Passmed OG Flashcards
First line treatment for urge incontinence?
Bladder retraining
First line treatment for stress incontinence?
Pelvic floor muscle training
What is used in medical management of a miscarriage?
Vaginal misoprostol
What is used in the medical management of an ectopic pregnancy?
IM methotrexate
Why would we give MGSO4 to pregnant ladies?
In eclampisa to prevent seizures
Symptoms of PMS?
Anxiety, stress, fatigue, mood swings, bloating and breast pain
Management of PMS?
Mild = regular small complex carbohydrates Moderate = new COCP Severe = SSRI (sertraline)
What are the stages of ovarian cancer?
1 = confined to ovaries 2 = local spread within the pelvis 3 = spread beyond the pelvis to the abdomen
Presentation of ovarian cancer?
Abdominal distention and bloating Abdominal and pelvic pain Urinary symptoms Early satiety Diarrhoea
Investigations for ovarian cancer?
CA125
US
Bishop score is inversely correlated with…
Labour duration
What does a bishop score of <6 suggest?
Cervical ripening is needed
What is the most common cause of early-onset severe infection in the neonatal period?
Group B streptococcus
Presentation of vulval carcinoma?
Lump or ulcer on labia majora, can be itching and irritation
Presentation of vulval intraepithelial neoplasia?
White or plaques
What does high beta hCG, low TSH and high thyroxine suggest?
Molar pregnancy
What is a complete hydatidiform mole?
Benign tumour of trophoblastic material.
Empty egg is fertilised by a single sperm, then duplicates its own DNA. All 46 chromosomes are of paternal origin
Presentation of molar pregnancy?
Bleeding in first or early second trimester
Exaggerated symptoms of pregnancy (hyperemesis)
Uterus large for dates
High hCG
Hypertension and hyperthyroidism
What is a partial mole?
A normal haploid egg fertilised by either
- 2 sperm
- 1 sperm with duplication of paternal chromosomes
DNA is both maternal and paternal but is triploid
When can expectant management be used in an ectopic pregnancy?
Unruptured embryo, <35mm, no heartbeat, asymptomatic, declining B-hCG
Can you prescribe contraception to a 13 year old?
NO - even if competent
What secretes hCG?
Syncytiotrophoblasts
Function of hCG?
Maintains production of progesterone by corpus luteum in early pregnancy
When can hCG be detected?
8 days after conception
When do hCG levels peak?
8-10 weeks gestation
What is a simple cyst?
Unilocular - more likely to be physiological or benign
What is a complex cyst?
Multilocular - more likely to be malignant
Management of a cyst in a post-menopausal woman?
REFER to gynaecology
What is the McRobert’s manoeuvre?
Patient supine with both hips fully flexed and abducted.
Used in shoulder dystocia
What methods of contraception are contraindicated in smokers?
all combined hormonal methods:
COCP, patch, vaginal ring
Risks for hyperemesis gravidarum?
Multiple pregnancies Trophoblastic disease Hyperthyroidism Nulliaparity Obesity
Is smoking associated with hyperemesis?
Smoking is associated with a DECREASED incidence of hyperemesis
1st line treatment for hyperemesis gravidarum?
Antihistamines
What is the primary mode of action of the contraceptive implant?
Inhibition of ovulation
What is the mode of action of the COCP?
Inhibits ovulation
What is the mode of action of the POP?
Thickens cervical mucous
What is the mode of action of the intrauterine contraceptive device?
Decreases sperm motility and survical
What is the mode of action of the intrauterine system?
Prevents endometrial proliferation
Name the 3 types of emergency contraception?
Levonorgestrel
Ulipristal
IUD
What is the first line treatment for pre-eclampsia?
Labetalol
What is the first line treatment for pre-eclampsia in a patient with asthma?
Nifedipine
labetalol is contraindicated in smokers
What is a ‘white curdy discharge, pH <4.5’ likely to suggest?
Candidiasis
Treatment for chlamydia?
Oral doxycycline
Name the causes of infertility?
Male factor, unexplained, ovulation failure, tubal damage
What would a ‘6-8 week amenorrhoea with lower abdominal pain and vaginal bleeding’?
Ectopic pregnancy
What is a threatened miscarriage?
Painless vaginal bleeding occurring < 24 weeks. Cervical os is closed
What is a missed/delayed miscarriage?
Gestational sac containing a dead foetus <20 weeks without symptoms of expulsion.
What is an inevitable miscarriage?
Cervical os is open.
Heavy bleeding, clots and pain
What is an incomplete miscarriage?
Not all products of conception have been expelled
What is placental abruption?
Separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space
Features of placental abruption?
Constant pain
Tender, tense uterus
Normal lie and presentation
Foetal heart absent or distressed
What is the 1st line investigation for post-menopausal bleeding?
TVUS
Causes of postmenopausal bleeding?
Vaginal atrophy HRT Endometrial hyperplasia Endometrial cancer Cervical cancer Ovarian cancer Vaginal cancer
What is vaginal atrophy?
Thinning, drying and inflammation of the vagina due to a reduction in oestrogen following the menopause
At age 25-49 what is the timeframe for routine smears?
3 years
At >50 what is the timeframe for routine smears?
Every 5 years
What cardiovascular changes occur in pregnancy?
Increase SV, HR and CO
Diastolic BP reduced in early pregnancy, returns to normal at term
What respiratory changes occur in pregnancy?
Pulmonary ventilation, tidal volume increase.
Fall in pCO2
BMR raised
What is an amniotic fluid embolism?
Foetal cells/amniotic fluid enter the mothers bloodstream
Presentation of amniotic fluid embolism?
During labour or post-partum
Chills, shivering, sweating, anxiety and coughing
Is it safe to breastfeed while on anti-epileptics?
Yes
Effect of sodium valporate during pregnancy?
Neural tube defects
What is the least teratogenic of the anti-epileptics?
Carbamezepine
Effect of phenytoin during pregnancy?
Cleft palate
Which form of LARC is current breast cancer a contra-indication for?
Injectable progesterone contraceptives
1st line investigation for endometriosis?
Laparoscopy
Presentation of endometriosis?
Chronic pelvic pain
Dysmenorrhea
Deep dyspareunia
Urinary symptoms
If a woman presents with a ‘heavy, dragging’ sensation, what does this suggest?
Urogenital prolapse
What is placenta accreta?
Attachment of the placenta to the myometrium, due to a defective decidua basalis. As the placenta does not properly separate during labour there is a risk of post-partum haemorrhage
What are the risk factors for placenta accreta?
Previous C section
Placenta praevia
Can you use aspirin while breastfeeding?
NO.
It is associated with Reye’s syndrome which can cause liver and brain damage
What drugs should be avoided in pregnancy?
Antibiotics (ciprofoxaxin, tetracycline, chloramphenicol, sulphonamides) Psyhciatric durgs (lithium, benzodiazepens) Aspirin Carbimazole Methotrexate Sulfonylureas Cytotoxic drugs Amiodorone Clozapine
What is the 1st step after chicken pox exposure in pregnancy?
Check varicella antibodies
What are the features of foetal varicella syndrome ?
Skin scarring, eye defects, limb hypoplasia, microcephaly and learning disablilities
What should you do if the pregnant woman <20 weeks is exposed to chickenpox and is not immune?
Give varicella-zoster immunoglobulin
What are the risk factors for endometrial cancer?
Obesity Nulliparity Early menarche Late menopause HRT Diabetes mellitus PCOS HNPCC
How does endometrial cancer present?
Postmenopausal bleeding
If in premenopausal = change intermenstrual bleeding
Possibly pain and discharge
1st line investigation in endometrial cancer?
TVUS
Hysteroscopy with endometrial biopsy
Treatment for endometrial cancer?
Total abdominal hysterectomy with bilateral salpingo-oophorectomy
Name the 2 protective factors for endometrial cancers?
COCP
Smoking
What is a cord prolapse?
Umbilical cord descending ahead of the presenting part of the foetus.
Management of cord prolapse?
Presenting part of foetus may be pushed back into the uterus to avoid compression.
Tocolytics can be used.
If the cord is past the level of the introitus it cannot be pushed back, and a C section is performed.
What blood markers are measured in Down Syndrome?
Beta-human chorionic gonadotrophin (beta-hCG) and pregnancy associated plasma protein A (PAPP-A)
What test results show down-syndrome?
Increased HCG, decreased PAPP-A and thickened nuchal translucency
