinion

109
Q

Urine retention with
Mass below umbilicus in pregnant women

A

Incarcerated uterus

110
Q

Rhesus - mother

A

Give Rhogam at 28 weeks and 34th week routinely

111
Q

Rh - 1st trimester /2nd trimester procedure or precipitating events
Eg: D&C, amniocentesis, CVS, abortion

A

Give immediate Rhogam

112
Q

Post partum Rh -ve

A

Give Rhogam within 72 hrs

113
Q

Kleihaeur Betki test

A

Check fetomaternal blood mix level to determine extra dose Rhogam need to be given

114
Q

Mother already developed anti d antibodies

A

No need Rhogam

115
Q

MCC of PPH

A

Uterine atony
Reason:
Polyhydramnios/ multiple gestation/macrosomia/prolonged Labor

116
Q

Antiepileptic in pregnancy, how to withdraw

A

•Depends on type of epilepsy
•EEG finding
•Seizure free period
•Neurological deficits +/-
•Past HX of relapse upon withdrawal

117
Q

Lifelong epilepsy Rx

A

Juvenile myoclonic epilepsy

118
Q

Period of free from withdrawal antiepileptic before conception

A

6 months

119
Q

Uterine rupture vs abruptio

A

Uterine less tender,less tone, FHR far decreased in uterine rupture

120
Q

Post partum GDM check ✔️

A
  1. 1 day post delivery: RBG
  2. Before discharge: 4 point BG level ( 1 fast, 3 2hrs after meals)
  3. GP : OGTT 75gm at 6wk and 12 wk
121
Q

HIV mother
Contraindications

A

Breastfeeding

122
Q

Reduce risk of HIV to newborns

A

1.Mother on ART
2.Intrapartum Zidovudine
3.Neonatal ART
4. Elective LSCS

123
Q

LSCS for HIV mother
Rx for art

A

Give Zidovudine 3 hrs before op

124
Q

Intrapartum avoidance in HIV

A

No foetal scalp sampling
No amniotomy
No episiotomy
No forceps

125
Q

Rubella vaccine for non immune planning to conceive
Duration

A

3 months

126
Q

Herpes simplex virus in pregnancy

A

Near term with active lesion need Rx
Consider LSCS: active lesion or rupture of membranes
Newborn treated if signs+ or viral culture+

127
Q

Herpes simplex risk 1° vs recurrent

A

1° higher risk

128
Q

MRT rx

A

Within 2 years of cessation:
Estrogen+ 12 days MPA
After 1 - 2yrs : continuous estrogen + MPA

129
Q

PCOS
Most accurate ix

A

Testosterone level
(Hyperandrogenism)

130
Q

Bartholin cyst

A

<3cm: warm compress
> 3cm: surgery
a. Incision and drainage
b. Marsupialisatiom: recurrent
c. Word catheter

131
Q

PMS
Diagnostic criteria
Rx

A

•5 days before menses for 3 cycles
•Somatic and affective SX
Rx (Stepwise):
CBT
NSAIDs
OCP : ovulation suppression reduction SX

132
Q

PMDD
∆ criteria
Rx

A

Severe form PMS lasting 12mth
Rx: SSRI

133
Q

Mastalgia from PMS rx
Fluid retention from PMS rx

A

Danazol & EPO ( initial)
Spironolactone

134
Q

General stepwise approach in PMDD

A
  1. CBT, vitamin, relaxation
    Trial for 2-3 cycles, 8f fail then consider SSRI on intermittent basis or daily depending on response
135
Q

Rhogam not indicated for rh - mom

A

Threatened abortion<12 weeks

136
Q

Duration of Rhogam in maternal circulation

A

6 weeks

137
Q

Valvular heart disease which is most threatening for pregnancy

A

MS

138
Q

Ovarian cancer
Concept

A

> ovulation,more risk of cancer
Nulliparous,early menarche,late menopause,

139
Q

Postpartum fever

A
140
Q

Bacterial vaginosis Rx in pregnancy

A

1st line: Clindamycin 300mg BD X 7 days
2nd line: Metronidazole 400mg TDS X 7 days

141
Q

Endometrial thickness normal

A

2mm-4mm

142
Q

UPT + ,empty uterus on USG

A

False +
Ectopic pregnancy
Very early pregnancy
Complete abortion

143
Q

GDM evaluation in non risk pregnancy

A

OGTT Btw 24 -28 weeks

144
Q

GDM evaluation in high risk
Score» 2

A

2 hour 75g OGTT NOW !!!

145
Q

Hypertension in pregnancy
Medications

A

Hypertensive Mom’s Need Love
Hydralazine: acute
Methyldopa : ••• 1st line
Nifedipine
Labetolol : acute

146
Q

Steroids in PPROM

A

Given between 26 wk-34 wk

147
Q

PPROM< 23 week

A

Induce Labor
Or bed rest TCA once Labor SX begins

148
Q

Tocolysis indication
& contraindications

A

Refer table

149
Q

Tocolysis agent

A

1st : nifedipine
2nd: salbutamol

150
Q

Nifedipine/ salbutamol contraindicated eg. Mitral Stenosis with early contractions

A

Give oxytocin antagonists
Atosiban

151
Q

Seat belt trauma with marks seen on abdomen

A

bruises over the abdomen this patient should be considered as having significant abdominal trauma and observation for a minimum of 24 hours, should be considered.

152
Q

Fetal Fibronectin
Interpretation?
Criteria?

A

Absent: unlikely to deliver next 7 days ( high negative predictive value).
Candidates with intact membrane, os < 3cm & GA 22wk-34w6d

153
Q

Cervical incompetence
∆ 3 criteria

A

•2 /> pregnancy loss after 12wk POG
•cervical dilator size 9 can be easily passed & no snapping on withdrawal
• cervical thickness<25mm and dilation of os >3cm before 24wk of gestation

154
Q

Cervical length screening done for

A

2x btw 14wk-24 wk for:
1. Past HX of preterm babies
2. Suspected cervical incompetence
3. Multiple gestation
4. HX of cone biopsy

155
Q

Normal cervical length

A

40mm
34wk: 34mm
Iess than above in less than 24 wk is a predictor for early preterm labor

156
Q

Cervical cerclage
When to do?

A

Based on HX:
•12wk-14wk:
Hx pregnancy loss >2 after 12 weeks with shortened cervix
loss is earlier than previous pregnancy
USG based:
•14wk -26 weeks: progressive effacement of cervix on serial USG & external os is closed
Rescue based:
Cervical os> 2cm but no contractions
Effacement> 50 %
Membrane bulging at os
Pelvic pressure

157
Q

Hyperprolactinemia causing infertility.
1st choice of Rx
2nd choice of Rx

A

1st: Bromocriptine, to shrink and correct the prolactin level.
Fertility can be attempted at this 👉 point
If medical fails to correct
MRI to locate tumor and surgical resection

158
Q

2 elements given in pregnancy

A

Folic acid: 12 weeks before conception upto end of 1st trimester
Iodine: throughout pregnancy

159
Q

Breastfeeding contraindicated

A

Breast abscess

160
Q

Women with sudden onset severe headache,slurred speech and dysarthria
∆ ?
Ix ?

A

SAH
CT scan

161
Q

HPV screening

A

2 years after 1st SI
Or age of 25 years
Whichever is later
Done every 5 years

162
Q

LSIL repeat 1 year still LSIL
Next step?

A

Colposcopy

163
Q

HSIL treated, next step?

A

Rpt colposcopy and cytology 4-6 mth
Then repeat annually till 2 consecutive results of cytology and colposcopy are NEGATIVE
Negative»» 5 yearly basis

164
Q

HX of Abruptio Placenta

A

Recurrence is a worry,
Frequency of screening increased 3 month before the timing of previous Abruptio occurred

165
Q

CVS best timing

A

10-12 weeks for chromosomal abnormality

166
Q

Neutral tube defect

A

18-20week

167
Q

Maternal serum triple test for
Down Syndrome
Timing?
Test?

A

15-18weeks
Alpha fetoprotein
Beta hcG
Oestriol

168
Q

Amniocentesis

A

15-18 weeks
For chromosomal abnormality

169
Q

Parvovirus B19 exposure to pregnancy
1st step

A

Check serum IgG
If + no need to worry
If negative : check IgM
If both IgG negative, IgM negative
Repeat testing 2 weeks for IgM

170
Q

Parvovirus B19 risk to foetus

A

Foetal hydrops ( high risk throughout pregnancy)

171
Q

Parvovirus mother + infected

A

1-2weekly USG monitoring of foetus next 6-12 weeks looking for hydrops foetalis
If Hydrops +&raquo_space;> cord sampling & intrauterine blood transfusion

172
Q

Hydrops foetalis pathophysiology

A

Fetal anemia~~ hypoxia~~low hepatic/renal blood flow~~~RAAS activated~~increase blood volume~~increase lymphatic flow~~ fluid accumulation

173
Q

Uterine leiomyoma keen for conception (large fibroid)

A

GnRH analogue ( best medical therapy ) for 3/12 then myomectomy

174
Q

GBS sepsis risk

A

√ Preterm labor
√ ROM > 18 hours
√ Current GBS bacteruria
√ Maternal pyrexia intrapartum and within 24 hr post partum
√ Past HX of GBS sepsis

175
Q

GBS urine culture+ antenatal

A

Tx with abx
1st : cephalexin
2nd: nitrofurantoin
3rd: Augmentin

176
Q

GBS vaginal swab + antenatal

A

No need treatment for mother
Treatment aimed during Labor only - prevent neonatal sepsis !!!

177
Q

Intrapartum abx for GBS

A

•Current pregnancy vaginal/rectal swab +
•Current pregnancy bacteruria+
•Past HX of GBS sepsis newborn
•Prolonged ROM>18hrs
•Unknown culture status antenatal
•Maternal fever intrapartum and 24hr post partum

178
Q

CMV + in pregnancy
IgM +

A

Need to repeat as IgM may stay +ve for 1 year. Need specialist opinion on interpretation

179
Q

CMV infection in pregnancy

A

Amniocentesis+ USG
Look for PCR of amniotic fluid for CMv, no active treatment but counselling

180
Q

Mother hepatitis C Ab +ve

A

Check HCV RNA level using PCR to measure viral replication

181
Q

Child with mother of hepatitis C+

A

Check Hep C 12-18 age and if + to initiate treatment

182
Q

Genital herpes after 30 week of pregnancy

A

Prophylactic treatment for mother from 36 wk till delivery
PCR at cervix
LSCS mode of delivery

183
Q

Mother with chicken pox

A

< 7 days before delivery: give varicella IG to Child after birth
> 7 days before delivery: no need VZIG for child at birth
2-28 days after delivery: give VZIG to newborn esp preterm & <1000gm birth wt

184
Q

Triple screening marker
70% sensitivity using maternal serum

A

Elevated b-HcG
Decreased AFP
Decreased unconjugated estriol
Best done : 15-18 wk
If abnormal: USG to confirm dates for gestation
Amniocentesis is next

185
Q

Best and safe method to ∆ Down Syndrome

A

Amniocentesis
Used for:
Karyotyping
AFP elevated, Ach elevated in fluid

186
Q

1st trimester trisomy 21 screening

A

PAPP-A decreased
Nuchal translucency
B- HCG increased

187
Q

Quadruple screening

A

AFP low
b-HcG high
Estriol low
Inhibin high

188
Q

Sensitivity for trisomy

A

Triple test: 65-70%
Quadruple:70-75%
Triple test + USG : 70-75%
1st trimester (b-HcG+ PAPP-A : 60-65% + USG (nuchal) : 65-80%

189
Q

Ovarian cyst
Reproductive age group

A

<3cm: nothing
3-5cm: rpt USG 6-12wk
5-7 cm: rpt USG 6-12wk, then yearly
> 7cm: laparoscopy

190
Q

Best method of contraception for epilepsy patients (esp enzyme inducers)

A

Mirena (IUCD)

191
Q

OCP on antiepileptic

A

Use high dose as efficacy drops due to antiepileptic activity as enzyme inducers

192
Q

COCP with slightly high BP , keen to continue oral method

A

Switch to POP

193
Q

Postinor

A

Double dose at a time reduces failure rate & side effects

194
Q

POP indication

A

HPT
DM
Thyroid
Migraine
HX of VTE
Lactation
Superficial thrombophlebitis
Biliary tract disease

195
Q

POP contraindications
PBUHAL

A

Pregnancy
Breast ca
Undiagnosed genital bleed
HX of ectopic
Active liver dx
Liver cirrhosis

196
Q

Enzyme inducers antiepileptic

A

Phenytoin/Carbamazepine/phenobarbital

197
Q

Antiepileptic non inducers

A

Valproic acid
Gabapentin
Lamotrigine
Ethosuximide

198
Q

OCP with breakthrough bleeding
Acceptable duration?

A

3 months

199
Q

If no improvement after 3 months with erratic PV 🩸 on ocp

A

Increase dose of oestrogen

200
Q

Women missed OCP or severe AGE > 24 hr

A

Continue OCP but barrier protection for 7 days
*Efficacy of OCP reduced

201
Q

OCP missed

A

24-48 hr: take the pill and continue, no need barrier
> 48hr@ 2 pills or more: take one pill now+ barrier method 7 days

202
Q

Emergency contraceptive in OCP

A

1st 7 days: emergency contraceptive+
8-14 days: no need provided comply earlier
15-21: no need, but omit 7 day break

203
Q

Lactational amenorrhea
Criteria (3)

A

Exclusive BF
Post partum 6 months
Remain amenorrheic

204
Q

POP use post partum

A

3-4 weeks
Immediate: only condom

205
Q

Hormonal level indicator that pregnancy has occurred

A

LH

206
Q

Smoking vs cocaine
Which gives more adverse effects to foetus

A

Cocaine&raquo_space;> ICB

207
Q

Fetal alcohol syndrome
∆?
Features?

A

> 12 standard units daily
Low set ear/long philtrum/microcephaly/

208
Q

Antiepileptic with highest malformations in foetus?

A

Sodium valproic
But in idiopathic/juvenile myoclonic: use in low dose and explain the effects

209
Q

Drugs with highest CNS effect

A

Cocaine (ICB)

210
Q

Valproic acid side effects

A

Orofacial cleft
Cardiac anomalies
Neural tube defect

211
Q

PCOS rx

A

Non pharma: aimed age <35
wt loss aim for 6 month and reassess
> Age 35
Clomiphene citrate : 1st line
Metformin ( BMI> 30)

212
Q

Maternal Shock disproportionate to the blood loss per vagina post partum

A

Uterine rupture ! ! !

213
Q

Station of head

A
214
Q

Patient on MRT, frequency of mammogram

A

Same as not on MRT

215
Q

MRT with family HX of breast cancer

A

Yes , can be given

216
Q

MRT in personal HX of breast cancer with estrogen receptor+

A

Absolute contraindication !!!

AMC Key (11 decks)

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