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Gynecology > Past Papers > Flashcards

Past Papers Flashcards

1
Q

Which is the cause of increased incidence of multiple pregnancies in the last 25 years?

A

Change in the use of ovulation induction agents and assisted reproductive technologies

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2
Q

Minimum criteria for preeclampsia

A

Blood pressure is over 140/90 after 20 gw and proteinuria over 300 mg/24 hrs

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3
Q

When screening for gestational diabetes, average risk pregnant women should undergo OGTT?

A

At 24-28 gw. Blood glucose should be lower than 7,8 mmol/l 2 hours after ingesting a 75 g glucose

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4
Q

Which US examination is used to screen intrauterine growth retardation

A

3rd screening

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5
Q

Which hormone is responsible for milk ejection (letting down)?

A

Oxytocin

Production: prolactin

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6
Q

Causes of immediate postpartum hemorrhage

A
  • Retained placental tissue
  • Trauma to the genital tract
  • Coagulation defects
  • Uterine atony
    All are correct (4 T´s: tone, trauma, tissue, thrombin)
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7
Q

When there is uterine bleeding in the third trimester, to diagnose placental abruption, the first step is

A

To check with outer examinations whether there is a persistent uterine hypertonus

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8
Q

The most common type of anaesthesia in c-section is

A 
Spinal anesthesia
(Emergency: intratracheal, Vaginal: epidural)
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9
Q

Preterm delivery is when?

A

Before week 37 gw

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10
Q

Select the only one right anwer

A

In case of anti-TPO positivity the risk of having postpartum thyroiditis is about 40-50%

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11
Q

Pituitary hyperplasia of lactotroph cells is due to:

A

Estrogen

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12
Q

Progesterone functions and production

A
  • Inhibit lactation and uterine contraction

- Produced by ovaries and placenta

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13
Q

Indications of induced abortion

A

A) Social: up to week 12

B) Medical: up to week 20, or 24 if lab delay. Indications:

  • Fetal
  • Maternal
  • Feto-maternal
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14
Q

Methods of prenatal diagnosis

A

A) Invasive

  • Genetic amniocentesis (GAC)
  • Chorionic villus sampling (CVS)
  • Chordocentesis (percutan umbilical blood sampling - PUBS)

B) Non-invasive

  • US
  • Cell-free fetal DNA in maternal blood (NIPT)
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15
Q

Differential diagnosis vaginal bleeding in gw 30

A
  • Placental abruption: hard

- Placenta previa: soft

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16
Q

Presumptive signs of pregnancy

A

Nausea, vomit (can also be in men)

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17
Q

Probable pregnancy

A
  • Vulvar changes

- Pregnancy test etc

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18
Q

Definite pregnancy

A
  • US

- CTG

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19
Q

Stages of partution

A

Phase 0: uterine quiescence
Phase 1: Preparation of labour
Phase 2: the process of labor (1st, 2nd, 3rd)
Phase 3: recovery

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20
Q

Criteria for normal labour

A 
Spontaneous expulsion
Of a single (twins/triplets «not normal» labour)
Mature fetus (gw 37 - 42)
Presented by vertex
Through the birth canal
Within reasonable time (more than 3, less than 18 hours)
Without complications to the mother
Without complications to the fetus
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21
Q

3 P´s in progress of labour

A

Power: uterus (myometrium)
Passenger: fetus (head mostly)
Passage: pelvis of the mother

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22
Q

Stages of delivery

A

First stage:

  • Starts with onset of true labor contractions
  • Ends when cervix is fully dilated (10 cm)
  • Longest stage of labor

Second stage: birth

  • Begin with complete dilation of cervix
  • Ends with borth of baby
  • Duration between 60-90 minutes

Third stage: placental stage

  • Separation and expulsion of placenta and membranes
  • Duration between 5-30 minutes
  • Shortest stage of labour

Fourth stage: postplacental stage

  • First 2 hours of monitoring after expulsion of placenta
  • Increased risk for bleeding
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23
Q

Phases of cervical dilation - 2 phases

A
  • Latent phase: slow, first 3 cm (8 hrs at nulliparous, 3 hrs at multiparous), onset: regular contractions
  • Active phase: faster (stronger and more frequent contractions), from 3-10 cm, onset - protraction - arrest
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24
Q

Second stage: birth

A
  • Propulsive phase (full dilation - presenting part in pelvic floor)
  • Expulsive phase (delivery of fetus)
25
Q

Placental stage - phases + blood loss

A

Separation + Expulsion

Blood loss: 150 - 250 ml (average)

26
Q

Fetal lie

A
  • Longitudinal
  • Transverse
  • Oblique
27
Q

Fetal presentation

A
  • Vertex - 96,8 %
  • Breech
  • Transverse
  • Face, brow, shoulder etc.
28
Q

Fetal attitude or posture

A

Ovoid mass

29
Q

Fetal position

A

Left or right

30
Q

Fetal head bones compressed during delivery - is called:

A

Molding

31
Q

Naegele`s rule

A

Last day of last menstrual period - 3 months + 7 days + 1 year

32
Q

Best way to estimate due date

A

Crown-rump length by US

33
Q

Chadwick sign

A

Vaginal mucosa dark bluish or purplish-red and congested - normal in pregnancy

34
Q

Fetal movement

A

From week 18-20

35
Q

Obstetrical hemorrhage classification

A

1) Early
- If before gw 20 = miscarriage

2) Late
- Antepartum
- Intrapartum
- Postpartum

36
Q

Postpartum hemorrhage definition + causes

A

Loosing more than 500 ml after vaginal and over 1000 ml after c-section

4T`s: Tone, trauma, tissue, thrombin

37
Q

Techniques for inducing abortion before gw 6

A
  • Menstrual aspiration

- Medical abortion (mifeprisone+PG -or- methotrexate) - takes 2-3 days

38
Q

Techniques for inducing abortion before gw 12

A
  • Cervical dilatation (mechanical - Hegar-dilators, hygroscopic dilators - laminaria/dilapan, chemical - rivanol, PGs)
  • Evacuating pregnancy (vacuum aspiration, curettage)
39
Q

Techniques for inducing abortion before second trimester (gw 24)

A
  • Medical induction (extraamnial rivanol, laminaria, vaginal PG pill)
  • Oxytocin infusion
  • Curettage
40
Q

Screening for gestational diabetes

A
  • Part of screening program - check all pregnant
  • At time 0 min (lower than 5,6), 120 min (lower than 7,8) 5,6,7,8
  • 24-28 gw
  • 75 gram glucose
41
Q

Define preeclampsia

A

Original version: after 20 gw, hypertensive disorder (over 140/90) + proteinuria (300mg/24 hrs)

Need hypertension + something else (not necessary with proteinuria in new definition)

42
Q

4 T`s for postpartum hemorrhage

A
  • Tissue
  • Tone
  • Thrombin
  • Trauma
43
Q

Pregnant to emergency 30th gw and bleeding - DDx and what to do

A

First: good morning (no anamnesis) + CTG (fast)

DDx: Placenta previa vs placental abruption
How to check: First palpate uterus - outer examination/abdomen (if hard - abruption - surgery) (if normal - previa)

44
Q

Presumptive, probable, definite signs of pregnancy

A
  • Presumptive: signs we can have in pregnant, non-pregnant and men (nausea, vomiting)
  • Probable: in pregnant and non-pregnant (physical changes, pregnancy tests - can be tumor)
  • Definite sign: detecting fetus (US, CTG)
45
Q

Screenings

A

Five screenings

  • Type 0: detect pregnancy
  • Type 1: 11 gw +0 days - 13 gw+6 days, screen downs, malformations, detect pregnancy, size
  • Type 2: genetic
  • Type 3: IUGR
  • Type 4: 38 gw, position, size, estimated weight etc
46
Q

Stages of delivery

A
  • First stage: dilation cervix (9 or 11 hrs, multiparous: half)
  • Second: delivery of fetus (50-60 min, multi: half)
  • Third: delivery placenta (5-15 min, should not be longer than 30 min)
  • Fourth: artificial, 2 hrs observation
47
Q

Delivery starts when:

A
  • Regular contractions (every 10 min or more often)

- Rupture of membranes

48
Q

What is prevalence of preterm birth?

A

8-11 % (~1 / 10 births)

49
Q

What are those parameters that will form the perinatal mortality rate?

A

«The number of stillbirths and deaths in the first week of life per 1000 total births» (Perinatal: from gw 22 to 1 week (168 hrs) after birth)

50
Q

Problem at 1st stage of delivery

A

C-section

51
Q

Problems at 2nd stage of delivery

A

Vaccuum or forceps

52
Q

IUGR vs SGA

A

IUGR: Fetus is unable to reach its genetically potential size

SGA: Doesn`t have to be pathologically restricted

53
Q

Shortest stage of labor

A

3rd: Placental delivery

54
Q

Second stage of labor

A

Starts with complete cervical dilation - ends with birth

55
Q

HELLP

A

Hemolysis, Elevated Liver enzymes, Low Platelet count

56
Q

Which US screening checks nuchal translucency?

A

1st US (wk 11.0 - 13.6)?

57
Q

2nd Leopoldmaneuver

A

Hand on sides of abdomen

58
Q

Anesthesia for total placental abruption

A

Intratracheal (emergency)

Gynecology (4 decks)

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