Past Papers Flashcards
What investigations must you do for PCB
Pregnancy test Triple swab (exclude STI)
ONLY do cervical smear if due / overdue for screen
When do you do cervical smear if presenting for PCB
ONLY if due /overdue for screen
How do you manage cervical ectropion at GP
should resolve spontaneously if stop COCP / following pregnancy
Review 10-12 weeks
if persistent refer to gynae
How do you manage PCB if normal cervix and negative infection screen
Review in 6 weeks - if still present, refer to gynae
what women do you do Kleinhauer’s test in after abdo trauma in pregnancy?
all women
as it indicates degree of foetomaternal haemorrhage
What ix can you do for abdo trauma
CTG (foetal wellbeing), TAUSS (abruption), Kleihauer
What is Grava and Para?
Gravida = n times woman has been pregnant (regardless of outcomes) Para = n pregnancies that have reached gestation of 24 or more (dead or alive) -
what is a grand multipara
Given birth to 5 or more foetus beyond 24 weeks
what do you do if someone on colposcopy has CIN1
HPV swab in community in 12 months
What must you do from GP practice if adult woman comes in with FGM
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
WHEN WOULD YOU DO DE INFIB OF FGM
Only if appropriate
- sx of complications
- pregnant
what incidences do you need to do a cervical smear after a hysterectomy?
- 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
what signs do you see on USS for twins?
DCDA: lambda (thick membrane separating)
MC: T sign (thin membrane separating)
How do you diagnose PMS
- symptom diary over 2 cycles
- GnRH analogues if symptom diary is inconclusive
What is the ratio of LH: FSH in PCOS
LH:FSH = 2:1
or even 3:1
what happens to protein level in urine in pregnancy
it doubles what is normal
so it is notmal to have 1+ on urine dip
How would you broadly change antiepileptics in woman planning to get pregnanct?
change valproate to carbamazepine / lamotrigine (which do not seem to affect neurodevelopment)
use lowest effective dose
give 5mg folic acid
what do you do if you suspect PTL in woman who is 30+
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
What must you do postnatally if on antiepileptic drugs during pregnancy
breastfeed to weane the baby off the drug
as small quantities will cross over to breastmilk
what medication should you give rtoutinely prior to a CS
- PPI e.g. omeprazole to reduce gastric volume and acidity
- metoclopramide
- intrapartum antibiotics single dose (cefuroxime, metronidazole)
beyond what gestation is medical management recommended over expectant?
beyond 13 weeks
what are the two different types of endometrial cancer? explain
T1: ENDOMETRIOID
- adenocarcinoma
- arises from endometrial hyperplasia
T2: High grade SEROUS, CLEAR CELL
- arises from atrophic endometrium
which SSRI has increased risk of congenital malformation
Paroxetine
what’s the most useful test for PCOS
high free androgen index (testosterone/sex hormone binding globulin)
what else should you check for in PCOS dx
impaired glucose tolerance
HIV with undetectable viral load - what is contraind in labour?
Foetal bllood sampling
when can you insert IUS/IUD coil postpartum for it to be safe?
within 48h
or after 4 weeks
what contrac can you give immeditely after birth
LARC progesterone only
Coil
when can you give COCP after birth
6 wks pp even if breastfeedint
how is a brest abscess managed differently to mastitis
refer immediately to secondary care
they will drain abscess and culture the fluid (to guide antibiotic therapy)
keep breastfeeding from that breast / pump
can you vaccinate a pregnant woman with Hep B
YES - if she is in high risk category
what do you look for when checking for Hep B at booking
HBsAg
what treatment do you give pregnant women with HIV
start on antiretroviral treatment HAART (zivodudine monotherapy if HIV VL <10000)
or continue on what they are already on
How do you manage baby of HIV mother in terms of med
low risk: zivodudine
high risk: post exposure prophylaxis
WHO does the MDT care of a woman with HIV involve
- HIV specialist
- obstetrician
- specialist midwife
- pediatrician
what is the FIRST thing to do if someone comes in with stress incontinence as their management
- reverse any obvious cause
2. Lifestyle advice: reduce caffeine intake (improves sx)
Fluid intake (avoid excessive/reduced amounts)
Weight loss if BMI>30
- Pelvic floor exercises for 3 months
main VERY BAD complication of laparoscopy
perforation of bowel or bladder
what do you do if a couple wants to have a child but the man has azoospermia (due to tube blockage)
surgical sperm extraction
what are top 3 ABX for UTI in pregnancy
nitrofurantoin (NOT AT TERM)
Amoxicillin
Cefalexin
When can you use methods of induction?
Only if not progressing appropriately!
When must you NEVER give prostaglandin in labour?
if they are already contracting! because it can cause uterine hyperstimulation
What are indications for giving a prostaglandin
stimulating cervical softening and effacement
What stage of labour is an ARM appropriate for?
first stage of labour
when is it appropriate to use oxytocin in labour
if waters are broken
but still not progressing
what are the risks of meconium staining in labour
meconium aspiration syndrome in the foetus
What is meconium aspiration syndrome
respiratory distress in the newborn due to the presence of meconium in the trachea
What are RF for MAS
gestational age >42
foetal distress
oligohydramnios
chorioamnionitis
What is a prolonged active second stage of labour
> 2h in primip
1h in multip
+ 1 hour if epidural
What is prolonged active first stage of labour
<2cm per 4h
What are contraindicaations for ventouse
<34 weeks
face/breech presentation
Foetal bleeding disorder
Maternal infection
How must the baby be for using forceps in London
OA/OP
NOT rotated (otherwise use rotational forceps Kiellands)
What are options for anaesthesia in labour?
LADDER
- Natural methods: positioning, breathing exercises, walk, sit on ball, hydrotherapy
- Simple anaestheria (paracetamol, codeine)
- Entonox
- Epidural
- – if epidural contraindicated/declined: Pethidine or Patient Controlled Analgesia (using fentanyl)
How do you manage an infant with MAS
transfer to NICU
suction airway
oxygen delivery
ventilatory support (CPAP)
antibiotics
What are complications of meconium aspiration
pneumonia
persistent pulmonary HTN
HIE
pneumothorax
What is the only type of induction of labour you can give to someone with a prior CS
Cook balloon
because it is mechanical induciton (rather than hormonal!)
what do you give for active management of third stage labour?
Synctometrine (oxytocin + ergometrine, preferable)
Synctocynon alone (if ergometrine is contraindicated, e.g. asthmatic)
if prior hx of PID, what contraception would you avoid?
coil
when can you give the OCP post partum?
from d21 if not breastfeeding
from wk 6 if breastfeeding
what is the law for contraception in <16 yo
Fraser law - SPECIFIC FOR CONTRACEPTION
gillick refers to everything else e.g. children decision to consent to treatment if capacity
COCP increases risk of which cancers?
Cervical and breast
what are the most important criteria when prescribing contraception
UKMEC
then NICE
What can wet mount microscopy be used for
trichomoniasis
what proprtion of PID cases are due to Gonorrhoea, CHlamydia
25-50%
what ccommon STIs do you need to do a test of cure for?
CHlamydia - only if preg
gonorrhoea - all women
support group for multiple birth
TAMBA - Twins and Multiple Birth Association
what kind of pregnancy does TTTS occur in
MONOCHORIONIC ONLY
summarise PET bloods
FBC, Renal profile, LFT (consider clotting and XM)
MC&S if proteinuria (to exclude proteinuria due to infection)
Who and where is a 1st/2ns/3rd/4th degree tear repaired?
1st: no repair
2nd: by midwife
3rdd/4th: in operating theatre by experienced obstetrician
what fluid replacement must you NEVER give in hyperemesis and why?
NEVER give DEXTROSE
because it can precipitate Wernicke’s
Bishop score of EXACTLY QHAT indicates that IOL will likely fail?
Bishop score of 5 or less! including 5
what women do you give LMWH in, and when?
4+ RF: from 1st trimeste r
3 RF: from 28 weeks
2 RF: 10 days post partum
if previous VTE - anticoag throughout pregnancy
How long is contraception required for after menopause
2 years if <50
1 year if >50
How do you follow up a molar pregnancy
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
What do you do in a. bipolar woman on lithium who becomes pregnant?
switch gradually to antipsychotic
Risk factors for placenta accreta/increta/percreta
- previous TOP, dilatation and curettage,
- previous Caesarean section
- advanced maternal age
- placenta praevia
- uterine structural defects (absent or abnormal areas of decidualised endometrium).
why is polyhydramnios linked to cord prolapse?
because excess amniotic fluid prevents engagement oif the head
when and why must you NEVER perform a vaginal exam in GP in a young woman with PV bleed?
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
presentation of cervical endometriosis
blue dots on cervix
what can you give to delay period
norethisterone (progesterone)
from 3 days prior to excpected menses
what are contraindications and risks of prescribing norethisterone
it can cause a VTE
contraindications are same as HRT/COCP
murmur in aortic stenosis - describe what you hear
ejection systolic murmur
at upper RIGHT sternal edge
how long does a pregnancy test remain positive for after termination
4 weeks max
How do you investigate sickle cell disease
blood film - shows sickled cells and target cells
sickle solubility test
electrophoresis
what do you use Neville Barnes forceps?
FORCEPS: Fully dilated, Occipito-anterior position, Ruptured membranes, Cephalic presentation, Engaged presenting part, adequate Pain relief, Sphincter (empty bladder).
What can you use to rotate a baby in instrumental delivery?
a metal cup ventouse
How do you treat ITP in pregnancy?
steroids > IVIG
what do the anterior vs posterior fontanelles feel like on vaginal exam?
anterior: diamond shaped
posterior: Y shaped
what is AFLP in terms of urgency?
An OBSTETRIC EMERGENCY - delivery usually needs to occur within 24hours
How do patients with AFLP present?
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.
Ix for AFLP
bilirubin - high
LFT- high
PT- prolonged
cholesterol - low
proteinuria
differentials for ALFP
HELLP
PET
+ non-pregnancy conditions (viral hepatitis, gallstones etc)
what blood tests specific for hormones should you always get for a premenopausal woman with an ovarian cyst
CA125 (although unreliable)
to exclude germ cell tumour: AFP, bhCg, alphaFP
what is the boundary for Ca125 that requires referral to gynae
> 200
what do you calll herniation of the bladder into the vagina
cystocele
what are LH and FSH llevels like in PCOS
LH RAISED
FSH normal
