pass med questions obgyn Flashcards
If a woman has an inadequate smear test result in what timeframe should they have a repeat smear?
repeat the test in 3 months
- inadequate means that the cells weren’t able to be visualised properly, no evidence that the transformation zone was properly sampled
what is a smear test detecting
smear tests are done on a HPV first system.
If there is evidenced of HPV, then only after is a cytological exam performed
if there are two consecutive inadequate smear samples then what is the next step?
carry out a colposcopy
what are two common causes for hyperemesis gravidarium
this is usually due to high levels of BhcG, the body isn’t used to this hormone.
If it is a twin pregnancy or a molar pregnancy.
which medication is often used to treat hyperemesis gravidarium
cyclizine
why would you avoid using metoclopramide in HG
avoid using it for more than 5 days as it can cause acute dystonia
a movement disorder that involves involuntary muscle contractions. torticollis
what is the treatment for thrush in non-pregnant women
single dose of oral - fluconazole
which part of the fallopian tube is an ectopic pregnancy more likely to rupture
isthmus as it is the most narrow part of the fallopian tube
how would you manage a pregnant woman who is <6 weeks pregnant and presents with vaginal bleeding but no pain
- monitor expectantly and repeat pregnancy test in 7 days
*if negative then this confirms a miscarriage - if the test is positive or the symptoms continue to worsen then this is a urgent referral to EPAU
if someone presents with premature ovarian insufficiency and they present with a raised FSH then what’s the next step
repeat a FSH test in 4-6 weeks and it should remain raised
what is cervical excitation and when is it seen
- cervical excitation is also known as cervical motion tenderness, this when there is pain in the cervix when it is being moved in a pelvic exam
- it is often seen in PID and ectopic pregnancy
what is the timeframe of a threatened miscarriage?
painless vaginal bleeding before 24 weeks
cervical os is closed
When do you need to take a progesterone test
7 days before the next expected period
progesterone in HRT increases the risk of what?
breast tenderness, headaches, and mood swings. There’s also a small increased risk of stroke and ovarian cancer.
how long should someone wait post partum for a smear test
12 weeks
3 months
when would you prefer to do a laparoscopic salpingotomy vs salpingectomy
when there is a high risk of infertility in the woman, for example if they have PID, multiple adhesions
what are some indications to immediately refer to EPAU
woman with a positive pregnancy test with:
- positive pregnancy test
- abdominal pain
- cervical motion tenderness - ain experienced when a healthcare provider gently moves the cervix during a pelvic exam, often indicating an inflammatory process in the pelvic region, most commonly associated with pelvic inflammatory disease (PID) or ectopic pregnancy; i
when would surgical options in a miscarriage be necessary
- if there is evidence of haemorrhage or infection
what is the treatment for PID
stat IM Ceftriaxone (gonorrhoea)
14 days oral doxy (chlamydia)
and metro (trichomonias)
what is endometriosis a big risk factor for
ectopic pregnancy, the blastocyst has been implanted in other endometrial tissue
which ovarian tumour is associated with endometrial hyperplasia
granulose cell tumours
widely spaced nipples and primary amenorrhoea which are characteristics seen in
Turners syndrome Turner’s syndrome is caused by the presence of only one sex chromosome (X) or a deletion of the short arm of one of the X
what is a diagnostic test for turners syndrome
increased FSH / LH levels
High-risk human papillomavirus (hrHPV): POSITIVE.
Cytology: NEGATIVE.
what’s the next step
just continue with regular smear testing, only need to do colposcopy if the cytology comes back as abnormal
at what age is premature menopause
40
after 36 weeks of pregnancy a woman gets chicken pox what is the effect on the baby
This is the time when your baby is at greatest risk of getting chickenpox. If your baby is born within 7 days of your chickenpox rash appearing or you get chickenpox within the first week after birth, your baby may get severe chickenpox. He or she will be given VZIG and treated with an antiviral drug called aciclovir and monitored closely after birth.
This causes a risk of neonatal sepsis / disseminated infection
after 36 weeks baby is at a high chance of getting neonatal chickenpox
infection of chicken pox between 28 and 36 weeks in the mum can cause what affect in the baby
it can cause the baby to be exposed to the virus, it will stay dormant in the body and reappear as shingles
at first pregnancy will you likely feel baby move closer to 16 weeks or 20 weeks
closer to 20 weeks
if no movement by 24 weeks then this is bad
menopause can cause which type of incontinence
stress
muscles are weakened
69 year old woman has dramatic increase in urinary frequency, she has urgency, dysuria, and constantly wears a pad, she has been post menopausal for 20 years. She is not on HRT and urinalysis reveals blood and protein. Pelvic examination reveals there is a tender mass palpable anterior to the vagina what do you think this is and how would you manage it??
??
18 year old who started periods art 12 has heavy menstrual bleeding for 7-8 days which are not painful since then. What do you think its could be and what would your investigation be.
her Hb is low and platelets would be low
clotting as her platelets are low and her periods have always been heavy and non painful.
its not always first line ti do thyroid tests unless they have signs of thyroid dysfunction usually hypothyroidism
its not first line to do ferritin either
In pregnant woman if they have a UTI, what would your investigation be
MSU and urine dip, urine dip will show there is an infection and the MSU will show the culture and the antibiotics
what UTI meds do you give to pregnant woman and when
nitrofurantoin during the first and second trimester as in the last it can cause heamolysis
trimethoprim can cause low folate in the first trimester so it is not safe to give.
what is the most common cause for small for gestational age fetus
placental insufficiency
when do you do fetal blood sampling
Diagnose blood disorders, like fetal anemia
Diagnose fetal infections, such as toxoplasmosis
Diagnose genetic or chromosome abnormalities
Check oxygen levels in the baby
Give certain medicines to the baby
sagittal sinus thrombosis
someone with hyperemesis gravidarium should be given what treatments
- anti sickness - cyclizine
- iv fluids
- thiamine as they are at a risk if deficiency
what are the rhesus status of the mother and baby that causes issues
mum is rhesus negative
baby rhesus positive
if new baby is rhesus positive then mothers IGG will attack baby
when is the earliest external cephalic conversion can be offered
in nulliparous women 36 weeks is the earliest
37 for multiparous
what are some indications for an elective c section
Indications for elective caesarean section include:
Abnormal presentation e.g. breech or transverse.
Twin pregnancy if first twin is not cephalic.
Maternal HIV.
Primary genital herpes in third trimester.
Placenta praevia.
Anatomical reasons
if a mother is found to be GBS positive during pregnancy what is the management
She should be given antibiotics intravenously during labour and delivery to prevent newborn GBS infection
peniclllin
what week of pregnancy is anti d given
Rhesus negative mothers are also routinely given Anti-D at 28 weeks of pregnancy.
what are some rhesus sensitisation events
Sensitisation events are those which carry a risk of foetal blood crossing the placenta into the material circulation and triggering formation of these antibodies. Sensitisation events include:
Antepartum haemorrhage
Significant abdominal trauma
Ectopic pregnancy
Miscarriage
Termination
Intrauterine death
External cephalic version
Invasive uterine procedures e.g. chorionic villus sampling or amniocentesis
Delivery of foetus (vaginal or by caesarean section)
acronym for PPH
Tone - uterine atony is the most common for primary
Trauma
Thrombus
Tissue retained
difference between primary and secondary PPH
Primary postpartum hemorrhage (PPH) is heavy bleeding within the first 24 hours after giving birth, while secondary PPH is heavy bleeding after 24 hours and up to 12 weeks after birth.
most common cause for secondary PPH
postpartum endometriosis
which test is specific for downs vs test for downs, Edwards and patau
downs specific is quadruple
for all three - combined test (10-14) weeks
first line management for PPH
oxytocin
at what stage of pregnancy is it serious if a non immune woman to varicella zoster is infected
usually bad in the first trimester
what is the treatment for a pregnant woman who is not immune to varicella zoster
give treatment immediately
oral aciclovir should be given as a preventive measure 7-14 days post-exposure.
Post delivery, the neonate should be monitored and given IV aciclovir.
what is the treatment for asymptomatic bacteriuria in pregnancy
Oral antibiotics are recommended in cases of asymptomatic bacteriuria to prevent progression to pyelonephritis and increased risk of preterm labour.
Women should have a routine urinalysis at booking to screen for asymptomatic bacteriuria. If this is positive for nitrites or leukocytes, it should be sent for culture
what is the main cause for polyhydramnios
oesophageal atresia - foetus cant swallow amniotic fluid and maintain normal levels
following rupture of membranes when should induction of Labour be commenced
within 24 hours
what is the immediate management when the mother presents with an amniotic fluid embolism
offer 15l oxygen non re breathe mask before emergency c section as there is a high risk of maternal hypoxia
what pain relief is used in Labour for mild pain
Entonox
Entonox is a patented mixture of inhaled nitrous oxide and oxygen (1:1). It is the most popular form of analgesia for mild labour pain
treatment for candida
Oral fluconazole 150mg as a single dose is the standard treatment for uncomplicated cases of this fungal infection.
what complication can polyhydramnios have in pregnancy
umbilical cord prolapse
excess amniotic fluid can prevent engagement of the head and leave room for the cord to extend past the presenting part
test to determine pre rupture of membranes
An Actim-PROM vaginal swab detects insulin-like growth factor binding protein-1 (IGFBP-1) in vaginal fluid. The concentration of IGFBP-1 is much higher in the amniotic fluid than in the maternal blood. Therefore, a positive Actim-PROM suggests pre-labour rupture of membranes.
maternal eclampsia treatment
IV magnesium sulfate
regular blood tests needed in pre eclampsia
THREE TIMES A WEEK
U&E, FBC, transaminases and bilirubin
bilirubin -= Low levels of bilirubin were associated with poor maternal and infant outcomes in women diagnosed with pre-eclampsia.
what is the diagnostic testing for ovarian tortion
laparoscopy
what increase in bHCG over 48 hours suggests a viable pregnancy
more than double
what is a big no no for vaginal delivery once had a c section
classic c section scar - vertical - uterine abruption
what is a common rule for unexplained problematic bleeding after starting a form of contraception
- screen for pregnancy
- screen for STI
- screen cervix
start cocp for 3 months
what medication can be prescribed in advanced PMS
fluoxetine
triad of pre eclampsia
high blood pressure over 140/90
protein in urine
PCR > 30
ACR > 8
odema
- end organ failure
- appears more than 20 weeks,
do to vasospasm and vasoconstriction of the spiral arteries causing high vascular resistance, and poor perfusion of the placenta, leading to oxidative stress of placenta
if you see a woman who is at risk of developing pre eclampsia what prophylaxis can you offer before 20 weeks
from 12 weeks gestation offer them aspirin till birth
In Gestational Diabetes what is the treatment management depending on the fasting glucose level
< 7 mmol/L then lifestyle and consider metformin if after two weeks its not improving
> 7 Insulin and can consider metformin
consider more regular US
reason for high glucose is because the body resists the insulin to allow more glucose for the baby to grown
gestational diabetes is only diagnosed when the mother has not had any history of diabetes in the past, if she did this would not be classesd as gestational diabetes (20 weeks)
can present with high uric acid if kidneys are damaged
HELLP syndome summary
It is part of the hypertensive issues in pregnancy, associated with pre eclampsia
Occurs post 20 weeks gestation and is very serious, leading to end organ failure, rupture of placenta and IUGR
what are some key complications to baby when the mother has an issue with her blood pressure
- too high can cause IUGR
- Placental abruption
key difference between pre eclampsia and eclampsia
eclampsia is a condition with generalised tonic clonic siezures,
have headache, Vision changes, abdominal pain, vomiting
Mg sulphate first line one as a bolus then infusion, second line is lorazepam
Cure is delivery of the placenta
