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Passmed questions > PASSMED OBS AND GYNAE > Flashcards

PASSMED OBS AND GYNAE Flashcards

1
Q

Rubella in pregnancy - non immune ?

A

-Advise to keep away from people with rubella
-Offer MMR vaccination postnatal period

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1
Q

Down syndrome combined test?

A
  • Decrease PAPPA-A
  • Increase in beta-hCG
    -Thickened nuchal translucency
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2
Q

RCOG guidance development DVT?

A

If clinical suspicion of DVT or PE - LWMH commenced

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3
Q

What women on LWMH should be monitored with a specific blood test?

A

-Women at extreme of body weight <50 or >90
-Complicating factors (renal impairment or recurrent VTE)

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4
Q

What is used to monitor women on LMWH?

A

Anti-Xa factor

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5
Q

What should be used to monitor women with unfractioned heparin?

A

APTT

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6
Q

How long to wait after taking ulipristal?

A

5 days - this is because ulipristal acetate may reduce the effectiveness of hormonal contraception - barrier methods should be used

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7
Q

When can women continue taking the combined pill?

A

-Must be on established on COCP
-COCP restarted after a pill-free interval
-The missed pill must be later than the first week o fill taking

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8
Q

When refer to midwife led breastfeeding clinic?

A

If breastfed baby looses >10% birth weight in 1st week life - refer

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9
Q

In preterm rupture of membranes what medication should be given to reduce the risk of RDS?

A

Corticosteriods such as dexamethasone
(<37 weeks)
-IM dexamethasone

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10
Q

What weeks should magnesium sulphate be given if PPROM?

A

Women who are less than 34 weeks - foetal neuroprotection

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11
Q

What are results in downs syndrome quadruple test?

A

-Decreased AFP
-Decreased oestridol
-Increase hCG
-Increase Inhibit A

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12
Q

Combined test vs quadruple test?

A

-Combined test (11-13+6 weeks)
-Quadruple test (15-20 weeks)

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13
Q

What is measured in combined test?

A

-HCG -increase
-PAPPA-A - decrease
-Nuchal translucency - thickened
-Edwards (18) and patau (13) syndrome - similar result but HcG tends to be lower

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14
Q

What do results of combined and quadruple test show?

A

-Lower chance e.g. 1 in 300
-higher chance 1 in 100

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15
Q

If woman has higher chance then what should be offered?

A

NIPT (screening test) or CVS (diagnostic)

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16
Q

Sensitivity and specificity for NIPT?

A

very high for trisomy 21 (>99%)
-Measures cell free fetal DNA

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17
Q

Fetus in OP position during labour?

A

-Delievry possible may be longer and more painful
-Fetal head may rotate spontaneously to OA position
-Augmentation offered if process is slow
-Kielland forceps are associated with most successful outcome - require expertise
-Women will experience an early urge to push in OP than OA

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18
Q

3 types of placenta accreta

A

-accreta: chorionic villi attachment to myometrium
-Increta: chorionic villi into myometrium
-Percreta: chorionic villi invade through he perimetrium

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19
Q

Breech baby prolonged vaginal delivery?

A

-Caesaran section

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20
Q

1st line investigation for premature rupture of membranes?

A

-Careful speculum examination to look for amniotic fluid in posterior vaginal vault
-avoid bimanual risk of infection

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21
Q

When can IUS be inserted after?

A

within 48 hours of childbirth or 4 weeks after
-4 week after is due to increased rusk of expulsion and lacking data surrounding uterine perforation

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22
Q

What form of contraception should be discontinued >50?

A

Injectable contraceptives - Depo-provera - associated with loss in bone mineral density
-COCP should also be stopped

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23
Q

What presentation has greatest mortality and morbidity risk?

A

Footling presentation
-5-20% risk of cord prolapse

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24
Q

What should women with high or moderate risk of preeclampsia take?

A

75-150mg of aspirin from 12 weeks until brith

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25
Q

When can you take COCP post part?

A

-wait 21 days risk of venous thromboembolism

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26
Q

When is anomaly scan?

A

18-20+6 weeks

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27
Q

Medical for PPH?

A

-IV oxytocin: slow IV injection followed by an IV infusion -syntometrine
-Ergometrine slow IV or IM (unless there is a history of hypertension)
-Carboprost IM (unless there is a history of asthma)
misoprostol sublingual
there is also interest in the role tranexamic acid may play in PPH

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28
Q

When do you need to continuously monitor CTG when in labour?

A

-suspected chorioamnionitis or sepsis, or temp >38
-Severe hypertension >160/110
-Oxytoxcin use
-Significant meconium
-fresh vaginal bleeding

29
Q

Painless bleeding, uterus large for date, hyperesmsis?

A

Hydatifrom mole

30
Q

Endometritis?

A

Admit - clindamycin and gentamicin until afebrile for >24 hours

31
Q

Reduced foetal movements - no heartbeat detected with handheld doppler?

A

Immediate ultrasound scan

32
Q

When should fetal movements be established?

A

-24 weeks gestation

33
Q

Risk factors for RFM

A

-Posture (more prominent lying down and less when sitting and standing)
-Distraction (women not as aware of movements)
-anterior placenta prior 28 weeks lesser awareness
-Medication - alcohol and benzodiazepines
-Fetal position (anterior fetal position means movements are less noticeable)
-Obese women
-Oligohydramnios and polyhydramnios can cause reduction in fetal movements
-Fetal size - 29% presenting with RFM have SGA foetus

34
Q

Refer to fetal medicicine unit?

A

-If fetal movements have not been felt baby 24 weeks

35
Q

When is lactational amenorrhea a reliable form of contraception?

A

-Amenorrhoeic, <6 months, breastfeeding exclusvely

36
Q

When to give aciclovir to women contact with chicken pox ?

A

-Present within 24 hours onset of rash and are 20+0 weeks

37
Q

Post natal depression scale?

A

Edinburgh postnatal depression scale
>13 indicates depressive illness of varying severity

38
Q

When can postpartum women take progesterone pill?

A

immediatley

39
Q

When do women require contraception post partum?

A

21 days after giving birth

40
Q

Pearl index COCP 0.2

A

every thousand women using contraception 1 year 2 pregnant

41
Q

Cephalosporins breastfeeding?

A

considered safe

42
Q

Umbilical cord prolapse

A

-can push presenting part of fetes back into the uterus to avoid compression
-minimal handling
-all fours
-retrofillign bladder with 500-700ml saline

43
Q

Stretococcus agalacticae

A

-Gram postive
-Cocci in chains

44
Q

Aspirin breast feeding?

A

Aspirin avoided in pregnancy - can increase risk of reyes syndrome and also cause metabolic acidosis

45
Q

What is a serious manifestation of pre-eclampsia?

A

HELLP syndrome

46
Q

Postpartum thyroiditis

A
  1. Thyrotoxicosis
  2. Hypothyroidism
  3. Normal thyroid function (but high recurrence rate in future pregnancy)
47
Q

What do you treat postpartum thyroiditis with in the thyrotoxicosis stage?

A

Propranolol

48
Q

POP take missed pill as soon as possible and advise condom use until pill taking re-established

A

take missed pull as soon as possible and advise condom use until pill taking reestablished

49
Q

What is oligohydraminos ?

A

Deficiency of amniotic fluid during pregnancy - can present with smaller symphysis fundal height

49
Q

Quantify oligohydramnios

A

<500ml 32-36 weeks and an amniotic fluid index <5th percentile

50
Q

starting COCP after taking levonorogestrel?

A

Can immediately be started

51
Q

What are the causes of oligohydramnois?

A

-PROM
-potter sequence (bilateral agenesis + pulmonary hypoplasia)
-Intrauterine growth restriction
-Post-term gestation
-Pre-eclampsia

52
Q

What are the most effective form of contraception?

A

Implantable contraceptives very low failure rate 0.05%

53
Q

Cardiac changes in pregnancy ?

A

96% have ejection systolic murmur
84% women have third heart sound
-This is because there is increased cardiac output and volume increase which occurs during pregnancy

54
Q

PPH medical management?

A

-Palpate the uterine fundus and rub it
-Ensure bladder empty
-Oxytocin 5 iu slow IV or 10 units IM
-Ergometrine 0.5mg slow IV or IM (not women with HTN)
-Oxytocin infusion (40iu in 500ml)
-Carboprost
-misoprostol

55
Q

When is first dose of anti-D given to rhesus negative women?

A

28 weeks

56
Q

Early scan to confrim dates?

A

10-14 weeks

57
Q

Anamoly scan?

A

18-20+6 weeks

58
Q

What should you measure when giving magnesium sulfate?

A

-Monitor reflexes and respiratory rate

59
Q

Women with SLE?

A

At higher risk of pre-eclmapsie - takle aspirin 12 weeks

60
Q

BISHOP SCORE <6

A

-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

61
Q

Bishops score >6

A

-Amniotomy and an intravenous oxytocin infusion

62
Q

Transverse lie - amniotic sac not ruptured

A
  • Can perform external cephalic version
63
Q

IUD switch to COCP

A

if day 1-5 cycle no contraception needed

64
Q

Postive hep B mother - neonate vaccination?

A

Hep B vaccine and 0.5 ml within 12 hours of birth with further vaccine 1-2 months and furtehr vaccine 6 months

65
Q

AFP down syndrome vs nerual tube defects?

A

AFP raised in neural tube
AFP decreased in Downs

66
Q

COCP before surgery?

A

Stop for 4 weeks and prescribe POP

67
Q

Quadruple test results

A

Low AFP, high inhibin A, low eostridol

68
Q

Raised AFP associated with?

A

omphalocele

69
Q
A

Passmed questions (11 decks)

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