Passmedicine Flashcards
Which chemotherapy drug increases the risk of which type of gynae cancer?
Tamoxifen increases the risk of endometrial cancer
Most common cause of post-coital bleeding
Cervical ectropion
Risks of hysterectomy surgery with antero-posterior repair
Enterocele and vaginal vault prolapse
What is Meigs syndrome?
OAP
Ovarian tumour (benign)
Ascites
Pleural effusion
-usually occurs in those over age 40
One of your patients has endometrial hyperplasia, which medication is associated with the development of this condition?
Tamoxifen
What is premature menopause?
Menopause that occurs in a woman below the age of 40
The most common type of ovarian epithelial tumour
Serous cystadenoma
If this ovarian tumour ruptures, it may cause pseudomyxoma peritonei
Mucinous cystadenoma
What inhibits FSH and LH?
Oestrogen
Which LFT might be raised in pregnancy?
ALP (because of placental ALP)
What might raise your CA-125?
Ovarian cancer
Endometriosis
Pelvic inflammatory disease
Raised at certain points of menstrual cycle
In terms of the bishop score, what level is 0 for fetal station
0 = level of ischial spines
When are people with rubella contagious?
From 7 days before rash, to 4 days after rash
What is port-partum haemorrhage?
A loss of 500mls or more
What is primary post-partum haemorrhage?
Haemorrhage that occurs within 24 hours
What is secondary post-partum haemorrhage?
Haemorrhage that occurs between 24 hours and 12 weeks
Most common cause or primary post-partum haemorrhage?
Uterine atony
Which antibiotic would you give a breastfeeding woman with a UTI?
Trimethoprim
When would you offer external cepahlic version? (ECV)
At 36 weeks
What might cause a macrocytic anaemia?
B12 or folate deficiency
What is the Kleihauer test?
Used to measure the amount of fetal RBCs present in the maternal circulation
When are oxytocin and vaginal prostaglandin contraindicated?
In foetal distress
Treatment for baby affected in rhesus
Transfusions, UV phototherapy
Why might you be more likely to have placenta praevia?
Caesarian sections, multiparity
Invesitgation if you suspect placenta praevia
Ultrasound
Management of placenta praevia with bleeding
Admit, treat shock, cross match
Caesarean section for grades III/IV
Vaginal delivery for grade I
First line treatment for gestational hypertension
Oral labetalol
When can gestational hypertension be diagnosed?
From 20 weeks
Which anti-epileptic medication can be used during pregnancy?
Lamotrigine
The combined test
HCG and PAPP-A
The triple test
HCG, AFP and oestriol
Low and raised AFP
Raised AFP - neural tube defects
Low AFP - Down syndrome
How often should fetal heart rate be checked in labour
Every 15 minutes
How often should contractions be assessed in labour
Every 30 minutes
How often should maternal pulse be checked during labour?
Every 60 minutes
How often should maternal BP and temp be checked during labour?
Every 4 hours
How often should maternal urine be checked during labour?
Every 4 hours (check for ketones and protein)
How often should vaginal exam be performed during labour?
Should be offered every 4 hours to check for progression of labour
Antibiotic of choice for premature rupture of membranes
Erythromycin
Say a patient had PROM and a swab should group B strep, what antibiotics would you give?
Penicillin and clindamycin
A mother has hep B, what should you give her baby?
Should be given a complete course of vaccination and hep B immunoglobulin
Which women are screened for hep B?
All women
Is it safe for a woman with hep B to breastfeed her baby?
yes
Can hep B or HIV be transmitted during breast feeding?
Hep b - no
HIV - yes (avoid even if taking anti-virals as still risk of transmission)
A 19 year old woman presents with a 2 day history of central lower abdominal pain and one day history of vaginal bleeding. Her last period was 8 weeks ago. On examination her cervix is tender to touch
Ectopic preganancy
Which procedure commonly predisposes to Asherman’s syndrome?
Dilatation and curettage
Initial definitive management for cord prolapse?
Place hand into vagina to elevate the presenting part
How might cord prolapse present?
Variable decelerations
When do the majority of cord prolapses occur?
At artificial rupture of the membranes
Most common explanation for short episodes (<40 minutes) of decreased variability on CTG?
Baby is sleeping
start to worry if decelerations last longer than 40 minutes
A pregnant lady comes into contact with someone with chicken pox, what should you do?
1) ask her if she has ever had chicken pox
2) if she doesn’t know, then check her antibodies
3) if she isn’t immune then give her varicella immunoglobulin (within 10 days of exposure)
Risk factors for uterine atony?
Multiple pregnancy
Induction of labour
When are women screened for anaemia?
At booking visit (done at 8-10 weeks)
and at 28 weeks
What normally happens to blood pressure during pregnancy?
Falls in first half of pregnancy before rising to pre-pregnancy levels before term
Diagnostic criteria for hyperemesis gravidarum?
5% pre-pregnancy weight loss AND dehydration AND electrolyte imbalance
What is the direct Coombs test?
Investigation used to look for autoimmune haemolytic anaemia
What is the indirect Coombs test?
Investigation used antenatally to detect antibodies in the maternal blood that can cross the placenta and result in haemolytic disease of the newborn
How much folate should an epileptic planning to get pregnant take?
5mg per day
A hepatitis B serology positive woman gives birth to a healthy baby girl. The mother is surface antigen positive. What treatment should be given to the baby?
Hap B vaccine and 0.5 millilitres of HBIG within 12 hours of birth, with a further vaccine at 1-2 months and a further vaccine at 6 months
Deficiency of which vitamin causes Wernickes encephalopathy?
Vitamin B1
Budd-chiari triad
Ascites
Liver enlargement
Abdominal pain
Where is hCG secreted from?
Secreted by syncytiotrophoblasts
What does HCG do?
Maintains the production of progesterone by the corpus luteum
(basically stops the corpus luteum from breaking down)
When can HCG be detected in the maternal blood stream?
Can be detected in the maternal blood as early as 8 days after conception
What happens to HCG levels during pregnancy?
hCG levels double approximately every 48 hours in the first few weeks of pregnancy. Levels peak at around 8-10 weeks gestation. Measurement of hCG levels form the basis of many pregnancy testing kits
Active management of the third stage of labour involves what?
Uterotonic drugs
Deferred clamping and cutting of cord, over 1 minute after delivery but less then 5 minutes
Controlled cord traction after signs of placental separation
(also give oxytocin to reduce risk of post-partum haemorrhage)
What is HELLP syndrome?
A severe form of pre-eclampsia
When is the anomaly scan performed?
18-20+ 6 weeks
Which diabetes medication is safe during breastfeeding?
Metformin
What is lochia?
Vaginal discharge containing blood, mucous and uterine tissue, which may continue for 6 weeks after childbirth
What should you give a pregnant lady with Factor V Leiden?
Low molecular weight heparin (LMWH) antenatally AND for 6 weeks postpartum
(i.e. during and after pregnancy)
