PassMed wrong Qs Flashcards
What must be monitored in a patient being treated for eclampsia with magnesium sulphate?
-Reflexes
-Respiratory rate
What is the first-line investigation for women >50 with symptoms suggestive of ovarian cancer?
Ca-125
When is Ulipristel contraindicated for emergency contraception?
Patients with asthma
What pattern does women’s BP follow in pregnancy?
-Falls in first half
-Rises to pre-pregnancy levels before term
-Placenta formed from 20 weeks
What is the first-line management of large fibroids in women who wish to conceive in the future?
-Myomectomy
What criteria of ectopic pregnancies indicate surgical management?
-Measuring >35mm on TVUS
-bHCG >5000
What 4 main medications are contraindicated in breastfeeding?
-Aspirin
-Amiodarone
-Warfarin
-Lithium
What are the classic 4 symptoms of endometriosis?
-Subfertility
-Dysmenorrhoea
-Dyspareunia
-Pelvic pain
What could be a cause of abdominal pain in late pregnancy?
-Labour
-Placental abruption
-Symphysis pubis dysfunction
-Pre-eclampsia / HELLP
-Uterine rupture
What would cause a whirlpool sign on USS?
Ovarian torsion
What factors are taken into account when calculating the Risk Malignancy Index?
-Ca-125
-Menopausal status
-USS findings
What medication can suppress lactation?
-Cabergoline
What would you be suspecting if a woman suddenly collapsed soon after rupture of membranes?
Amniotic fluid embolism
How should placental abruption be managed <36 weeks?
-If foetus is not compromised –> IV corticosteroid therapy
What is the most suitable contraception for a woman with breast cancer?
-Copper IUD
ALL hormonal contraception is contraindicated
How should women at risk of pre-eclampsia be managed?
Give aspirin from 12 weeks –> birth
How should exposure to VZV in pregnancy be managed?
If asymptomatic (ie just contact):
-Test immunity first
-If no VZV IgG present –> give VZ IgG
If presenting within 24h of rash:
-Oral aciclovir
How does chorioamnionitis present?
PPROM + triad of symptoms:
-Maternal pyrexia
-Maternal tachycardia
-Foetal tachycardia
What diabetes medication should be stopped in pregnancy?
Gliclazide
When is anti-D administered antenatally for Rh-negative women?
-28 weeks
-If <28 weeks and at risk of sensitisation –> give one dose anti-D
What laboratory findings are normal in pregnancy?
-Low urea
-Low creatinine
-Raised protein in urine
How long should mag sulf be continued for?
-24h after delivery / last seizure
What are the lower limits of normal Hb in different trimesters in pregnancy?
1st trimester = 110
2nd/3rd = 105
Post-partum = 100
What cancers does COCP put you more at risk of?
INCREASED risk of BREAST and CERVICAL cancers
DECREASED risk of OVARIAN and ENDOMETRIAL
What is the first-line management of an overactive bladder and urge incontinence?
Bladder retraining
What is the best management option of fibroids to reduce their size prior to surgery?
GnRH agonists eg triptorelin
What would a macrocytic anaemia indicate?
Folate / B12 deficiency
How should a cord prolapse be managed?
-Woman should adopt all fours position
-Keep cord warm and moist and avoid touching it
What is Sheehan’s syndrome?
-Postpartum hypopituitarism
-Ischaemic necrosis of pituitary due to hypovolaemic shock following birth
-Presents with amenorrhoea, hypothyroidism, problems with lactation
What is the biggest risk factor for placenta accreta?
Previous C-section
What is the long-term anti-emetic of choice in pregnancy?
Promethazine
How long can a PT remain positive following TOP?
-For up to 4 weeks
How do molar pregnancies present?
-Uterus large for dates
-Hyperemesis gravidarum
-Thyrotoxicosis
-Significantly raised bHCG
-Snowstorm appearance on USS
What combined testing results would indicate Down’s syndrome?
-Thickened nuchal translucency
-Increased bHCG
-Reduced PAPPA
How does the LH:FSH ratio vary in different causes of infertility?
-PCOS –> raised LH:FSH ratio (high LH, low FSH)
-Hypothalamic / underweight –> normal ratio (v low LH + FSH)
-Ovarian insufficiency / menopause –> low LH:FSH ratio (high LH, v high FSH)
How should women with a fasting glucose of >7 on diagnosis be managed?
-Commenced on insulin immediately
When is a Kleihauer test done?
-If there is risk of fetomaternal haemorrhage / blood mixing eg in antepartum haemorrhage
When is a salpingostomy elected for over a salpingectomy?
SALPINGECTOMY
-First line S-TOP
-Removal of fallopian tube
-If no other RFs for infertility
SALPINGOSTOMY
-2nd line
-Creation of opening into fallopian tube
-If other RFs for infertility eg PID
What pharmacological treatment is used in urge incontinence?
-Anti-muscarinics
eg oxybutynin, tolterodine
What type of HRT increases the risk of breast cancer?
-Combined HRT
What are the 3 key features of Meig’s syndrome?
-Benign ovarian tumour
-Ascites
-Pleural effusion
Where is the most common site for ectopic pregnancies?
Ampulla of Fallopian tube
What is the difference between active and latent first stage of labour?
Latent = 0-3cm
Active = 3-10cm
What risks are associated with taking ondansetron in pregnancy?
-Small risk of cleft lip / palate in the newborn if taken in 1st trimester
What is the most common cause of umbilical cord prolapse?
Artificial amniotomy
What is the most appropriate way to investigate a ?placenta previa?
TVUSS
What UKMEC would a patient with anti phospholipid antibodies be placed under?
UKMEC 4
When does the 2nd screen for anaemia and atypical red cell autoantibodies occur in ANC?
28 weeks
How should women being treated for a DVT be monitored, especially if they are overweight?
Anti-Xa activity
What HPV types cause cervical cancer?
16 + 18
What could cause a raised maternal serum AFP?
Abdominal wall defects eg omphalocele
What is the most suitable form of contraception for women taking enzyme-inducing drugs?
Cu-IUD
What is the next step in management of endometriosis after NSAIDs / hormonal contraception?
GnRH analogues
How should women at risk of pre-eclampsia be managed?
Aspirin
How should thrush be managed in pregnancy?
Clotrimazole pessary
How long should folic acid be taken for in pregnancy?
For the first trimester
When should progesterone levels be measured in fertility investigations?
7 days before next expected period
What should be advised to couples trying to conceive if one or both of them are taking methotrexate?
Stop methotrexate 6 months prior to conceiving
How long can lochia be expected to be noticed postpartum?
6 weeks
How do placenta praaevia and vasa praevia present differently?
Vasa praevia = foetal blood vessels run across internal os
–Usually rupture of membranes occurs in VP, but does not in PP
–Foetal compromise is a more significant risk in VP compared to PP
What side effect do GnRH analogues have?
Loss of bone mineral density
What quadruple screening test results would indicate Edward’s syndrome?
-Low AFP
-Low estriol
-Low bHCG
-Normal inhibin A
How is postpartum thyrotoxicosis managed?
Propanolol
What is a contraindication to HRT?
PM bleeding
What risk does the progesterone component of HRT carry?
Increased risk of breast cancer
How do androgen insensitivity and congenital adrenal hyperplasia present differently?
AIS = primary amenorrhoea, little pubic hair, elevated testosterone, undescended testes
CAH = primary amenorrhoea, deep voice / hirsutism
How should women at risk of eclampsia be managed?
-75-150mg aspirin from 12 weeks until birth
What contraception is suitable for women taking EIDs?
-Cu-IUD
-Depo provera
When is AFP raised and when is it low?
-Raised in neural tube defects
-Low in Down’s and Edward’s
What is Asherman’s syndrome?
-Intrauterine adhesions following procedures
-Can cause amenorrhoea
What is given as GBS prophylaxis to women in labour?
-Benzylpenicillin
What advice should be given to women undergoing surgery if they are on the COCP?
Stop 4 weeks before, recommence 2 weeks later
When is a test of cure and cervical smear done for women with CIN?
6 months later
When can contraception be re-started after ullipristal and levonorgestrel?
Ullipristal = 5 days
Levonorgestrel = immediately
What is the most common type of benign ovarian tumour in women under 25?
Dermoid cyst (teratoma)
What is the best emergency contraception for women who are breast-feeding?
-Levonorgestrel / Cu-IUD
-If taking ullipristal, must stop BF for 1 week
What is a suitable alternative treatment for urge incontinence for the elderly?
Mirabegron
-Oxybutynin = anticholinergic which is associated with confusion in the elderly
When should absent foetal movements be investigated from?
24 weeks
When should ECV be offered to women?
From 36 weeks
How often should women with HIV have cervical smears?
Annually
How should chorioamnionitis be managed?
Co-amoxiclav
-Cefuroxime + metronidazole if pregnant
What is Heroghe’s sign and what condition is it associated with?
Sign = loss of lateral third of the eyebrow
Sign of hypothyroidism
What does a ‘red velvet halo’ surrounding the cervical os indicate on speculum examination?
Cervical ectropion
What is frank breech vs complete breech?
Frank = legs are fully extended
Complete = legs are flexed at the knee
What endometrial thickness raises suspicion of cancer?
Thickness >5mm
How do you calculate the EDD?
LMP + 7 days + 9 months
What is classed as an abnormal pH or lactate on foetal blood samples during labour?
Abnormal pH = 7.20 or below
Abnormal lactate = 4.9 or above
How are ectopic, miscarriage and TOP managed medically?
ECTOPIC = methotrexate
MISCARRIAGE + MTOP = mifepristone + misoprostol
When should cervical smears be done during pregnancy?
Delay until 3 months after birth / termination
What is the most common type of fibroid?
Intramural
What is placenta accreta vs increta vs percreta?
ACCRETA = mild - attachment to myometrium with no penetration
INCRETA = moderate - attachment into myometrium but does not invade all the way through
PERCRETA = severe - extends through entire myometrium
What can CMV infection during pregnancy cause in the newborn?
Hearing loss + learning difficulties
How should hypothyroidism be managed in pregnancy?
Increase levothyroxine by 25 mcg and check levels after 4 weeks
When should ECV be offered from?
37 weeks
What is the most common type of ovarian cyst?
Follicular cyst
When is anti-D administered in pregnancy?
28 and 34 weeks
How should PCOS patients take the COCP?
Induce a bleed every 3 months
What chemical is applied during colposcopy to help visualise abnormal cells?
Acetic acid
How should hyperthyroidism be managed in pregnancy?
1st trimester = propylthioyuracil
2nd/3rd = carbimazole
