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Reproductive Health > Passmed > Flashcards

Passmed Flashcards

1
Q

What is the most common cause of severe early onset fever in newborn infants

A

Group B strep
< 7 days birth

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2
Q

Risk factors for Group B strep

A

prematurity
prolonged rupture of the membranes
previous sibling GBS infection
maternal pyrexia e.g. secondary to chorioamnionitis

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3
Q

What should women who’ve hade GBS in prev pregnancy have in next

A

Risk of GBS carraige is 50%
Intrapartum antibiotic prophylaxis offered OR
testing in late pregnancy and antibiotics if still positive

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4
Q

When should swabs for GBS be offered

A

35-39 weeks
or 3-5 weeks prior to anticipated delivery date

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5
Q

When should IAP be offered

A

Women with prev baby with early or late onset GBS disease
Preterm
Pyrexia - >38 degrees - during labour

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6
Q

What is antibiotic of choice in GBS

A

Benzylpenicillin

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7
Q

Why is d-dimer in pregnancy useless

A

will always be positive

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8
Q

What is the management of pregnancy for intrahepatic cholestasis of pregnancy

A

Induce at 37-38 weeks as increases risk of stillbirth
Increased foetal surveilance before this

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9
Q

When is C scetion done in IH cholestasis of pregnancy

A

When non reassuring foetal status

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10
Q

Medical management of IH cholestasis of pregnancy

A

Antihistamines - symptomatic + reassurance
Ursodeoxycholic acid
Colestyramine
Topical emollients
Vit K supplementation

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11
Q

Features of IH cholestasis

A

pruritus - may be intense - typical worse palms, soles and abdomen
clinically detectable jaundice occurs in around 20% of patients
raised bilirubin is seen in > 90% of cases

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12
Q

What is medroxyprogesterone acetate

A

Depot injection

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13
Q

Clinical features of endometriosis

A

chronic pelvic pain
secondary dysmenorrhoea
pain often starts days before bleeding
deep dyspareunia
subfertility
non-gynaecological: urinary symptoms e.g. dysuria, urgency, haematuria. Dyschezia (painful bowel movements)
on pelvic examination reduced organ mobility, tender nodularity in the posterior vaginal fornix and visible vaginal endometriotic lesions may be seen

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14
Q

First line for endometriosis

A

NSAIDs abd/or paracetemol
COCP or progesterogens

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15
Q

Secondary treatments for endometriosis

A

GnRH analogues - pseudo menopause - low oestrogen
Surgery - laparoscopic excision or ablation + adhesiolysis + ovarian cystectomy - improves fertility

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16
Q

Placental abruption vs placenta praevia

A

Both: vaginal bleeding in pregnancy
Abruption:
Shcok outkeeping with visible loss
Pain constant
Tender, tense uterus
Normal lie and presentation
Foetal heart - absent/distressed
Coag problems
Beware pre-eclampsia, DIC, anuria

Praevia:
Shock in proportion to visible loss
No pain
Uterus not tender
Lie and presentation may abnormal
Foetal heart normally normal
Coag problems rare
Small bleeds before large

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17
Q

What should be avoided in croup

A

Throat examination may obstruct AW

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18
Q

What is croup characterised by

A

URTI in infants and toddlers, stridor + laryngeal oedema and secretions caused by parainfluenza virus

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19
Q

Mild croup features

A

Occasional barking cough
No audible stridor at rest
No or mild suprasternal and/or intercostal recession
The child is happy and is prepared to eat, drink, and play

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20
Q

Moderate croup features

A

Frequent barking cough
Easily audible stridor at rest
Suprasternal and sternal wall retraction at rest
No or little distress or agitation
The child can be placated and is interested in its surroundings

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21
Q

Severe croup features

A

Frequent barking cough
Prominent inspiratory (and occasionally, expiratory) stridor at rest
Marked sternal wall retractions
Significant distress and agitation, or lethargy or restlessness (a sign of hypoxaemia)
Tachycardia occurs with more severe obstructive symptoms and hypoxaemia

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22
Q

When prompt admission of croup

A

Any child with moderate or severe croup
<6 months age
Known upper AW abnormalities (laryngomalacia, Downs syndrome)
Uncertainty about diagnosis - acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation

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23
Q

Emergency treatment croup

A

High flow oxygen
Nebulised adrenaline

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24
Q

Management of croup

A

Single dose oral dexamethasone (0.15mg/kg) to all children regardless of secerity
Prednisolone is alternative

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25
Q

Investgiations - what CXR show in croup

A

Post ant view - subglottic narrowing - steeple sign
Contrast lateral view - acute epiglottitis - thumb sign

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26
Q

What cont machinery murmur suggests

A

PDA

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27
Q

What intervention for PDA

A

Indomethacin - inhibit PGE2 which maintains PDA

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27
Q

What intervention for PDA

A

Indomethacin or ibuprofen - inhibit PGE2 which maintains PDA

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28
Q

When use PGE2 in heart failure infant

A

Complex congenital heart defects - shunt necessary to maintain life eg transposition of great arteries

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29
Q

Why is aspirin not given to children under 16

A

Risk of reyes syndrome

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30
Q

What can treat apnoea in neonates

A

Caffeine citrate

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31
Q

What babies is PDA more common on?

A

High altitude babies, premature, maternal rubella in first trimester

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32
Q

Features of PDA

A

L subclavicular thrill
Cont machinery murmur
Large volume. bounding, collapsing pulse
Wide pulse pressure
Heaving apex beat

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33
Q

What would poor feeding, grunting and lethargy in a neonate signal

A

Neonatal sepsis

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34
Q

Common oragnsims causing neonatal sepsis

A

Group B strep - early onset
E.coli

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35
Q

What is late onset neonatal sepsis cuased by

A

Transmission pathogens from environemnt post-delivery from contacts
Staph pecies - S.epidermis
Gram - = psueomonas aeruginosa, klebsiella, enterobacter

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35
Q

What is late onset neonatal sepsis cuased by

A

Transmission pathogens from environemnt post-delivery from contacts
Staph pecies - S.epidermis
Gram - = psueomonas aeruginosa, klebsiella, enterobacter

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36
Q

Risk factors for neonatal sepsis

A

Mother who has had a previous baby with GBS infection, who has current GBS colonisation from prenatal screening, current bacteruria, intrapartum temperature ≥38ºC, membrane rupture ≥18 hours, or current infection throughout pregnancy
Premature (<37 weeks): approximately 85% of neonatal sepsis cases are in premature neonates
Low birth weight (<2.5kg): approximately 80% are low birth weight
Evidence of maternal chorioamnionitis

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37
Q

Presentation neonatal sepsis

A

Respiratory distress (85%)
Grunting
Nasal flaring
Use of accessory respiratory muscles
Tachypnoea
Tachycardia: common, but non-specific
Apnoea (40%)
Apparent change in mental status/lethargy
Jaundice (35%)
Seizures (35%): if cause of sepsis is meningitis
Poor/reduced feeding (30%)
Abdominal distention (20%)
Vomiting (25%)
Temperature: not usually a reliable sign as the temperature can vary from being raised, lowered or normal
Term infants are more likely to be febrile
Pre-term infants are more likely to be hypothermic
The clinical presentation can vary from very subtle signs of illness to clear septic shock
Frequently, the symptoms will be related to the source of infection (e.g. pneumonia + respiratory symptoms, meningitis + neurological symptoms)

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38
Q

Investigations into neonatal sepsis

A

Blood culture
Full blood examination
CRP
Blood gas
Urine microscopy, culture and sensitivity
Lumbar puncture

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39
Q

Treatment for neonatal sepsis NICE

A

IV benzylpenicillin with gentamycin as first line regimen

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40
Q

Main complication of GI anaemia

A

Haemolytic uraemic syndrome

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41
Q

What is managemnet of hypospadias

A

Surgical correction using foreskin remnant after 6 months - normally around 12 months - avoid circumcision

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42
Q

What do and what can pulsatile sound in ear be

A

MRA - MRI of inner ear
acoustic neuroma inner ear cnacer

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43
Q

What is hypospadias characterised by

A

Ventral urethral meatus
Hooded prepuce
Chordee - ventral curvature of penis - more severe
Urethral meatus proximal opening if more severe

ass conditions - cryptorchidism, inguinal hernia

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44
Q

What is the most common side effect first 6 months IUS

A

Irregular bleeding

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45
Q

What are the features of acute fatty liver of pregnancy

A

jaundice, mild pyrexia, hepatitic LFTs, raised WBC, coagulopathy and steatosis on imaging
predominantly non-specific symptoms (e.g. malaise, fatigue, nausea

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46
Q

What can severe acute fatty liver disease cause

A

Pre-eclamspia

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47
Q

What resp rate should a child be referred to hopsital with bronchiolitis with

A

> 60

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48
Q

What bishop score indicates labour is progressing fine and no interventions are needed

A

> 8

49
Q

What bishops score suggests interventions are needed

A

<5

50
Q

How long should the first stage of labour last?

A

Up to 12 hours

51
Q

What is a risk with oxytocin?

A

Oxytocin infusion carries the risk of uterine hyperstimulation

52
Q

What is a membrane sweep and when is it offered?

A

Finger seperating chorionic membrane from the decidua
Offered from 40-41 weeks in nulliparous women

53
Q

Indications for induction

A

prolonged pregnancy, e.g. 1-2 weeks after the estimated date of delivery
prelabour premature rupture of the membranes, where labour does not start
maternal medical problems
diabetic mother > 38 weeks
pre-eclampsia
obstetric cholestasis
intrauterine fetal death

54
Q

How is labour induced

A

PGE2 vaginal suppositry (dipinestrone)
Oral PGE1 - misoprostol
maternal oxytocin infusion
amniotomy (‘breaking of waters’)
cervical ripening balloon

55
Q

NICE recommendations induction of labour

A

if the Bishop score is ≤ 6
vaginal prostaglandins or oral misoprostol
mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean
if the Bishop score is > 6
amniotomy and an intravenous oxytocin infusion

56
Q

What is uterine hyperstimulation

A

refers to prolonged and frequent uterine contractions - sometimes called tachysystole

57
Q

Potential consequences of uterine hyperstimulation

A

potential consequences
intermittent interruption of blood flow to the intervillous space over time may result in fetal hypoxemia and acidemia
uterine rupture (rare)

Manage by:
removing the vaginal prostaglandins if possible and stopping the oxytocin infusion if one has been started
consider tocolysis

58
Q

What to do if a baby presents with jaundice in first 24 hours

A

Measure and record the serum bilirubin level urgently (within 2 hours) since this is likely to be pathological rather than physiological jaundice.

59
Q

What should fundal height measure

A

The week of parity +/- 2cm

60
Q

What is potters sequence

A

a rare fatal genetic disorder, characterised by severe oligohydramnios, resulting either from polycystic kidney or bilateral renal agenesis. This causes a specific appearance of the newborn, called Potter facies. The affected babies usually die within a few hours of birth or are stillbirths, and have wrinkly skin, low-set ears, flat noses and chins, and widely separated eyes with epicanthic folds.

61
Q

Causes of polyhydraminos

A

Duodenal atresia
Foetal anaemia
Maternal diabetes
Trisomy 21

62
Q

Causes of oligohydraminos

A

premature rupture of membranes
Potter sequence
(bilateral renal agenesis + pulmonary hypoplasia)
intrauterine growth restriction
post-term gestation
pre-eclampsia

63
Q

What is oligohydraminos

A

500ml at 32-36 weeks and an amniotic fluid index (AFI) < 5th percentile.

64
Q

What is worrying in development?

A

Referral points
doesn’t smile at 10 weeks
cannot sit unsupported at 12 months
cannot walk at 18 months

Fine motor skill problems
hand preference before 12 months is abnormal and may indicate cerebral palsy

Gross motor problems
most common causes of problems: variant of normal, cerebral palsy and neuromuscular disorders (e.g. Duchenne muscular dystrophy)

Speech and language problems
always check hearing
other causes include environmental deprivation and general development delay

65
Q

What are half of cord prolapses caused by?

A

Artificial rupture of membranes

66
Q

Features of foetal varicella zoster syndrome

A

skin scarring, eye defects (microphthalmia), limb hypoplasia, microcephaly and learning disabilities

67
Q

When can you give oral aciclovir to a woman ant presenting with chickenpox?

A

> 20 weeks
Presents within 24 hours of rash
If under 20 weeks should use with caution

68
Q

Why sometimes need to use PPI with SSRIs

A

Risk of GI bleeding

69
Q

What head circumference presents with fragile X

A

larger than normal

70
Q

Causes of microcephaly

A

normal variation e.g. small child with small head
familial e.g. parents with small head
congenital infection
perinatal brain injury e.g. hypoxic ischaemic encephalopathy
fetal alcohol syndrome
syndromes: Patau
craniosynostosis

71
Q

When is bone marrow biopsy required for ITP?

A

When abnormal features eg splenomegaly, bone pain, and diffuse lymphadenopathy,

72
Q

Physiological features of anorexia nervosa

A

Features
reduced body mass index
bradycardia
hypotension
enlarged salivary glands

Physiological abnormalities
hypokalaemia
low FSH, LH, oestrogens and testosterone
raised cortisol and growth hormone
impaired glucose tolerance
hypercholesterolaemia
hypercarotinaemia
low T3

73
Q

Drugs to avoid in breastfeeding

A

antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

74
Q

What is acute dystonia treated with

A

Procyclidine (anticholingergic)
Caused by first gen anitpsychotics

75
Q

SSRIs in pregnancy

A

BNF says to weigh up benefits and risk when deciding whether to use in pregnancy.
Use during the first trimester gives a small increased risk of congenital heart defects
Use during the third trimester can result in persistent pulmonary hypertension of the newborn
Paroxetine has an increased risk of congenital malformations, particularly in the first trimester

76
Q

How logn does it take for steroids to be effective in neonate when given to mother for lungs

A

1-2 dyas

77
Q

When admit w bronchiolitis

A

Apnoea (observed or reported)
Persistent oxygen saturation of <92% in air
Inadequate oral fluid intake (<50% of normal fluid intake)
Persisting severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute

78
Q

Whencan do ECV for transverse lie

A

when sac not rupturef

79
Q

What is used to reduce risk of blood loss in hystercetomy

A

GnRH - reduce size of uterus and fibroid - risk of bleeding is related to uterus size

80
Q

What test is done in schools hearing

A

Pure tone audiometry

81
Q

First line for endometrail cancer

A

Transvaginal US

82
Q

How long before negative pregnancy test after abortion?

A

4 weeks
If positive before then reassure and repeat at 4 weeks

83
Q

What is used to screen newborns hearing

A

Otoacoustic emission test

84
Q

What to give IV to women with sev hyperemsis gravidarum

A

IV saline with potassium chloride

85
Q

Why is IV saline and dextrose contraindicated in hypermesis gravidarum

A

Women with hyperemesis gravidarum are at risk of hypokalemia and wernickes encephalopathy
Therefore only give dextrose if K is normal (otherwise cause hypo as K absorbed into cells) and thiamine supplements

86
Q

Triad of vasa previa

A

rupture of membranes followed by painless vaginal bleeding and fetal bradycardia.

87
Q

What do NICE recommend for severe pre-eclampsia/eclampsia after 37 weeks gestation?

A

Delivery within 24-48 hours, therefore give IV magnesium sulphate if within 24 hours or concerned women has eclampsia

88
Q

Symptoms of ovarian hyperstimulation syndrome

A

shortness of breath, fever, oliguria, and peripheral oedema.

89
Q

What is a side effect of ovarian induction

A

Ovarian hyperstimulation syndorme

90
Q

What women should take high dose folic acid in pregnancy

A

Epilepsy (antiepileptics_)
Diabetes
Obesity
Parents have a neural tube defect
FH neural tube defects
Prev preg with neural tube degect
you take anti-retroviral medicine for HIV

91
Q

SSRI discontinuation syndrome symptoms

A

increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia

92
Q

What cardiac problems can citalopram cause?

A

QT prolongation and torsades de pointes

93
Q

Can you continue breastfeeding on flucloxacillin

A

YES

94
Q

Why do FBC if taking clozapine and present with tonsilitis?

A

Risk of agranulocytosis/neutropenia with clozapine, need to check neutropenia isnt causing infection with any infection present with

95
Q

What decelerations on CTG are non reassuring/abnormal

A

Variable decelerations occurring with over 50% of contractions may be non-reassuring or abnormal depending on their response to conservative treatment.
ABNORMAL - single prolonged deceleration over 3 minutes

96
Q

4 features on CTG

A

foetla HR
variability
Decelerations
Accelerations

97
Q

Abnormal decelerations on CTG

A

either non-reassuring variable decelerations still observed 30 minutes after starting conservative measures with >50% of contractions or late decelerations not improving with conservative measures, present for over 30 minutes and occurring with >50% of contractions or a bradycardia or single prolonged deceleration for more than 3 minutes.

98
Q

Non reassuring accelerations on ECG

A

either variable decelerations of ≤60 bpm and taking ≤60 seconds to recover, present for >90 minutes and occurring with >50% of contractions or variable decelerations of ≥60 bpm or taking ≥60 seconds to recover, present for up to 30 minutes and occurring with >50% of contractions or late decelerations present for up to 30 minutes and occurring with >50% of contractions.

99
Q

Reassuring foetal variability CTG

A

over 5 BPM

100
Q

Non reassuring variability CTG

A

<5 or >25 for 30-90 mins

100
Q

Non reassuring

A

<5 or >25 for >25 minutes

101
Q

Non reassuring foetal HR on CTH

A

161-180 BPM

102
Q

Abnormal HR on CTG

A

<100 or >180

103
Q

How often monitor blood sugar in pregnancy if diabetes

A

fast, pre meal, 1 hr post meal and bed time

104
Q

Most important risk of oestrogen only HRT

A

Endometrial cancer - for women with a womb!!!

105
Q

What painkillers should be avoided with SSRIs?

A

Triptans

106
Q

Earliest that ECV can be offered

A

36 weeks

107
Q

When should insulin be started immediately in pregnancy with GDM

A

If fasting plasma glucose is over 7

108
Q

When should insulin be started immediately in pregnancy with GDM

A

If fasting plasma glucose is over 7

109
Q

Why is lithium not first line in mania

A

1-2 week onset of action - longer acting
first line is risperidone/Haloperidol/ Olanzapine/Quetiapine

110
Q

Why monitor BMs closely and adjust insulin accordingly if giving steroids in pregnancy

A

Steroids can cause hyperglycaemia

111
Q

sIGNS OF dehydration on bloods

A

Low serum urea
Raised haematocrit
Ketonuria
Examination findings

112
Q

Electrolyte imbalances in hyperemesis gravidarum

A

Hypokalemia
Hyponatremia
Metabolic alkalosis

113
Q

What score measures HG severity

A

PUQE

114
Q

First line antiemetics

A

Cyclizine
Prochlorperazine
Prometha\inw
Chlorproma\ine

115
Q

Second mline antiemttics hyperemesis

A

Metoclopramide
Domperidone
Ondanestron

116
Q

Third line antiemetics hyperemsis

A

Corticosteroids

117
Q

What is the most importnat treatabel cause of miscarriage

A

Antiphospholipid syndrome (AI disease stopping placental function)

118
Q

Treatment for antiphospholipid syndrime causing miscarriage

A

Heparin

119
Q

How does antiphospholipid syndrome cause miscarriage and pregnancy problems

A

Inhibitis trophoblastic function and didfferentiation
Acitvation of complement pathways at maternal foetal interface -> local inflam response, VTE

120
Q

How determine viability of pregnancy

A

Measure crown rump length
<7 and no HB = rescan in 7 days
>7 and no HB - second opinion, scan in at least 7 days

Measure gestational sac if foetal pole not visible
<25mm - at least 7 days later rescan
>25mm = second opinion, rescan at least 7 dyas later

Reproductive Health (69 decks)

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