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PACES > PACES Obs&Gynae > Flashcards

PACES Obs&Gynae Flashcards

1
Q

What Additional Blood Tests Should a pregnant women testing positive for HIV Have?

A
  • Varicella Zoster
  • Hep C
  • Measles
  • Toxoplasmosis
  • She should be screened for genital infections (at booking an again at 28 weeks)
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2
Q

Postnatal management of
a baby born to an HIV+ mother?

A

All neonates should be treated with anti-retroviral therapy within 4 hours of birth. –> Zidovudine monotherapy for 2-4 weeks

Those at high risk of HIV infection should be treated with HAART. (Highly active anti retroviral therapy)

Infants should be tested for HIV DNA and RNA at 1 day, 6 weeks and 12 weeks of age.
A confirmatory HIV antibody test is performed at 18 months of age.

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3
Q

Which babies should have PCP prophylaxis?

A

Prophylaxis against PCP is recommended only for neonates at high risk of HIV infection.

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4
Q

What is contraindicated intrapartum in HIV+ mothers?

A

Foetal blood sampling

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5
Q

Mode of delivery for HIV+ mothers

A

Women should have elective C section at 38 weeks to prevent ROM

Exception: Vaginal delivery can be considered in women taking HAART with a VL<50 copies at 36 weeks

BUT avoid ARM, invasive foetal monitoring (scalp electrode) or instrumental delivery

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6
Q

Breastfeeding advice in HIV+ women

A

Not to Breastfeed
(breastfeeding if the viral load is low is only recommended in low resources countries therefore not the UK)

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7
Q

Can women HIV+ have ECV

A

Yes if the viral load is <50 copies/mL

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8
Q

Follow up of HIV+ women during pregnancy

A

They will be seen every 2 weeks at the joint HIV and obstetric clinic

Viral load will be monitored every 2-4 weeks + 36 weeks + post delivery

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9
Q

Post natal management of babies at high risk of transmission of HIV

A

Triple ART (zidovudine, lamivudine and nevirapine) for 4 weeks

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10
Q

Anti retroviral treatment in pregnancy

A

All HIV+ women should be offered it regardless of whether they were previously taking it

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11
Q

Vaccinations offered to HIV+ mothers in pregnancy

A

All pregnant women are offered the whooping cough vaccine. Flu vaccine and COVID vaccine

You will also be recommended to have vaccinations for hepatitis B (if you are not immune) and pneumococcus, and the flu vaccine (in the autumn/ winter months).

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12
Q

Is anti-retroviral treatment safe in pregnancy?

A

Anti-retroviral drugs are generally safe but they can sometimes have side effects, including stomach and digestive problems, diabetes, rashes, extreme tiredness, high temperature and breathlessness.

Anti-retroviral treatment itself does not appear to be harmful for babies. Not taking the medication is much more likely to be harmful for your baby, because the risk of passing HIV on to your baby will be much higher.

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13
Q

What is hysteroscopic sterilisation?

A

Insert expanding springs into the tubal ostia via a hysteroscope
This induces fibrosis over 3 months
Additional contraception should be used during this time

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14
Q

How is female sterilisation performed at laparoscopy?

A

Occlude Fallopian tubes with Filshie clips

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15
Q

What advice should be given to women who have had a laparoscopic sterilisation?

A

Additional contraception should be used until the first period after the procedure

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16
Q

Which organism causes thrush

A

Candida albicans

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17
Q

What are some causes of dysmenorrhoea?

A

Endometriosis
Adenomyosis
PID
Fibroids

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18
Q

List some causes of PV bleeding

A

Cancer (endometrial, cervical, ovarian)

Fibroids

Endometriosis

Bloody show

PID

Period

Cervical ectropion

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19
Q

List some types of endometrial cancer

A

Endometrioid:
- Mucinous adenocarcinoma
- Serous adenocarcinoma

Non-endometrioid:
- Clear cell carcinoma

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20
Q

List some risk factors for endometrial cancer

A

Obesity

Nulliparity

Early menarche and late menopause

Unopposed oestrogen therapy

Diabetes mellitus

Tamoxifen

PCOS

HNPCC

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21
Q

How is endometrial cancer treated?

A

Localised disease: total abdominal hysterectomy with bilateral salpingo-oophorectomy

High risk patients may receive post-operative radiotherapy

Progesterone therapy is sometimes used in frail elderly patients who are unfit for surgery

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22
Q

What might you do to high risk patient with endometrial cancer?

A

High risk patients may receive post-operative radiotherapy

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23
Q

Alternative treatment to surgery for frail patients with endometrial cancer

A

Progesterone therapy (Mirena Coil for at least 6 months) is sometimes used in frail elderly patients who are unfit for surgery

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24
Q

How frequently are women offered cervical cancer screening?

A

Every 3 years: 25-49

Every 5 years: 50-64

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25
Q

What are some risk factors for ectopic pregnancy?

A

Maternal age

Previous ectopic pregnancy

Pelvic or abdominal surgery

PID

Termination of pregnancy

Smoking

Endometriosis

Copper IUD

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26
Q

What are the types of gestational trophoblastic disease?

A

Complete and partial mole

Invasive mole

Choriocarcinom

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27
Q

What must you always do with cases of FGM?

A

Document in the hospital notes

If < 18 years, refer to police and social services

Explore whether other children are at risk

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28
Q

Core features of PTSD (ICD-10)

A

TRIAD = HYPERAROUSAL, AVOIDANCE, RE-EXPERIENCING

  1. An event of exceptionally threatening nature that is likely to cause pervasive distress in almost anyone
  2. Symptoms start within 6 months
  3. Avoidance of circumstances
  4. Intrusive recollection/memories of the event
  5. Difficulty remembering some of the event

6.Increased psychological/autonomic sensitivity: hypervigilant, difficulty concentrating, outbursts of anger, poor concentration, difficulty sleeping, startle response

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29
Q

Charities for FGM

A
  • Daughters of Eve
  • NSPCC FGM Helpline
  • Foundation for Women’s Health Research and Development (FORWARD)
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30
Q

Why is FGM undertaken?

A
  • To signal that a girl has now become a woman.
  • To protect a girl’s virginity /to prove she has not had sex before marriage.
  • To decrease a womans’ sexual desire.
  • To prepare a girl for marriage. Once FGM has been performed a girl is seen as ready for marriage.
  • To follow a religious requirement (although there is no evidence to suggest that FGM is required by any religion).
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31
Q

Where is FGM most prevalent?

A

Mali
Somalia
Sudan
Egypt
Ethiopia

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32
Q

What is the legal situation of FGM in UK?

A

Mandatory legal DUTY to inform police about suspected FGM in under 18s

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33
Q

What is the legal situation of underage marriage in UK?

A

It is now an offence to cause a child under the age of 18 to enter a marriage in any circumstances, without the need to prove that a form of coercion was used.

This includes non-legally binding ‘traditional’ ceremonies which would still be viewed as marriages by the parties and their families.

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34
Q

When should an OGTT be performed in women with a high risk of GDM?

A

24-28 weeks

If previous history of GDM, this should be done at 16-18 weeks and a repeat at 24-28 weeks

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35
Q

Why should an ultrasound scan be performed at the time of diagnosis of GDM?(3)

A

Exclude congenital anomaly
Assess foetal growth
Assess liquor volume

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36
Q

Who should review a woman with a new diagnosis of GDM and when should this happen?

A

Joint diabetes and antenatal clinic within 1 week of diagnosis

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37
Q

What is gestational trophoblastic disease?

A

Spectrum of tumours and tumour-like conditions characterised by proliferation of pregnancy-associated trophoblastic tissue

38
Q

What are the risks associated with intrauterine contraceptive devices?

A

Uterine perforation (2 in 1000)

Ectopic pregnancy (relative not absolute) ( and only for IUD)

Infection (in first 20 days)

Expulsion (risk is 1 in 20)

Abnormal bleeding (IUS: initial frequent bleeding and spotting followed by intermittent light menses; IUD: heavier, longer and more painful)

39
Q

State some risks of HRT

A

VTE& stroke (but can be avoided if given as a patch or gel)
Coronary heart disease if over 60
Breast and ovarian cancer

40
Q

What are the main benefits of HRT?

A
  • Improved vasomotor symptoms
  • Reduced risk of osteoporosis
  • Improved genital tract symptoms
41
Q

List some absolute contraindications for HRT (6)

A

Pregnancy
Breast cancer
Endometrial cancer
Uncontrolled HTN
Current VTE
Thrombophilia

42
Q

What is the most common gynaecological cancer in women?

A

Endometrial

43
Q

Which cancers occurring in females have national screening programmes?

A

Breast

Cervical

44
Q

List some non-hormonal treatments for menopause.

A
  • Alpha agonists (clonidine)
  • Beta-blockers (propranolol)
  • SSRIs (fluoxetine) Symptomatic: lubricants, osteoporosis treatments
45
Q

List some causes of subfertility.

A

PCOS

Idiopathic

Male factor

Surgery/chemotherapy

Adhesions

Endometriosis

Blocked Fallopian tubes

46
Q

List some causes of premature ovarian insufficiency. (5)

A
  • Chromosomal abnormalities (e.g. Turner’s syndrome, fragile X)
  • Autoimmune disease (e.g. hypothyroidism, Addison’s, myasthenia gravis)
  • Enzyme deficiencies (e.g. galactosaemia, 17a-hydroxylase deficiency)
  • Chemotherapy or radiotherapy
  • Infections (e.g. TB, mumps, malaria, varicella)
47
Q

Causes of secondary amenorrhoea

A

Hypogonadotrophic hypogonadism (e.g. Sheehan’s syndrome)

PCOS

Asherman’s syndrome

Low BMI

Cervical stenosis

Physiological: lactational, pregnancy

Aetiology of secondary amenorrhoea

Usually due to HPO axis dysfunction:
S → {{c1::Stress}}
T → {{c2::Tumour (Pituitary)}}
O → {{c3::Over-exercise and weight loss == Hypothalamic Hypogonadism}}
P → {{c4::Psychiatric: anorexia nervosa}}
Other causes
T → {{c5::Thyrotoxicosis}}
A → {{c6::Asherman’s syndrome: adhesions}}
M → {{c7::Menopause (early)}}
P → {{c8::PCOS}}
O → {{c9::Ovarian tumour}}
N → {{c10::Neonatal → post-pregnancy and breast-feeding}}

48
Q

What is the definition of a miscarriage?

A

Pregnancy that ends spontaneously before 24 weeks gestation

49
Q

List some causes of recurrent miscarriage.

A

Antiphospholipid syndrome

Cervical abnormalities

Foetal chromosomal abnormalities

Uterine malformations

Thrombophilia

50
Q

Most common site of the fallopian tube for ectopic pregnancies

A

The ampullary portion of the tube, where over 80% of ectopic pregnancies occur

51
Q

The site where an ectopic pregnancy is more likely to burst?

A

Isthmus

52
Q

List some common side-effects of sex hormones.

A

Progestogenic – depression, PMS, bleeding, acne, weight gain

Oestrogenic – headache, nausea, breast tenderness

53
Q

Can you describe some methods of male and female sterilisation?

A

Female – Filshie clips, transcervical sterilisation involving hysteroscopic placement of micro-inserts, hysterectomy

Male – vasectomy

54
Q

Risk factors for vaginal prolapse

A

Obesity

Chronic cough

Chronic constipation

Post-menopausal

Connective tissue disorders

55
Q

Which complex of muscles makes up the bulk of the perineum

A

Levator ani

56
Q

Which muscles make up the levator ani?

A

Puborectalis

Pubococcygeus

Iliococcygeus

57
Q

What are the four categories of uterine prolapse?

A

Stage 1: cervix is in the upper half of the vagina

Stage 2: cervix is at the introitus

Stage 3: cervix protrudes out of the introitus

Stage 4: procidentia – uterus is outside the vagina

Treated conservatively with pelvic floor exercises, wt loss, less constipation and avoiding heavy lifting.

MEdically with oestrogen cream and pessary

Surgically depending on the prolapse.

58
Q

Which blood test would you do if you suspected anti-phospholipid syndrome?

A

Lupus anticoagulant

Anticardiolipin antibodies

Diagnosis requires 2 positive results at least 12 weeks apart

59
Q

How can a miscarriage be managed medically?

A

Vaginal misoprostol

Analgesia and anti-emetic

60
Q

What is a uterine fibroid?

A

Leiomyoma – benign tumour arising from the smooth muscle

61
Q

What is a dangerous complication of fibroids in pregnancy?

A

Red degeneration

62
Q

What are the three types of fibroid?

A

-Submucous

Intramural

Subserosal

63
Q

What agent may be used to reduce the size of the fibroid in preparation for surgery?

A

Injectable GnRH agonist

–> not sure if they do this anymore

64
Q

What is the difference between a complete and partial mole?

A

Complete: empty egg is fertilised by 2 sperm or 1 sperm that duplicates. Produces a mass of cells with no foetus

Partial: normal ovum gets fertilised by 2 sperm. An abnormal foetus starts to form but it cannot survive of develop into a baby

65
Q

What can be given to ripen the cervix before suction and curettage?

A

Prostaglandins

66
Q

What is the incidence of molar pregnancy?

A

1 in 600
–> it’s 590 if you want to be exact

67
Q

What are the different types of FGM?

A

Type 1: clitoroidectomy

Type 2: clitoroidectomy with partial or total removal of the labia minora with or without removal of the labia majora

Type 3: infibulation (stitching to narrow the vagina)

Type 4: any other non-medical procedures to the external genitalia (e.g. piercings, cauterisation)

68
Q

What are some complications of pelvic inflammatory disease?

A

Infertility

Ectopic pregnancy

Chronic pelvic pain

Sepsis

Fitz-Hugh-Curtis syndrome

69
Q

What is the difference between a high vaginal swab and an endocervical swab?

A

Endocervical – chlamydia and gonorrhoea

High vaginal – anaerobes (e.g. BV)

70
Q

What are the high risk types of HPV?

A

16 and 18

71
Q

Name an HPV vaccine and the types of HPV covered by it.

A

Gardasil – 6, 11, 16 and 18

72
Q

What are some causes of antepartum haemorrhage?

A

Placental abruption

Placenta praevia

Placenta accreta

Vasa praevia

Cervical ectropion

Trauma

73
Q

What are some risk factors for placental abruption

A

Previous placental abruption

Smoking

C-sections

Cocaine use

Pre-eclampsia

74
Q

Investigations for suspected placenta abruption

A
  • Observations
  • Pregnant Abdomen Examination
  • CTG
  • Ultrasound
  • Speculum
  • Kleihauer Test: can be performed to determine the extent of fetomaternal mixing of the blood so that a sufficient dose of anti-D can be given
  • FBC, coagulation screen and 4 units of blood cross-matched
75
Q

What are the steps in the management of a patient with hyperemesis gravidarum?

A

1st line: antihistamines (promethazine or cyclizine)

2nd line: ondansetron or metoclopramide

Alternative: P6 acupressure, ginger

If severely dehydration: admit for IV rehydration, thiamine supplementation and thromboprophylaxis

76
Q

What triad of features defines hyperemesis gravidarum?

A

More than 5% pre-pregnancy weight loss

Electrolyte imbalance

Dehydration

77
Q

Which treatment option can be used if the patient fails to respond to several anti-emetics

A

Steroids

78
Q

How long does normal morning sickness tend to last?

A

It gets better by around 14 weeks

79
Q

If the symptoms of HG persist into the second and third trimesters, are there any additional aspects of management that you might offer?

A

Serial scans to monitor foetal growth

80
Q

How can preterm premature rupture of membranes be prevented in high-risk women?

A

Prophylactic vaginal progesterone

Cervical cerclage

81
Q

If pooling of amniotic fluid is not observed on examination of a woman with suspected PPROM, which other test could be conducted?

A

IGF binding protein-1 test or placental alpha-microglobulin-1 test

82
Q

Which organisms are typically implicated in chorioamnionitis?

A

GBS

E. coli

83
Q

How would a patient with PPROM but no signs of infection be managed?

A

Monitor for signs of infection

Offer oral erythromycin 250 mg QDS for a maximum of 10 days or until the patient is in established labour

Do NOT use tocolysis (increases risk of infection)

Decision to deliver depends on balance of risk of prematurity and risk of maternal/foetal infection if delivery is delayed

84
Q

How can women at high-risk of pre-eclampsia be managed during pregnancy?

A

75 mg OD aspirin from 12 weeks until birth

Indications: diabetes mellitus, autoimmune disease, hypertensive disease during previous pregnancy, chronic hypertension, chronic kidney disease

85
Q

List some risk factors for pre-eclampsia.

A

First pregnancy
Multiple pregnancy
History of PET
Age > 40 yrs
BMI >35
> 10 year pregnancy interval

86
Q

Gestational diabetes is defined as

A

Fasting plasma glucose > 5.6 mmol/L

2-hour OGTT > 7.8 mmol/L

87
Q

risks of gestational diabetes and why it needs to be controlled

A

Foetal: macrosomia, polyhydramnios, neonatal hypoglycaemia, shoulder dystocia, congenital defects, miscarriage, later risk of T2DM and obesity

Maternal: traumatic delivery due to macrosomia, increased risk of T2DM, increased future risk of gestational diabetes (50%), pre-eclampsia

88
Q

What is the target level of plasma glucose in a patient with GD?

A

Fasting plasma glucose < 5.3 mmol/L

2-hour post-meal < 6.4 mmol/L

89
Q

How should sexual contacts of someone with PID be treated?

A

Single dose azithromycin 1 g

90
Q

Which antibiotic regimen is recommended for PID?

A
  • Intramuscular ceftriaxone 250 mg immediately

+oral doxycycline 100 mg twice a day for 14 days

+ metronidazole 400 mg twice a day for 14 days.

91
Q

What is the treatment of PMS?

A

Mild -> Lifestyle such as sleep better or exercise more and stop smoking. Smaller more meals with complex carbohydrates

Moderate -> COCP

Severe -> SSRIs

PACES (2 decks)

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