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Ob/gyn > Pastest > Flashcards

Pastest Flashcards

1
Q

When is hyperemesis worst?

A

Between 8 and 12 weeks, although it can persist

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2
Q

What is the triad of symptoms required to diagnose hyperemesis gravidarum?

A

1) Loss of 5% pre-pregnancy weight
2) dehydration
3) electrolyte imbalance (ketones often present)

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3
Q

Management of hyperemesis

A

1) Anti-histamine e.g. promethiazine
2) anti-emetic such as ondansetron/ metoclopramide
3) Admission

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4
Q

What level is a ‘raised’ CA125?

A

> 35 IU/ml

ovarian cancer + endometriosis, menstruation, ovarian cyst etc

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5
Q

Lamotrigine is a good in pregnancy

A

Remember that trimethoprim is CI in the first trimester as it is a folate antagonist

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6
Q

How does acute fatty liver of pregnancy present?

A 
Abdo pain
Jaundice
Mild pyrexia
Raised LFT
Steatosis on imaging 
Presents after 30 weeks

Supportive management - beware clotting

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7
Q

How does cholestasis of pregnancy present?

A

Pruritis - hands and soles in second half of pregnancy

Manage with ursodeoxycolic acid

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8
Q

What drug are women at high risk of pre-eclampsia advised to take?

A

Aspiring from week 12 to birth

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9
Q

What is the target HbA1c for women planning a pregnancy?

A

<48 mmol/ mol

remember metformin and insulin are ok

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10
Q

How is the contraceptive patch taken?

A

Water patch for 1 week, then change x 3

For week 4 wear no patch

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11
Q

Managment of a lady who is pregnant and has been exposed to a child with chickenpox. She has never had chickenpox

A

Refer for varicella zoster immunoglobulin

Only effective if given up to 10 days post-exposure

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12
Q

What is the commonest complication of surgical TOP?

A

Infection - the risk is up to 10%

Prophylaxis is given e.g. metronidazole before and azithromycin after

Other complications such as haemorrhage, retained products, failure and cervical damage occur less often

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13
Q

Management of pregnant lady who has had a previous VTE

A

High risk for VTE in pregnancy

Needs LMWH antenatally for the duration of pregnancy and 6 weeks post-partum

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14
Q

If a patch change is delayed for >48 hours what should you advice?

A

Barrier contraception for next 7 days

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15
Q

What is first line for painful periods?

A

NSAIDs such as ibuprofen or mefenamic acid

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16
Q

What is the first line management of shoulder dystopia?

A

McRobert manoeuvre

Get mum to flex and abduct hips maximally to maximise pelvic outlet

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17
Q

A pregnant lady is invited for her smear. All previous smears have been normal. What should be advised?

A

Reschedule smear for at least 12 weeks post-partum

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18
Q

Management of a breech presentation

A

If < 36 weeks, many will turn spontaneously
Breech at 36 weeks = external cephalon version (turn it round)
Unsuccessful = planned section (preferred) or vaginal birth

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19
Q

What is the management of thrush in pregnancy?

A

Clotrimazole pregnancy

Oral fluconazole is CI in pregnancy

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20
Q

Define HT in pregnancy?

A

Systolic >140 or diastolic >90

OR

Increase of >30 systolic or 15 diastolic from booking

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21
Q

What is the normal fetal HR?

A

100-160 bpm

Loss of baseline variability and late deceleration are bad signs

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22
Q

Management of a pregnant lady with +ve GBS swab?

A

IV benzylpencillin during labour
There is no advantage in treating before labour

(same for women with previous group B strep in pregnancy)

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23
Q

What is the commonest ovarian cyst?

A 
Follicular cyst
(due to non-rupture of dominant follicle or non-atresia of non-dominant)
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24
Q

What is the commonest benign epithelial tumour?

A

Serous cystadenoma

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25
Q

The forceps mnemonic can be used to remember the requirements for an instrumental delivery

A 
F = fully dilated
O = OA position
R = ruptured membranes
C = cepheid Presentation
E = engaged presenting part
P = pain relief 
S = sphincter (bladder) empty
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26
Q

What is gold standard investigation for endometriosis?

A

Laparoscopy

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27
Q

Membrane rupture + vaginal bleeding + fetal bradycardia

A

Most likely placenta/ vasa praevia

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28
Q

What is the main complication of monochorionic twins?

A

The risk of twin to twin transfusion syndrome - one is overloaded, one is anaemia

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29
Q

After treatment for CIN II, patients should have repeat colposcopy in 6 months

A

After treatment for CIN II, patients should have repeat colposcopy in 6 months

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30
Q

First line management in patients with stress incontinence?

A

Pelvic floor exercise

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31
Q

Atony is the major risk factor for PPH. How is it managed?

A

ABCDE
Uterine massage is first line
Then pharmacological e.g. Syntocinon or IV ergometrine

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32
Q

Pre-eclampsia and gestational DM can only occur after 20 weeks gestation

A

Prior to that, HT is longstanding

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33
Q

Which screening tool is used to identify post-natal depression?

A

Edinburgh screening tool

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34
Q

How does metformin work in PCOS?

A

It increases the peripheral insulin sensitivity

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35
Q

Who should be prescribed cyclical combined HRT?

A

Women with a uterus and menopausal symptoms who had their LMP <1 year ago

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36
Q

Who should be prescribed continuous HRT?

A

Women with a uterus who have been on cyclical for 1 year or if it has been >1 year since LMP

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37
Q

What are the components of the Bisphops score?

A 
Cervcical dilatation
Position
Consistency
Effacement 
Fetal station

A score <5/6 = labour unlikely to start spontaneously
A score > 9 = spontaneous labour likely

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38
Q

If the cord is palpable vaginally in labour what should you do?

A

Call the obstetrics reg

Elevate the presenting part or push the presenting part back in (if it is out) to avoid compression

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39
Q

What is the most common identifiable cause of postcoital bleeding?

A

Cervical ectropion

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40
Q

What is the smear test policy in HIV +ve patients?

A

Attended for smear every year (rather than the 3 years) which is typical

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41
Q

What is a high voiding pressure and low peak flow rate suggestive of?

A

Bladder outlet obstruction

Presents with straining, poor flow and incomplete bladder emptying

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42
Q

What is a tocolytic? Give an example

A

Drugs which delay onset of labour in lady who beings labour prematurely
E.g. Terbutaline or nifidepine

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43
Q

What are the fetal and maternal risks of PROM?

A 
Fetal = prematurity, infection, pulmonary hyperplasia
Maternal = chorioamnionitis

Admit and give steroids (if beyond 24 weeks) and antibiotics (erythromycin)

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44
Q

What is the commonest cause of early onset severe infection in a newborn?

A

Group B strep

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45
Q

What is Sheehan’s syndrome?

A

A complication of a severe PPH - the pituitary undergoes ischaemia —> presents as hypopituitarism

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46
Q

Which serotypes of HPV are most associated with cervical cancer?

A

16, 18 and 33

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47
Q

Placenta praevia occurs when the placenta is attached to the lower part of the uterus. It presents with painless PV bleeding. What are the RF?

A

Previous placenta praevia
Previous LSCS
Multiple pregnancies

Remember the lie is often unusual due to the placenta location

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48
Q

What is the fetal fibronectin test?

A

A test to assess if a lady is in premature labour
If not the fetal fibronectin will be -ve

It is kind of like a glue which is in the membranes

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49
Q

What are the 4 classifications of perineal tear?

A 
1 = superficial only
2 = involves the perineal muscles but not anal sphincters
3 = perineal muscle and anal sphincter involved
4 = perineal muscles, anal sphincter and rectal mucosa involved
50
Q

What is the cut off age to be able to consent for sex?

A

Regardless of competency, no child under 13 can consent - it is a child protection issue

51
Q

What is the difference between tranexamic acid and mefenamic acid?

A

Tranexamic = plasminogen activator which acts as an anti-fibrinolytic to reduce heavy flow

Mefenamic acid = an NSAID

52
Q

Uterine fibroids are sensitive to oestrogen so can grow in pregnancy. If they outgrow their blood supply, red degeneration can occur. How does this present?

A

Abdo pain
Fever
Vomiting

Usually resolves ok with rest and analgesia

53
Q

Breast feeding and <6 weeks post-partum is a UKMEC 4 for using OCP

A

Migraine with no aura, BMI >35 and FH of VTE in 1st degree relative aged <45 is UKMEC 3

54
Q

What medication could be given to relieve symptoms of fibroids prior to surgery?

A

GnRH agonists e.g. buserelin or goserelin

55
Q

Women under the age of 50 require contraception at least 2 years after their LMP

A

For those >50, they need contraception for at 1 year after their LMP

56
Q

Beta HCG is very similar in structure to LH, FSH and TSH.

A

Women with a molar pregnancy often have high thyroxine (as stimulated by bHCG) and low TSH (-ve feedback)

57
Q

Action in a 16 y/o child with FGM?

A

Inform medical team and police ASAP

58
Q

What is the normal endometrial thickness in a post-menopausal lady?

A

<4mm

59
Q

Diagnostic criteria for PCOS?

A

At least 2/3 of:

1) Infrequent or absent periods
2) Evidence of androgen excess
3) Polycytic ovaries

60
Q

Vaginal discharge after being treated for UTI?

A

Most commonly fungal infection due to recent antibiotics

61
Q

Define perpetual pyrexia

A

A temperature >38 in the first 14 days following delivery

Most common causes are endometriosis, UTI, wound infection and VTE

If endometritis is suspected, she should be sent to hospital for IV fluids

62
Q

Nexplanon is effective immediately with no need for condoms if fitted…

A

Within the first 5 days of you cycle

63
Q

It is safe for mothers with Hep B to breastfeed. What is the risk of transmission for a Hep B +ve mum?

A

20%

If they gave the Hep B e antigen this increases to 90%

64
Q

How do you describe head position of the presenting part?

A

1) Remember the symphysis pubis is anterior and the coccyx is posterior
2) talk in terms of the occipital bone (single bit at the back)

65
Q

Features of combined test for DS?

A

AT 10 - 13+ 6 weeks
Nuchal thickness + BHCG + PAPPA

BHCG = high in DS
PAPPA = low in DS
66
Q

Features of quadruple assessment in DS

A

Done between 14 and 20 weeks
BHCG and inhibin = high
AFP and oestrodiol = low

67
Q

Other than DS, what other causes of increased nuchal thickness are there?

A

CHD

CDH

68
Q

Lady with sudden onset SOB and collapse after rupture of membrane?

A

Think amniotic fluid embolism

69
Q

Rokitansky protuberance?

A

Dermoid cyst

70
Q

Smear frequency for ladies aged 50 or over?

A

From 50-64 = every 5 years!

71
Q

Briefly talk about the staging of ovarian cancer

A

Stage 1 = confined to ovary
Stage 2 = outisde ovary but within pelvis
Stage 3= outside ovary but within abdomen
Stage 4 = distant mets

72
Q

75% of women with endometrial cancer present with stage 1 disease

A

Treatment is usually a TAHBL

73
Q

Remember that although chorioamnionitis is more common with ruptured membranes, it can happen without - especially with mycoplasma genital infection

A

Septic miscarriages make people really unwell with crampy pain and heavy, prolonged bleeding

74
Q

What is the early point that a lady would need emergency contraception post-partum?

A

21 days

Ovulation can begin at 28 days and sperm can survive for 7 days

75
Q

What if first line for anovulatory infertility from PCOS? What is the major risk?

A

Clomifene - it is an oestrogen blocker which increase LH/ FSH release due to lack of negative feedback
6 month treatment - it increases multiple pregnancy risk to 11%

76
Q

First line treatment for endometriosis in a lady who does not want to conceive?

A

COCP

Endometriosis is worsened by oestrogen, COCP blocks ovulation -> symptoms improve

77
Q

A family history of a mother who developed pre-eclampsia =

A

Moderate risk —> take aspirin

78
Q

How long after insertion will the IUD and IUS become effective?

A 
IUD = immediately (whenever inserted)
IUS = 7 days (if inserted out with first 5 days)
79
Q

What normally happens to blood pressure in pregnancy?

A

Falls in the first half of pregnancy then rises to pre-pregnancy level before term

80
Q

Advice for a patient on the COP having elective surgery?

A

Stop pill 4 weeks before and start 2 weeks after

81
Q

The POP primarily inhibits ovulation, but also thickens cervical mucus

A

The IUD inhibits fertilisation as is toxic to egg and sperm

82
Q

What clinical features suggest IUGR?

A

SFH < expected
Reduced liquor
Reduced movement

83
Q

When is fetal movement normally felt?

A

From about 18 to 20 weeks

84
Q

How is fetal growth monitored?

A

By measuring head and abdominal circumference and plotting on graph

85
Q

Define loss of baseline variability of CTG?

A

Baseline fetal heart rate varying by <5beats/ minute

86
Q

What 3 Doppler measurements are done to assess fetal wellbeing?

A

1) Umbilical flow (2 arteries, 1 vein)
2) Middle cerebral artery (increased flow is a bad sign)
3) Ductus venosus

87
Q

3 risk factors for placental abruption?

A

Maternal trauma
Multiparity
Increased maternal age

88
Q

What is the primary mode of action of the implant?

A

Inhibits ovulation

also COC and injection

89
Q

Rules for POP and antibiotics?

A

No need for extra precautions

90
Q

What is the most common side effect of the IUS?

A

Irregular bleeding for the first 6 months

91
Q

List some indications for anti-d prophylaxis?

A

1) PV bleeding in pregnancy/ trauma
2) Miscarriage after 12 weeks
3) Ectopic pregnancy managed surgically
4) External cephalic version
5) TOP
6) Amniocentesis

92
Q

What is the Kleihauer test?

A

A test of fetomaternal haemorrhage e.g. how many baby cells are in the mum
Should be performed after any sensitising event after 20 weeks gestation

93
Q

What is the most common type of ovarian cancer?

A

Serous carcinoma (a type of epithelial cancer which accounts for 70-80% of all cancer)

The primary treatment for stage 2,3 and 4 is surgical excision of the tumour (with or without chemo)

94
Q

Lady with hyperemesis gravidarum, diplopia and ataxia?

A

She has developed Wernicke’s encephalopathy due to thiamine (vit B1) deficiency

95
Q

Define premature ovarian failure

A

The onset of menopausal symptoms + elevated gonadotropin before the age of 40

96
Q

Which is the only form of contraception that has no restriction for use in migraine with aura?

A

IUD

97
Q

Why are perimenopausal women given cyclincal HRT?

A

It produces predictable withdrawl bleeds - continuous causes very unpredictable bleeding

98
Q

OCP + surgery rules?

A

Stop 4 weeks before
Can switch to POP if desired
Only restart OCP after mobilisation

99
Q

HIV and pregnancy?

A

All women should be on ART
Elective section will reduce risk of transmission
If in UK avoid breastfeeding

100
Q

What is the pneumonic for looking at a CTG?

A

Dr = Define risk

C = Contractions - should have 5 in 10 min in established labour

BRA = Baseline rate - 110-160

V = variability - 5 -25 beats/ min

A = Acceleration - a rise of 15 bpm lasting for 15 seconds or more

D = deceleration - a decrease of 15 bpm lasting for 15 seconds of more

O = overall impression

101
Q

Indications for a category 1 (urgent c section)

A

Bradycardia

Single prolonged deceleration with baseline below 100 bpm for > 3min

102
Q

Action if late deceleration and no other abnormality on CTG?

A

Fetal blood sampling to look for hypoxia and acidosis - pH >7.2 is normal

103
Q

Methotrexate is teratogenic and must be stopped in both men and women at least 3 months before conception

A

Methotrexate is teratogenic and must be stopped in both men and women at least 3 months before conception

104
Q

Oxybutynin should be stopped in frail, elderly women at risk of falls

A

It causes constipation, dizziness and drowsiness and is a falls risk

105
Q

How would you explain cervical ectropion to a patient?

A
  • the cells normally inside your cervix have moved to the outside.
  • they are a bit fragile so can bleed very easily
  • nothing to worry about, very common in women, especially if they are on the pill
106
Q

CBT is first line for women with PND who do not have a history of severe depression

A

If there is a history of severe depression or CBT is unacceptable/ ineffective then try SSRI

107
Q

Which drug should be given prior to surgery for uterine fibroids?

A

GnRH agonists such as leuroplide which reduce the size of the fibroid pre-surgery

This makes surgery easier and helps to reduce bleeding

108
Q

VTE prophylaxis in a lady with 2 previous DVT who gets pregnant

A

Will need LMWH starting ASAP and continued until 6 weeks post-natal

109
Q

Teenage girl with sudden onset lower abdominal pain. US shows free fluid and ‘whirlpool sign’

A

Ovarian torsion

110
Q

In PCOS and infertility, clomifene is better than metformin at inducing ovulation and getting pregnancy BUT

A

It is associated with a greatly increased risk of multiple pregnancy

111
Q

What is the criteria for methotrexate therapy to manage an ectopic?

A
  • Small <35mm
  • unruptured with no heart beat
  • bHCG <1500
  • no pain
112
Q

In a well positioned, well flexed baby what is the smallest skull diameter?

A

Suboccipitobregmatic diameter = 9.5cm

113
Q
  • 5 = fetal head at ischial spines
A

0 = at level of ischial spines = engagement

114
Q

COCP inhibits ovulation

A

POP inhibits implantation

115
Q

OHSS results from the release of vasoactive mediators from the hyperstimulated ovaries. What symptoms does it cause?

A

Symptoms result from fluid shift from intravascular compartment to 3rd space:

Effusions - pleural, pericardial and Ascites
Liver or kidney dysfunction
Haemoconcentration —> increased risk of thrombosis and coagulopathy

Known complication are AKI, ARDS, VTE and ovarian torsion

Young women with PCOS are at greatest risk

116
Q

Which medical treatment is available for ladies with stress incontinence who have not controlled treatment with pelvic floor exercises?

A

Duloxetine (SNRI)

117
Q

In what circumstances should a Sim’s speculum be used to perform a vaginal examination?

A

To assess for a uterovaginal prolapse

The patient should be examined on her left lateral position

118
Q

OCP raises risk of Breast and Cervical cancer

A

Decreases risk of ovarian and endometrial cancer

119
Q

Which form of contraception is associated with a long delay in return to natural fertility?

A

Depo-provera

Can take up to 12 months to return

120
Q

What is the commonest side effect of the POP?

A

Eratic bleeding

up to 40% will be affected

Ob/gyn (4 decks)

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