Passmed Key Concepts Flashcards
Which SSRI leads to QT elongation and torsades de pointes?
Citalopram
What is first-line treatment for menorrhagia?
Tranexamic acid
What is the definition of pre-eclampsia?
New-onset BP >140/90mmHg after 20w AND proteinuria/organ dysfunction
When can hormonal contraception be started again after using levonorgestrel for emergency contraception?
Immediately
How do you manage a pregnant woman with previous VTE history?
Prophylactic LMWH throughout pregnancy until 6 weeks postnatal
What does an older woman with a labial lump + inguinal lymphadenopathy suggest?
Vulval carcinoma
What should you do if you are presented with a case of FGM in someone under 18?
Report it to the police
How does ovarian cancer initially spread?
Locally into pelvic area
What advice should you give about contraception to patients assigned female at birth?
Can’t use any contraceptions with oestrogen in if they’re undergoing testosterone therapy as antagonises it
What does a complete hydatidiform mole (pregnancy) look like on ultrasound?
‘snow storm’ appearance on ultrasound scan
How are pregnant women >20w who present within 24 hrs of a rash appearing (chickenpox) treated?
Oral aciclovir
What sign is ovarian torsion associated with on ultrasound?
Whirlpool sign
For transgender males, does testosterone therapy provide protection against pregnancy and what effects can it have on the pregnancy if it doesn’t?
No it doesn’t
Teratogenic effects
What is an important risk factor for hyperemesis gravidarum?
Multiple pregnancy
What is the cervical screening timeline?
25y - first invite 25-49 - every 3 years 50-64 - every 5 years 65+ not offered delay 3 months post-partum unless missed previous or previous abnormal
What treatment is first-line for painful periods that are otherwise normal?
NSAIDs - inhibit prostaglandin synthesis (one of main causes of dysmenorrhoea pains)
What is the symphysis-fundal height, where is it measured, and what should you do if it’s abnormal?
Measure to establish whether small for dates, should be 1-2cm from the gestational age in weeks e.g. 24 weeks should have a SFH of 22-26cm.
Measured from top of pubic bone to top of uterus in cm.
Get ultrasound to confirm if foetus is small for gestational age.
What is the main investigation of suspected placenta praevia?
Transvaginal ultrasound
What are 2 common long-term complications of vaginal hysterectomy with antero-posterior repair?
Enterocele
Vaginal vault prolapse
Which emergency contraception should be used with caution in patients with severe asthma?
Ulipristal
What is the first step after a woman presents concerned about reduced foetal movements?
Handheld Doppler to confirm foetal heartbeat
How long does it take each contraceptive type to be effective after administration?
Instant - IUD
2 days - progesterone-only pill
7 days - combined oral contraceptive, injection, implant, IUS
What is a major risk factor for cord prolapse?
Artificial rupture of membranes
What is a potential complication of ovulation induction?
Ovarian hyperstimulation syndrome
What is a typical presentation of ovarian hyperstimulation syndrome?
Acute presentation of hours-ago onset abdominal pain + bloating that has been increasing. On exam abdo tenderness + ascites. Hx of IVF treatment (ovulation induction)
What is a major contraindication for injectable progesterone contraceptives?
Current breast cancer
What scale is used to screen for postnatal depression?
The Edinburgh Scale
How should you manage premenstrual syndrome?
SSRIs (fluoxetine) either continuously or during the luteal phase
What is the first-line treatment for a <35mm ectopic pregnancy with no heartbeat?
Methotrexate (interferes with DNA synthesis and disrupts cell multiplication so pregnancy doesn’t develop)
What is the definition of pregnancy-induced hypertension? (and what features does it lack that differs from pre-eclampsia?)
> 140/>90 mmHg after 20w
No proteinuria or oedema
How do you manage pregnancy-induced hypertension?
Oral labetalol
When must methotrexate be stopped for males AND females before conception?
At least 6 months in both men and women
What is the management if at the time of diagnosis of gestational diabetes, the fasting glucose is >7mmol/L?
Insulin (with or without metformin) should be started immediately
How is PPROM (preterm premature rupture of membranes) investigated and why?
Sterile speculum exam
Then, if no fluid in posterior vaginal vault, use US to assess for oligohydramnios
How are perineal tears classified after birth?
1st degree - tear within vaginal mucosa only
2nd degree - tear into subcutaneous tissue (submucosa)
3rd degree - laceration extends into external anal sphincter
4th degree - laceration extends through external anal sphincter into rectal mucosa
What is the key clinical feature of placenta praevia?
Painless bleeding after 24w
How long are healthy couples expected to take to conceive and when would investigations be started?
Up to 1 year, investigations only started after 1 year of regular attempts to conceive
What are 3 important causes of placental abruption and what are their distinguishing features?
Placental abruption - abdominal pain + vaginal bleeding
HELLP (Haemolysis, Elevated Liver enzymes, Low Platelets) syndrome - Anaemia or low platelets seen in blood results
Cocaine use - Dilated pupils + hyperreflexia
Pre-eclampsia - absence of the other 2 and fit of clinical scenario
