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Year 4 - ObGyn > Osce Topics > Flashcards

Osce Topics Flashcards

1
Q

Antenatal screening components

  • Infections
  • Maternal
  • Genetics
A

Antenatal screening components

  • Infections
    1. BBVs
    2. Syphilis
    3. Asymptomatic bacturia
  • Maternal
    1. Blood
    2. PET risk
    3. Psychiatry
  • Genetics
    1. Downs
    2. Anomalies
    3. Neural tube
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2
Q

Ultrasound in pregnancy

  • Calls
  • NT
  • Bowel
A

Ultrasound in pregnancy

  • Calls
    1. 11-13
  • NT
    1. Down’s
    2. Heart
    3. Abdominal wall
  • Bowel
    1. CF
    2. Down’s
    3. CMV
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3
Q

SGA
- Definition
- Causes
- Mx

A

SGA
- Definition
1. <10th centile
2. Severe <3rd

  • Causes
    1. Constitutional (50-70%)
    2. Placenta FGR (low BMI, substances, AI condition, renal, DM, HTN)
    3. Non placenta FGR (chromosome, structure, metabolic, infection)
  • Mx
    1. USS (AC and HC)
  • Fetal anatomical survey
    2. UAD. (Uterine A. Doppler)
    3. Karyotyping and infection screens
  1. Steroids
  2. Induction/C Section
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4
Q

Abnormal lie, position, presentation
- identification
- Mx and risks

A

Abnormal lie, proportion, presentation

  • identification
    1. Palpation
    2. VE during labour
  • Mx
    1. USS
  1. ECV
    - 50-60%
    - Fetal distress, PROM, APH, Rupture
    - No recent APH, RoM, previous section, abnormalities
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5
Q

PROM and PPRoM
- Definitions

  • Ix
  • Mx
  • Risks
A

PROM and PPRoM

  • Definitions
    1. PROM - At least 1 hour prior to labour
  • 15% of term
    2. PPROM - Prior to 37 weeks
  • 2% pregnancies and 40% preterm
    3. Chorion and amnion weakened
  • Enzymes, Infections, Genetics
  • Ix
    1. Amnisure (PaMg1)
    2. Actim-Prom (IGF BP 1)
    3. HVS (GBS)
  • Mx
    1. 36+ - Induce
    2. 34 - steroids +/- Induce
    3. 34 - favour gestation
  • Risks
    1. Infection (chorioamnionitis)
    2. Oligohydramnios (lungs)
    3. Cord prolapse
    4. Abruption
    5. Neonatal death (prem, sepsis, lungs)
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6
Q

VBAC
- Risks (2)
- Benefits (4)
- Mx (5)

A

VBAC

  • Risks
    1. Uterine rupture (0.5%)
    2. Anal sphincter injury (5%)
  • Benefits
    1. Shorter stay
    2. Lower maternal risk
    3. Increased future VBAC
    4. Lower transient tachypnoea
  • Mx
    1. Hospital setting
    2. Continuous CTG
    3. Mechanical induction (not prostaglandins)
    4. Senior input
    5. Only prior to 39 weeks
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7
Q

Multiple pregnancy

  • Incidence
  • ANC
  • Birth mx
A

Multiple pregnancy

  • Incidence
    1. 1/60
    2. Older mothers, fertility treatment
  • ANC
    1. Consultant lead
    2. Care plan
    3. Additional visits and growth scans
    4. Fetal medicine input
  • Birth
    1. VD (usually induced)
  • 1/3 end up CS
    2. CS
  • Monoamniotic or 3+
    3. Cannula and epidural
    4. Timing
  • 37 DCDA
  • 36 MCDA
  • 35 triplet
  • 34 MCMA
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8
Q

Gestational diabetes

  • Incidence
  • Risks
  • Ix
  • Mx
A

Gestational diabetes

  • Incidence
    1. 1/5
  • Risks
    1. Macrosomia - dystocia, delayed labour, instrumental delivery
    2. Organomegaly - cardiomegaly
    3. Polycythaemia
    4. Polyhydramnios
    5. Prematurity
  • Ix
    1. OGTT (5678)
    2. 2+ glucosuria (1+ x2)
  • Mx
    0. Consultant led, GS at 28,32,36
    1. Lifestyle
  1. Metformin
  2. Glibenclamide (SU)
  3. Insulin
  4. Deliver at 37-38
  5. PP fasting glucose 6-13 weeks
  6. OGTT subsequent pregnancies
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9
Q

GBS colonisation

  • Incidence
  • Mx
A

GBS colonisation

  • Incidence
    1. 25% of pregnant women
    2. 0.05% of neonates (5% mortality)
  • Mx
    1. High dose IV pen
  • Benpen

( - Cefuroxime
- Clindamycin)

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10
Q

Hyperemesis Gravidarum
- Incidence and timing
- Ix
- Mx

A

Hyperemesis Gravidarum (HG)

  • Incidence
    1. 3% of women
    2. Starts 4-7 weeks peaking 9th
    3. Settles by 20 in 90%
  • Ix
    1. Weight
    2. Urine dip and CBG
    3. FBC, U&Es, LFTs
    4. TFTs
    5. ABG
  • Mx
    1. Mild
  • Hydration, diet, oral antiemetics
  1. Moderate
    - Ambulatory care
    - IV fluids, IV antiemetics, Pabrinex
  2. Severe
    - IV hydration
    - Cyclizine (H1)
    - Prochlorperazine (D2), promethazine (H1), chlorpromazine (H1, D2, M1)
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11
Q

PET
- Incidence
- Complications
- Ix
- Mx

A

PET

  • Incidence
    1. 5%
  • Complications
    1. HELLP
    2. Eclampsia
    3. AKI
    4. DIC, ARDS, CVA, Death
  • Ix
    0. BP
    1. Urine dip, 24hr urine
    2. FBC
    3. U&E, LFT
  • Mx
    1. Labetalol - not asthma, HpoT, N&V
    2. Nifedipine - oedema, flushing, dizzy, constipated
    3. Methyldopa - Drowsy, headache, GI, oedema, brady
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12
Q

Epilepsy in pregnancy
- Risks
- Mx

A

Epilepsy in pregnancy

  • Risks
    1. Small but significant increase in obstetric risk
    2. Haemorrhagic disease of the newborn (Vit K deficiency)
  • Mx
    1. 5mg/day folate
    2. Lowest possible AED dose (not valproate)
    3. Good sleep and reduced stress
    4. Growth scans for SGA
    5. 1mg IM vitamin K
    6. Consider long acting benzo if high risk for peripartum seizure
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13
Q

Asthma in pregnancy
- Incidence
- Mx

A

Asthma in pregnancy

  • Incidence
    1. 10% of pregnant women
    2. 1/3 worsening control
  • Mx
    1. No risks of inhaled CSTs or LABA
    2. Theophylline safe in pregnancy
    3. Continuous CTG in acute exacerbation
    4. Caution with Ergometrine, oxytocin, and Prostaglandin
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14
Q

Obstetric cholestasis

  • Incidence
  • Risks
  • Ix
  • Mx
A

Obstetric cholestasis

  • Incidence
    1. 1%
    2. South Asian higher
  • Risks
    1. Raised PET
    2. Raised GDM
    3. Stillbirth if 100micromol/L
  • Ix
    1. LFTs (ALT)
    2. Random total bile acid (19micromol/L)
  • Repeat at 1 week
    3. LFTs after birth
  • Mx
    1. Topical emollients
    2. Chlorphenamine
    (3. Ursodeoxycholic acid)
    4. 38-39 weeks induction
    5. 35 wk induction if 100 micromol/L
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15
Q

VTE in Pregnancy

  • Prevalence
  • Prevention
  • Mx
A

VTE in Pregnancy

  • Prevalence
    1. 1/3 maternal deaths
    2. 4-5x increased risk
    3. Highest risk postpartum
  • Prevention
    0. 4RFs inT1-2, 3 rfs in T3, 2rfs pp
    1. LMWH (Clexane)
  • Mx
    0. Bloods and coag
    1. Duplex USS
    2. LMWH until 6-12wk pp
    3. UFH used at term
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16
Q

Miscarriage
- Definition
- Incidences
- Ix
- Mx

A

Miscarriage

  • Definition
    1. Loss up to 24 wks
    2. Early (12-13)
    3. Late (13-24)
  • Incidences
    1. 20-25%
  • Ix
    1. Obs
    2. Abdo
    3. Speculum
    4. Bimanual
    5. TVUSS
  • Mx
    1. Expectant
  1. Medical (misoprostol)
  2. Surgical (ERCP)
17
Q

Miscarriage
- Abx
- Anti-D Requirements

A

Miscarriage
- Anti-D Requirements

  1. Threatened >12 weeks
    - Anti-D if negative
  2. Inevitable >12 weeks
    - Anti-D if negative
  3. Missed/Incomplete/complete >12 weeks
    - Anti-D if negative
  4. Septic
    - IV fluids and ABx
    - Anti-D if negative >12 weeks
18
Q

Breastfeeding contraindications
- CVS x2
- Endo x2
- Psych X 2

  • Imm x 2
  • ID x4
A

Breastfeeding contraindications

  • CVS x2
    1. Amiodarone
    2. Aspirin
  • Endo x2
    1. Sulphonureas
    2. Carbimazole
  • Psych X 2
    1. Lithium
    2. Benzos
  • Imm x 2
    1. Methotrexate
    2. Cytotoxic
  • ID x4
    1. Cipro
    2. Tetro
    3. Chloramphenicol
    4. Sulphonamides
19
Q

Ectopic
- Incidence
- Ix
- Mx

A

Ectopic

  • Incidence
    1. 1/85
    2. Commonly ampulla & isthmus
  • Ix
    1. B-HCG (1500iU)
    2. Pelvic USS
    3. Urine dip
  • Mx
    0. Stabilise
  1. Expectant
    - HCG
  2. Medical (<1500, stable, unruptured, no heartbeat)
    - IM methotrexate
    - monitor HCG
  3. Surgical (>5000, >34mm, heartbeat)
    - Lap salpingectomy/otomy
20
Q

Pregnancy of Unknown Location (PUL)
- Definitions
- Ix

A

Pregnancy of Unknown Location (PUL)

  • Definitions
    1. Very early IU pregnancy
    2. Miscarriage
    3. Ectopic
  • Ix
    1. B-HCG (1500)
    2. Urine dip
21
Q

Endometriosis
- Incidence
- Ix
- Mx

A

Endometriosis

  • Incidence
    1. ~10%
    2. Mostly diagnosed 25-40
  • Ix
  1. USS
  2. Laparoscopy
  • Mx
    1. Pain - NSAIDs/ladder
    2. Anovulation - COCP/PoP/Mirena
    3. Surgery - Excision, fulguration, ablation
22
Q

Ovarian cysts
- Incidence
- Ix
- Mx

A

Ovarian cysts

  • Incidence
    1. Ovarian ca - 2% of cancers, common over 65
    2. BRCA1 (45%), BRCA2, Lynch
  • Ix
    1. USS
    2. Under 40
  • LDH, AFP, hCG
    3. P-M women
  • CA125
  • Mx
  1. Rescan cysts in 6 weeks
  2. Laparoscopic cystectomy
  3. Bilateral oophorectomy
    + hysterectomy, omentum, lymph
    + Staging laparotomy
23
Q

Heavy menstrual bleeding
- Incidence
- Ix
- Mx

A

Heavy menstrual bleeding

  • Incidence
    1. 3%
    2. 40-51 most likely
    3. 50% AUB
    4. PALM COEIN
  • Ix
    1. b-HCG
    2. Bloods - FBC,TFTs, Coag,
    3. USS pelvis
    4. HVS
    5. Hysteroscopy +-Pipelle
  • Mx
    1. LNG-IUS
    2. Tranexamic acid, mefanamic acid, COCP
    3. PoP, Depo, Implant
  1. Surgery
    - Ablation
    - Hysterectomy (subtotal/total)
24
Q

Dysmenorrhoea
- DDx
- Ix
- Mx

A

Dysmenorrhoea

  • DDx
    1. Endometriosis
    2. Adenomyosis
    3. PID
    4. Adhesions
    5. Non-gynae
  • Ix
    1. HVS
    2. TVS
    3. Lap
  • Mx
    1. NSAIDs
    2. COCP
    3. LNG-IUS
  1. Heat/hot water bottle
  2. TENS
25
Q

Urinary incontinence
- Ix
- Stress Mx
- Urge Mx

A

Urinary incontinence

  • Ix
    1. Frequency/volume charts
    2. Urodynamic studies (for stress surgery)
  • Stress Mx
    1. Lifestyle
    2. Pelvic floor
    3. Duloxetine
    4. Colposuspension
  • Urge Mx
    1. Lifestyle
    2. Bladder retraining
    3. Mirabegron
  • (Anticholinergics
    -oxybutynin/solifenacin/tolterodine)
    4. Oestrogens/botox
    5. Sacral nerve stimulation
26
Q

Pelvic organ prolapse
- Incidence
- Types
- Staging
- Mx

A

Pelvic organ prolapse

  • Incidence
    1. 1/10 over 50
  • Types
    1. Anterior wall (cystocele)
    2. Posterior wall (rectocele/enterocele)
    3. Uterine (complete - procidentia)
    4. Vault prolapse (post hysterectomy)
  • Staging
  • Mx
    1. Lifestyle - weight, constipation, lifting
    2. Physio - pelvic floor
  1. Support pessaries
  2. Surgeries
    - Pelvic floor repair
    - Vaginal hysterectomy
    - Sacrocolpopexy/sacrospinous fixation
27
Q

Cervical screening
- Components
- Grades
- Colposcopy

A

Cervical screening

  • Components
    1. HPV screening
    2. Liquid based cytology (LBC)
  • dyskaryosis
  • Grades
    1. Low-grade, borderline, high grade
  • Colposcopy
    1. Acetic acid
    2. LLETZ
  • Large loop excisions of T Zone
    3. Cone biopsy
  • Under GA
28
Q

C Section

  • Anaesthetics
  • Incisions
  • Layers
  • Placenta
A

C Section

  • Anaesthetics
    1. FBC
    2. H2 antagonist (Ranitidine)
    3. VTE prophylaxis
  1. Epidural/spinal (GA in some Cat 1)
  2. Left lateral tilt (15º)
  3. Foley’s catheter
  • Incisions
    0. ABx
  1. Skin
    - Pfannenstiel or Joel-Cohen
  2. Camper’s fascia (superficial SC)
  3. Scarpa’s fascia (deep SC)
  4. Rectus sheath
  5. Rectus muscle
  6. Abdominal peritoneum
  7. Visceral peritoneum
  8. Uterine incision
  • Placenta
    1. Oxytocin
    2. Controlled cord traction

Year 4 - ObGyn (9 decks)

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