PPQs + Related Flashcards
A low risk woman would like to have epidural anaesthesia but is concerned about the risks. What is the risk of permanent paralysis (give as 1:X)
~1:140,000 it is so rare it is difficult to put a number on it
Drug given to women to prevent expression / stop expression of breast milk?
Cabergoline
49 y/o woman has heavy, irregular menstrual bleeding. TVUSS shows a thickened endometrium with cystic spaces. What investigation would be diagnostic in this scenario?
Pipelle biopsy - irregular periods likely suggesting peri/menopausal –> ?endometrila ca
Naegles rule for EDD?
(1y+7d) - 3m
Most common cause of vaginal discharge in children?
Vulvovaginitis (or Foreign body)
What type of discharge in TV?
frothy and thin offensive yellow vaginal discharge
- 22 y/0 woman is planning a water birth. She is low risk with no medical problems. What complication of normal delivery is increased by a water birth?
Umbilical cord avulsion / snapping
Medication of choice in mx of anorexia?
Fluoxetine (most effective in co-morbid depression)
What is this describing?
“experiences where she thinks she isn’t real”
Derealisation can be seen in schizophrenia
What cardiac condition are children born to SLE mums at increased risk of?
Congenital heart block
Differences between periorbital and orbital cellulitis?
Peri = infectious process occurring in the eyelid tissues, superficial usually due to superficial tissue injury (can progress to orbital)
Orbital = - infection affecting the muscles and fat within the orbit, posterior/ deep to the orbital septum usually due to underlying bacterial sinusitis
Complications of orbital cellulitis?
Abscess formation, meningits, cavernous sinus thrombosis, infection of optic nerve which can lead to visual defects
Mx of peri/ orbital cellulitis?
Urgent hospital admission, prompt mx w/ empirical IV Abx (eg ceftriaxone)
Imaging of choice for suspected paeds raised ICP?
Brain MRI
- 36 y/o woman sees GP for routine appointment at 32 weeks pregnancy. This is her first pregnancy and has so far been uncomplicated. She has normal fetal movements and is generally well with temperature 36.3, HR 90, BP 128/82, RR 13, O2 sats 96% on room air. Fundal height is 32cm and fetal HR is normal. Urine dipstick shows ++ protein but no other abnormalities. What is the most appropriate management?
a. Immediate referral to obstetrics
b. Repeat urinanalysis in 1 day
c. Repeat urinanalysis in 1 week
d. Send urine for MC&S and start Nitrofurantoin
e. Send urine for MC&S and start Trimethoprim
A - “If there is [2+] protein or more on dipstick testing, arrange urgent secondary care assessment, even if there is evidence of a possible UTI”
- 37 y/o woman has her anomaly scan at 20+3 weeks of pregnancy, and it reveals echogenic bowel. What is the most likely cause?
Trisomy 21 (out of the options given - not sure if overall most likely)
- 41 y/o women attends her dating scan. LMP dates make her 12 weeks pregnant. An intrauterine pregnancy is seen with no fetal heartbeat. CRL is equivalent to a fetus of 9 weeks gestation. What is the best next step?
a. Admit her for laparoscopy
b. Counsel her on management options for miscarriage
c. Offer her a repeat USS in 1 week
d. Offer treatment with methotrexate
e. Serum beta-hCG now and repeat in 48 hours
Counsel her on management options for miscarriage
Describe the obstetric pain ladder.
- Non-pharmalogical methods:
- Exercise/movement
- Heat e.g. warm bath, heat pack
- TENs stimulation
- Acupuncture
- Hypnosis
- Massage - Nitrous Oxide (Entonox or ‘gas and air’)
- Simple analgesia
Paracetamol (REMEMBER NO NSAIDs) - Opiate analgesia
- Oral codeine phosphate
- IV /IM Diamorphine - Epidural analgesia - not usually sited until the woman is in ‘established labour’
- Pudendal nerve block - used when you need rapid regional anaesthesia such as episiotomy or operative vaginal delivery
Mx of pt w/ prolonged tampon insertion but assymptomatic?
Reassure and discharge
No point doing high vaginal swabs as toxic shock is caused by staph aureus hence isnt tested for by these swabs
When can a woman expect periods to return post-partum?
Cannot be preducted
What additional testing is requried in a pregnant woman w/ previous cocaine use?
Hep C
Nb: this is an additional infection screen done in high risk individuals
A woman is having a repeat USS at 32 weeks gestation for a previously low-lying placenta. The USS shows the placenta is clear of the cervical os and an additional succenturiate lobe is seen.
Which condition needs to be excluded in the USS?
Vasa praevia -???
How long after methotrexate can couples safely conceive?
3m
Mx of urogenital prolapse?
Conservative - those that can cope with mild symptoms
- Pelvic floor muscle training (16w) + lifestyle changes
Symptomatic:
- Vaginal pessary (every 4m change it)
What are the different types of prolapse and what do they mean?
ANTERIOR VAGINA:
- Cystocele- if in the upper half of the vagina
- Urethrocele- if in the lower half of the vagina
POSTERIOR VAGINA:
- Enteroceleif in the upper third of the vagina
- Rectocele- if in the lower two-thirds of the vagina
What is a velamentous cord insertion?
where the cord inserts into the membranes and travels within the membranes before joining the placenta (the cord should insert straight into the placenta)
Examples of atypical antipsychotics?
clozapine
olanzapine: higher risk of dyslipidemia and obesity
risperidone
quetiapine
amisulpride
aripiprazole: generally good side-effect profile, particularly for prolactin elevation
What is bacterial tracheitis caused by?
Staph aureus - presents similar to epiglottitis w/ progressive airway obstruction + thick airway secretions
What congenital disorders are associated w duodenal atresia?
Prader-Willi + Downs syndromes
Mx of cerebral venous thrombosis?
1st Line = IV heparin
Followed by catheter guided local thrombosis
F/U = 3-6m anticoagulation (LMWH or NOACs)
ToP - surgical options?
Before 14w = suction curettage
After 14w = dilation and evacuation
MUST score is used to..
scale risk of refeeding syndrome
torticollis, opisthotonus, dysarthria and oculogyric crises are examples of what type of reaction? mx?
Acute dystonic reactions usually seen w typical antipsychotics
Reduce dose / change to atypical -> procyclidine if this isnt working
FBC abnormality in Lithium users?
Benign leukocytosis
Centor criteria?
1+ tonsillar exudate
1+ cervical lymphadenopathy / adenitis
1+ fever / hx of
1+ no cough
Pre-eclampsia order of drugs to use for BP control?
Labetalol
Nifedipine
Methyldopa
Woman had some intrauterine growth and endometrial thickness. What was the diagnosis
Fibroids
Pregnant woman with Gram negative bacilli in urine microscopy. What do you do?
Gram -ve rod = e coli hence give amoxicillin
What do you do in a woman in labour after 4 hours of checking, she’s 4cm.
Vaginal prostaglandin, Cervical sweep, Oxytocin, Ergometrine, ARM
Oxytocin
What is CI in mx of PPH in HTN pts?
Ergometrine
Foetus with transverse lie, recent SROM, CTG shows fetal distress. Most likely cause?
Cord prolapse
What’s the management for DVT risk in a pregnant woman after an elective Caesarean?
LMWH, LMWH and Ted stockings, Ted stockings, Warfarin or something, Aspirin, Aspirin and Ted stockings
LMWH + Ted stockings = 10day regimen
What do you measure at booking for hepatitis b?
Hep B surface antigen
What is the most common cause of subfertility?
Unknown cause - normal bloods + 30% all subfertility
Hysterectomy yesterday. How long to stay off work for:
48 hours/ 1 week/ 4 weeks/ 3 months
4 weeks
What extra testing is needed a mother that smokes during pregnancy?
Serial growth scans if >10 cigarettes a day
UTI in first trimester of pregnancy. What would be the safest and most effective treatment?
Trimethoprim, Ciprofloxacin, Doxycycline, Cefalexin, Meropenem
Cefalexin
Cefalexin
Amenorrhoea for 4 months – what is the best initial investigation?
URINARY b-HCG
Effect of paroxetine during pregnancy?
1st trimester = Small risk of congenital heart defects
3rd trimester = Risk of persisten pulmonary HTN
Woman with a slow growing painless lesion on labia
Bartholin’s cyst
Woman with tender lump inside her vagina
Vaginal cancer
Blue specks on cervix?
Nabothlian cyst
