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Y5 Gynae & Obstetrics > Past Papers > Flashcards

Past Papers Flashcards

1
Q

What investigations must you do for PCB

A 
Pregnancy test 
Triple swab (exclude STI)

ONLY do cervical smear if due / overdue for screen

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2
Q

When do you do cervical smear if presenting for PCB

A

ONLY if due /overdue for screen

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3
Q

How do you manage cervical ectropion at GP

A

should resolve spontaneously if stop COCP / following pregnancy

Review 10-12 weeks

if persistent refer to gynae

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4
Q

How do you manage PCB if normal cervix and negative infection screen

A

Review in 6 weeks - if still present, refer to gynae

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5
Q

what women do you do Kleinhauer’s test in after abdo trauma in pregnancy?

A

all women

as it indicates degree of foetomaternal haemorrhage

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6
Q

What ix can you do for abdo trauma

A

CTG (foetal wellbeing), TAUSS (abruption), Kleihauer

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7
Q

What is Grava and Para?

A 
Gravida = n times woman has been pregnant (regardless of outcomes) 
Para = n pregnancies that have reached gestation of 24 or more (dead or alive) -
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8
Q

what is a grand multipara

A

Given birth to 5 or more foetus beyond 24 weeks

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9
Q

what do you do if someone on colposcopy has CIN1

A

HPV swab in community in 12 months

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10
Q

What must you do from GP practice if adult woman comes in with FGM

A

Refer / self refer to gynae
Specialist needs to determine whether de-infib is indicated and if there are any complications of FGM

Also offer referral to:

  • psychological services
  • HIV, Hep B, C, sex health screen
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11
Q

WHEN WOULD YOU DO DE INFIB OF FGM

A

Only if appropriate

  • sx of complications
  • pregnant
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12
Q

what incidences do you need to do a cervical smear after a hysterectomy?

A
  • subtotal hysterectomy (as cervix is left)
  • no up to date smear > do vault smear 6m later
  • if prior positive CIN as reason for hysterectomy > do smear at 6m, 18m after operation
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13
Q

what signs do you see on USS for twins?

A

DCDA: lambda (thick membrane separating)
MC: T sign (thin membrane separating)

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14
Q

How do you diagnose PMS

A
  • symptom diary over 2 cycles

- GnRH analogues if symptom diary is inconclusive

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15
Q

What is the ratio of LH: FSH in PCOS

A

LH:FSH = 2:1

or even 3:1

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16
Q

what happens to protein level in urine in pregnancy

A

it doubles what is normal

so it is notmal to have 1+ on urine dip

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17
Q

How would you broadly change antiepileptics in woman planning to get pregnanct?

A

change valproate to carbamazepine / lamotrigine (which do not seem to affect neurodevelopment)

use lowest effective dose

give 5mg folic acid

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18
Q

what do you do if you suspect PTL in woman who is 30+

A

Cervical length on TVUSS

  • if >15, unlikely
  • if <15mm, likely

Use foetal fibronectin only if TVUSS not available

do not use both cervical length and foetal fibronectin for assessment

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19
Q

What must you do postnatally if on antiepileptic drugs during pregnancy

A

breastfeed to weane the baby off the drug

as small quantities will cross over to breastmilk

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20
Q

what medication should you give rtoutinely prior to a CS

A
  • PPI e.g. omeprazole to reduce gastric volume and acidity
  • metoclopramide
  • intrapartum antibiotics single dose (cefuroxime, metronidazole)
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21
Q

beyond what gestation is medical management recommended over expectant?

A

beyond 13 weeks

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22
Q

what are the two different types of endometrial cancer? explain

A

T1: ENDOMETRIOID

  • adenocarcinoma
  • arises from endometrial hyperplasia

T2: High grade SEROUS, CLEAR CELL
- arises from atrophic endometrium

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23
Q

which SSRI has increased risk of congenital malformation

A

Paroxetine

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24
Q

what’s the most useful test for PCOS

A

high free androgen index (testosterone/sex hormone binding globulin)

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25
Q

what else should you check for in PCOS dx

A

impaired glucose tolerance

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26
Q

HIV with undetectable viral load - what is contraind in labour?

A

Foetal bllood sampling

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27
Q

when can you insert IUS/IUD coil postpartum for it to be safe?

A

within 48h

or after 4 weeks

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28
Q

what contrac can you give immeditely after birth

A

LARC progesterone only

Coil

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29
Q

when can you give COCP after birth

A

6 wks pp even if breastfeedint

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30
Q

how is a brest abscess managed differently to mastitis

A

refer immediately to secondary care
they will drain abscess and culture the fluid (to guide antibiotic therapy)
keep breastfeeding from that breast / pump

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31
Q

can you vaccinate a pregnant woman with Hep B

A

YES - if she is in high risk category

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32
Q

what do you look for when checking for Hep B at booking

A

HBsAg

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33
Q

what treatment do you give pregnant women with HIV

A

start on antiretroviral treatment HAART (zivodudine monotherapy if HIV VL <10000)

or continue on what they are already on

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34
Q

How do you manage baby of HIV mother in terms of med

A

low risk: zivodudine

high risk: post exposure prophylaxis

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35
Q

WHO does the MDT care of a woman with HIV involve

A
  • HIV specialist
  • obstetrician
  • specialist midwife
  • pediatrician
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36
Q

what is the FIRST thing to do if someone comes in with stress incontinence as their management

A
  1. reverse any obvious cause
2. Lifestyle advice: reduce caffeine intake (improves sx) 
    Fluid intake (avoid excessive/reduced amounts) 
     Weight loss if BMI>30
  1. Pelvic floor exercises for 3 months
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37
Q

main VERY BAD complication of laparoscopy

A

perforation of bowel or bladder

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38
Q

what do you do if a couple wants to have a child but the man has azoospermia (due to tube blockage)

A

surgical sperm extraction

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39
Q

what are top 3 ABX for UTI in pregnancy

A

nitrofurantoin (NOT AT TERM)
Amoxicillin
Cefalexin

40
Q

When can you use methods of induction?

A

Only if not progressing appropriately!

41
Q

When must you NEVER give prostaglandin in labour?

A

if they are already contracting! because it can cause uterine hyperstimulation

42
Q

What are indications for giving a prostaglandin

A

stimulating cervical softening and effacement

43
Q

What stage of labour is an ARM appropriate for?

A

first stage of labour

44
Q

when is it appropriate to use oxytocin in labour

A

if waters are broken

but still not progressing

45
Q

what are the risks of meconium staining in labour

A

meconium aspiration syndrome in the foetus

46
Q

What is meconium aspiration syndrome

A

respiratory distress in the newborn due to the presence of meconium in the trachea

47
Q

What are RF for MAS

A

gestational age >42
foetal distress
oligohydramnios
chorioamnionitis

48
Q

What is a prolonged active second stage of labour

A

> 2h in primip
1h in multip

+ 1 hour if epidural

49
Q

What is prolonged active first stage of labour

A

<2cm per 4h

50
Q

What are contraindicaations for ventouse

A

<34 weeks
face/breech presentation
Foetal bleeding disorder
Maternal infection

51
Q

How must the baby be for using forceps in London

A

OA/OP

NOT rotated (otherwise use rotational forceps Kiellands)

52
Q

What are options for anaesthesia in labour?

A

LADDER

  1. Natural methods: positioning, breathing exercises, walk, sit on ball, hydrotherapy
  2. Simple anaestheria (paracetamol, codeine)
  3. Entonox
  4. Epidural
    - – if epidural contraindicated/declined: Pethidine or Patient Controlled Analgesia (using fentanyl)
53
Q

How do you manage an infant with MAS

A

transfer to NICU

suction airway
oxygen delivery
ventilatory support (CPAP)
antibiotics

54
Q

What are complications of meconium aspiration

A

pneumonia
persistent pulmonary HTN
HIE
pneumothorax

55
Q

What is the only type of induction of labour you can give to someone with a prior CS

A

Cook balloon

because it is mechanical induciton (rather than hormonal!)

56
Q

what do you give for active management of third stage labour?

A

Synctometrine (oxytocin + ergometrine, preferable)

Synctocynon alone (if ergometrine is contraindicated, e.g. asthmatic)

57
Q

if prior hx of PID, what contraception would you avoid?

A

coil

58
Q

when can you give the OCP post partum?

A

from d21 if not breastfeeding

from wk 6 if breastfeeding

59
Q

what is the law for contraception in <16 yo

A

Fraser law - SPECIFIC FOR CONTRACEPTION

gillick refers to everything else e.g. children decision to consent to treatment if capacity

60
Q

COCP increases risk of which cancers?

A

Cervical and breast

61
Q

what are the most important criteria when prescribing contraception

A

UKMEC

then NICE

62
Q

What can wet mount microscopy be used for

A

trichomoniasis

63
Q

what proprtion of PID cases are due to Gonorrhoea, CHlamydia

A

25-50%

64
Q

what ccommon STIs do you need to do a test of cure for?

A

CHlamydia - only if preg

gonorrhoea - all women

65
Q

support group for multiple birth

A

TAMBA - Twins and Multiple Birth Association

66
Q

what kind of pregnancy does TTTS occur in

A

MONOCHORIONIC ONLY

67
Q

summarise PET bloods

A

FBC, Renal profile, LFT (consider clotting and XM)

MC&S if proteinuria (to exclude proteinuria due to infection)

68
Q

Who and where is a 1st/2ns/3rd/4th degree tear repaired?

A

1st: no repair
2nd: by midwife
3rdd/4th: in operating theatre by experienced obstetrician

69
Q

what fluid replacement must you NEVER give in hyperemesis and why?

A

NEVER give DEXTROSE

because it can precipitate Wernicke’s

70
Q

Bishop score of EXACTLY QHAT indicates that IOL will likely fail?

A

Bishop score of 5 or less! including 5

71
Q

what women do you give LMWH in, and when?

A

4+ RF: from 1st trimeste r
3 RF: from 28 weeks
2 RF: 10 days post partum

if previous VTE - anticoag throughout pregnancy

72
Q

How long is contraception required for after menopause

A

2 years if <50

1 year if >50

73
Q

How do you follow up a molar pregnancy

A

2 weekly hcG until back to normal

then:
- if partial: repeat hCG after 4 weeks > if negative you can discharge
- if complete: repeat hCG monthly for 6 months

DO NOT GET PREGNANT for 6 months after - go on contraception - discuss with specialist

74
Q

What do you do in a. bipolar woman on lithium who becomes pregnant?

A

switch gradually to antipsychotic

75
Q

Risk factors for placenta accreta/increta/percreta

A
  • previous TOP, dilatation and curettage,
  • previous Caesarean section
  • advanced maternal age
  • placenta praevia
  • uterine structural defects (absent or abnormal areas of decidualised endometrium).
76
Q

why is polyhydramnios linked to cord prolapse?

A

because excess amniotic fluid prevents engagement oif the head

77
Q

when and why must you NEVER perform a vaginal exam in GP in a young woman with PV bleed?

A

If there abdominal tenderness - i.e. suspecting an ectopic - do NOT do vaginal exam in GP

Because of RISK that internal palpation causes rupture of ectopic

78
Q

presentation of cervical endometriosis

A

blue dots on cervix

79
Q

what can you give to delay period

A

norethisterone (progesterone)

from 3 days prior to excpected menses

80
Q

what are contraindications and risks of prescribing norethisterone

A

it can cause a VTE

contraindications are same as HRT/COCP

81
Q

murmur in aortic stenosis - describe what you hear

A

ejection systolic murmur

at upper RIGHT sternal edge

82
Q

how long does a pregnancy test remain positive for after termination

A

4 weeks max

83
Q

How do you investigate sickle cell disease

A

blood film - shows sickled cells and target cells
sickle solubility test
electrophoresis

84
Q

what do you use Neville Barnes forceps?

A 
FORCEPS:
 Fully dilated, 
Occipito-anterior position, 
Ruptured membranes,
Cephalic presentation, 
Engaged presenting part, adequate Pain relief, 
Sphincter (empty bladder).
85
Q

What can you use to rotate a baby in instrumental delivery?

A

a metal cup ventouse

86
Q

How do you treat ITP in pregnancy?

A

steroids > IVIG

87
Q

what do the anterior vs posterior fontanelles feel like on vaginal exam?

A

anterior: diamond shaped
posterior: Y shaped

88
Q

what is AFLP in terms of urgency?

A

An OBSTETRIC EMERGENCY - delivery usually needs to occur within 24hours

89
Q

How do patients with AFLP present?

A

in THIRD trimester
non-specific liver symptoms: nausea, vomiting, abdominal pain, malaise, headache, and/or anorexia

+ symptoms of acute liver failure: jaundice, ascites, encephalopathy, disseminated intravascular coagulopathy, and hypoglycemia rapidly develop.

90
Q

Ix for AFLP

A

bilirubin - high
LFT- high
PT- prolonged

cholesterol - low
proteinuria

91
Q

differentials for ALFP

A

HELLP
PET

+ non-pregnancy conditions (viral hepatitis, gallstones etc)

92
Q

what blood tests specific for hormones should you always get for a premenopausal woman with an ovarian cyst

A

CA125 (although unreliable)

to exclude germ cell tumour: AFP, bhCg, alphaFP

93
Q

what is the boundary for Ca125 that requires referral to gynae

A

> 200

94
Q

what do you calll herniation of the bladder into the vagina

A

cystocele

95
Q

what are LH and FSH llevels like in PCOS

A

LH RAISED

FSH normal

Y5 Gynae & Obstetrics (34 decks)

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