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Obstetrics & Gynaecology > OSCE Study > Flashcards

OSCE Study Flashcards

1
Q

After what gestation would the loss of a pregnancy be considered a stillbirth?

A

20 weeks

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2
Q

Under what gestational age would the loss of a pregnancy be considered a miscarriage?

A

20 weeks

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3
Q

Give 6 causes of bleeding in early pregnancy

A 
Miscarriage
Ectopic pregnancy
Hormone-induced breakthrough
Infection
Trauma
Other pre-existing causes:
 - Fibroids
 - Polyps
 - Disorders of haemostasis
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4
Q

At what gestational age does the uterus normally become palpable?

A

12 weeks

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5
Q

What type of miscarriage is described here:
- Minimal vaginal bleeding, mild period-type pelvic pain, volume less than usual menstrual blood loss. Cervical os closed, uterine size corresponds to gestational period, USS confirms viable pregnancy

A

Threatened miscarriage

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6
Q

What type of miscarriage is described here:
- Open cervical os, vaginal bleeding associated with mild-severe crampy pelvic pain. USS confirms non-viable pregnancy, and reveals products of conception in utero.

A

Inevitable miscarriage

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7
Q

What type of miscarriage is described here:
- Vaginal bleeding, pelvic pain. Cervical os open, remains open until miscarriage is completed: medically, surgically or spontaneously. Some products of conception possibly visible on vaginal examination- may be passed and stuck in cervical os/uterus.

A

Incomplete miscarriage

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8
Q

What type of miscarriage is described here: - Vaginal bleeding, pelvic pain resolve spontaneously. Cervical os open, closes spontaneously. USS shows empty uterus: no products of conception remain, no ectopic pregnancy

A

Complete miscarriage

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9
Q

What is the management of an acutely unwell woman presenting with pain and bleeding in early pregnancy?

A
  1. Perform ABC’s with a few modifications for pregnancy
  2. Obtain IV access
  3. Give O2
  4. Continuous monitoring
  5. Give IV fluids if needed
  6. Give pain relief as required
  7. Request urgent bloods including group and hold. Transfuse blood while finding cause of bleeding and treating it.
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10
Q

Give 3 possible treatments for missed miscarriage

A

Conservative (65-80% will pass within 6 weeks)
Medical: Giving misoprostol will cause completion of miscarriage within a few days
Surgical: Vacuum aspiration

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11
Q

Give 3 risk factors for developing an ectopic pregnancy

A
  • Factors that slow the passage of the ovum to the uterus (e.g., salpingitis, previous ectopics or previous surgery)
  • Uterine pathology (e.g., endometriosis)
  • Contraception (e.g., IUD or POP)
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12
Q

What are the two treatments for an early ectopic pregnancy?

A

Medical: IM Methotrexate
Surgical: Often laparoscopic surgery

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13
Q

What is the definition of a recurrent miscarriage?

A

Loss of three or more consecutive pregnancies

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14
Q

What investigations should be done if a patient presents with vaginal bleeding during early pregnancy?

A

Transvaginal USS
Serial beta hCGs
Vitals
(Appropriate antenatal care bloods and scans)

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15
Q

What symptoms are usually present in hyperemesis gravidarum?

A

Persistent vomiting
Fluid loss (causing ketosis)
Electrolyte disturbances
Weight loss

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16
Q

What is the likely diagnosis in a pregnant woman with vomiting during early pregnancy but no volume depletion?

A

Normal morning sickness

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17
Q

What is the likely diagnosis in a pregnant woman with vomiting during early pregnancy, volume depletion and electrolyte imbalance?

A

Severe morning sickness

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18
Q

What is the likely diagnosis in a pregnant woman with vomiting during early pregnancy, volume depletion and electrolyte imbalance, ketosis and >5% weight loss?

A

Hyperemesis gravidarum

19
Q

Give 5 causes of hyperemesis gravidarum (or significant morning sickness)

A

Hydatidiform mole
Multi-gestational pregnancy (due to faster rising beta hCG)
Non-pregnancy related causes (e.g., hepatitis, pyelonephritis, appendicitis, bowel obstruction, raised intracranial pressure etc.)

20
Q

Give 5 complications of hyperemesis gravidarum

A

Wernicke’s encephalopathy
Mallory-Weiss tears
Hyponatraemia (Central pontine myelinolysis)
Thrombosis

21
Q

What investigations should be done for patient with hyperemesis gravidarum?

A

a) Full blood count (Anaemia, infection)
b) Urea and electrolytes (K, Na, Mg imbalances)
c) Liver function tests (Exclude alternative aetiologies)
d) Urinalysis (Ketonuria/rule out UTI or pyelonephritis)
e) Fetal ultrasound (Presence of multiple gestation/other fetal abnormalities)

22
Q

What treatments are available for hyperemesis gravidarum?

A

Fluid replacement (IV 0.9% normal saline + Potassium)
Antiemetics (Metaclopramide is 1st line)
Support and reassurance
Diet and lifestyle (small meals and avoidance)
Oral ginger
Corticosteroids

23
Q

Apart from metaclopramide, what antiemetics can be used for hyperemesis gravidarum (or morning sickness?)

A

Cyclizine
Prochlorperazine
Ondansetron

24
Q

What is the definition of gestational hypertension?

A

New onset hypertension > 20 weeks gestation (in the absence of features of pre-eclampsia)

25
Q

What is the definition of chronic hypertension?

A

Hypertension that was present prior to pregnancy or occurs <20 weeks gestation

26
Q

What is pre-eclampsia?

A

Pre-eclampsia is a multi-system progressive disorder occurring after 20 weeks gestation

It is the presence of:
- Hypertension (defined as a BP of ≥140 mmHg systolic and/or ≥90 mmHg diastolic, based on at least 2 measurements taken at least 4 hours apart) with signs of other organ involvement

27
Q

What are the signs of renal involvement in pre-eclampsia?

A

Proteinuria

Oliguria

28
Q

What are the signs of haematological involvement in pre-eclampsia?

A

Thrombocytopenia
Haemolysis
DIC

29
Q

What are the signs of liver involvement in pre-eclampsia?

A

Raised serum transaminases

Severe RUQ pain

30
Q

What are the signs of neurological involvement in pre-eclampsia?

A

Hyper-reflexia
Severe headache
Persistent visual disturbances
Stroke (due to coagulopathy/thrombosis)

Conulsions —> this is considered eclampsia

31
Q

What are the ‘other’ signs of pre-eclampsia?

A

Pulmonary (or peripheral) oedema
Fetal growth restriction
Placental abruption

32
Q

Give 6 risk factors for pre-eclampsia

A 
Nulliparity
Obesity
Previous pre-eclampsia
Family history of pre-eclampsia
Diabetes
Renal disease
Multiple pregnancy (i.e., twins)
Autoimmune diseases (e.g., antiphospholipid syndrome)
Chronic HTN
33
Q

What causes pre-eclampsia?

A

Failure of normal invasion of trophoblast cells leading to maladaptation of the maternal spiral arterioles (less dilation and poor extension into the myometrium). This leads to placental insufficiency and hindered fetal growth

These all combine to cause vascular inflammation that causes vasoconstriction and capillary leak (due to placental ischaemia) which leads to hypertension and proteinuria

34
Q

What investigations should be done for a mother with pre-eclampsia?

A

Regular blood pressure
Urine tests (MSU, dipstick, protein:creatinine, protein 24 hour collection)
FBC (platelets and possible coagulation profile)
LFTs
Group and hold
Fetal wellbeing (e.g., USS, cardiotocography, doppler)

35
Q

Early in pregnancy, what 2 drugs can be used to reduce the risk of pre-eclampsia developing?

A

Aspirin (100mg)
Calcium supplements

*Folic acid and multivitamins may also reduce the risk

36
Q

What drugs can be used to treat the HTN in pre-eclampsia?

A

Methyldopa
Labetalol (or metoprolol)
Nifedipine
Magnesium sulphate

37
Q

What is the treatment for women with eclampsia?

A

Magnesium sulphate

38
Q

After the delivery of a baby, how long does a mother who suffered from pre-eclampsia need to be treated for HTN and seizures?

A

Until recovery is obvious

39
Q

What is the main risk to a mother with eclampsia after delivery of the baby?

A

Fluid overload

40
Q

What are the components of HELLP syndrome?

A

Haemolysis
Elevated liver enzymes
Low platelets

41
Q

What are the symptoms of HELLP syndrome?

A 
Abdominal pain (often upper/epigastric)
Nausea and vomiting
Malaise
Headaches
Oedema
Visual disturbances
42
Q

What systems does pre-eclampsia affect?

A

Neurological (headache, visual, seizures)
Pulmonary (oedema/PE)
Renal (proteinuria, oliguria)
Hepatic (elevated transaminases and albumin)
Haematological (thrombocytopenia, haemolysis, DIC)
Cardiovascular (oedema)

43
Q

How can pregnancy cause diabetes (i.e., why is it diabetogenic)?

A

Pregnancy hormones (human placental lactogen, cortisol, progesterone, beta-hCG) are thought to interfere with the action of insulin as it binds to the insulin receptor, causing insulin resistance.

This encourages a relative hyperglycaemia (which essentially ensures there is lots of glucose in the blood for the baby to absorb) in all pregnancy women, however, in some women, this progresses to insulin resistance and hyperglycaemia. This causes gestational diabetes.

44
Q

Give 6 risk factors for developing GDM

A 
Obesity
PMHx of GDM or DM
FHx of GDM DMII
Previous LGA baby
Ethnicity (Polynesian, Indian, Middle Eastern)
Maternal age ( >30 years)
Multiple pregnancy
PCOS

Obstetrics & Gynaecology (1 decks)

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