Passmed (WH) Flashcards
Guidelines for chicken pox exposure in pregnancy?
Exposed:
<20 wk, vzIG w/i 10days
>20 wk VzIG/acyclovir after 2 weeks
Developed:
<20 wk, acyclovir w/ caution
>20 wk - acyclovir w/i 24hr of rash (oral!)
Definition of gestational hypertension vs pre-eclampsia?
GH: >140/90 after 20 weeks
PRe: Htn + symptoms (i.e. swelling) OR proteinurea
Fasting glucose > 7mmol, first line managment?
Insulin (w/ or w/o metformin)
Fasting glucose < 7mmol, managrment?
Start with diet & exercise offered
Managment of fibroids that are:
A) Large
B) Sub-fertility
Myomectomy
Which cancer does combined HRT cause an increased risk of?
Breast cancer (oestrogen & progestogen)
Whereas remember COCP protects from ovarian & endometrial & inc B&C
How to remember different management for stress & urinary incontinence?
Stress: lower causes, PFMT, Duloxetine
Urge: avoid trigger, bladder training, anti-muscarinics
Marker of an ectopic vs missed?
Both would show empty uterus but ectopic would still have bHCG>1,500
What are the different time limits for emergency contraception?
120 hours for ellaOne 72 for levonelle one
When should you do a saplingectomy instead of otomy?
If the other tube is still patent
When does smoking become part of UKMEC4?
If 35 yo + and 15 or more per day
Acroynm for shoulder dystocia mx?
HelpERR H- call for help
E- evaluate for episiotomy
L- leg to McRoberts
P- supraPubic Pressure
E- enter: rotational manouevres
R- remove the posterior arm
R- roll pt to hands and knees
Primary Mx of ovarian Ca: Ca125 or TVU first?
CA125, after pelvic and abdominal exam
Best anti-depressant for PPD?
Sertraline
Citalopram and duloxetine are present at higher levels in breast milk and so are less favourable compared with sertraline.
Risk factors for hypermesis?
Nulliparity, obesity, multiple parity
First line meds for PP thyroiditis
Propanolol (Sx mx) not carbimazole
Since PP T just becomes hypothyroid so can make it worse
First investigation for reduced foetal movements? Past how many weeks is serious?
Hand-held Doppler. Past 28 weeks
Concern of old woman with lump on labia?
Vulval carcinoma
What to do if a 1 cocp pill is missed?
Take the latest asap even if means having to take 2 in one day
Side effects of the progesterone only pill?
irregular vaginal bleeding
What is dialation and curettage?
Dilation of the cervix and scrapping out the endometrial cavity
What is the reason why those with migraines cannot have the Pill
Since increased risk of ischemic stroke
How to remember which is the medical treatment for urinary stress incontinence?
Duloxetine - if you’re stressed need to relaaax (SNRI)
n.b. desmopressin in enuresis, anti-muscarinic in OAB
What is the rule for followup of individuals who have been already treated for CIN ?
6 months
How to remember the bishops score components?
Call PEDS for station:
Cervical position effacement, dilatiion, softness; foetal station
Bishop score components are scored from 0-3, what is 2 score?
P: anterior E: 60-70% D: 3-4cm S: soft station, -1,0
What does bishops score >8 mean?
Spontaneous labour soon
Criteria for pre-eclampsia?
> 20 weeks, >140/90 & pain or proteinurea
What drugs are contraindicated in pregnancy?
- antibiotics: (ciprofloxacin, tetracycline, chloramphenicol, sulphonamides)
- psychiatric drugs (lithium, benzos)
- aspirin
- carbimazole
- methotrexate
- sulfonylureas
- cytotoxic drugs
- amiodarone
Women with risk factors of pre-eclampsia should take what from when?
75-150mg of aspirin from 12 weeks gestation
For women at risk of gestational diabetes how should they be investigated?
OGTT after booking and at 24-28
Moderate risk factors for pre-eclampsia? How many needed before you need to take aspirin?
first pregnancy
age 40 years or older
pregnancy interval of more than 10 years
body mass index (BMI) of 35 kg/m² or more at first visit
family history of pre-eclampsia
multiple pregnancy
2 or more
COC missed pill guidelines
1 miss pill -> 2 next day
2+ miss pill -> 2 next day & barrier for 7
Wk 1 : take emergency pills
Wk 2 : no need emergency pills, just barrier 7 days
Wk 3 : no need emergency pills and omit pill free interval
Tamoxifen is an SERM (selective oestrogen receptor modulator), how does it act in the body?
It blocks E receptors in the breast (prevent ca) and stimulates in the uterus & bones (preventing osteop’ but encouraging endometrial hyperplasia)
Which contraceptives are effective the quickest?
Instant: IUD
2 days for POP
What are some methods of surgical Mx of miscarriage?
Dilation & curettage, manual/electric vacuum aspiration
Policy if only one pill missed (COCP)
Can just take the next pill
Side effect of GNrH agonists?
Loss of bone mineral density
In a lady with a 35 day cycle, what day would be best to measure her progesterone?
So working back from 35, (-14) is start of luteal phase, so half way through then (i.e. 28)
Candidiasis treatment: not actually clotrimazole, what is it?
Oral fluconazole 150mg as a single dose first line
What is the medication for suppressing a woman’s lactation?
Cabergoline (think of a pair of breasts like cabbages)
Congenital rubella syndrome vs congenital cytomegalovirus?
Both might have low birth weight, seizures etc but rubella would classically have deafness & eye abnormalities
Bishops score, score milestones?
< 5 means unlikley to start w/o induction. >=8 spontaneous gonna happen
When is the HELPPER management used ?
In shoulder dystocia; help epistomy, legs in mcroberts, pressure suprapubic
When can women start to use the COCP post-partum?
Either after 6 weeks (if breast feeding, or 3 if not)
Chicken pox exposure brief guidelines?
Give VZ IG if needed <20 weeks; CP threat high: >20wk oral acyclovir, <20wk consider w/caution
If a semen sample is abnormal, when does it need to be re-tested?
ideally 3 months later
What is a long-term complication of vaginal antereo-posterior repair?
Vaginal vault prolapse. Prevents each side of the roof caving in but the top might droop in
The 3 methods of emergency contraception and when they can be used?
Levonorgesterel, w/i 72hrs; Ulipristal w/i 120hrs. IUD (copper) w/i 5 days or w/i 5 days of likely ovulation
How to remember the high risk factors for pre-eclampsia?
Hypertensive disease in pregnancy / chronic hypertension
SLE etc
Diabetes 1/2
What is the preventative risk for women with at least 1 high risk factor for pre-eclampsia?
Aspirin 75-150mg from 12 weeks
Which women need to take folate supplementation until 12th week?
Previous NTD; eplieptic/coeliac/diabetes; obese (BMI 30+)
What is androgen insensitivity syndrome?
Where they have testes but these don’t develop properly due to insensitivity. But they still develop breasts (testosterone converted into oestrogen)
What is the first line management for post-partum haemorrhage?
To compress the uterus (& catheritise)
For managing aTony,
Tissue, Tone, Trauma, Thrombin
Which genital tract infections present with discharge?
How to differentiate?
- BV (fishy white)
- Trich (green/grey)
- Candidiasis (cottage cheese)
Summarise the antibiotics used for genital infections?
Bv - Metronidiazole
Trich - metronidiazole
Gonorrhoea - IM ceftriaxone (gram -)
Chalmydia - doxycycline /azithromycin
When are we using mifepristone & misoprostol vs using methotrexate?
Methotrexate in ectopic. Other in termination
When do you need to have stopped methotrexate?
6 months before doing (m&f)
I.e. methosexate
Is candidiasis more acidic or alkali? Treatment normally vs pregnant?
More alkali. Oral fluconazole. Need clotrimazole pessary in pregnancy
How to remember risk factors for hyperemesis?
- Inc levels of B-HcG (twins/tropho’ d)
- First time (nuliparity)
- Obesity
- Past Hx (family or personal)
n.b. smoking decreases B-HcG so actually lower rise of HG
