Random Flashcards
Newborn Resuscitation
i) Warm and dry Baby
ii) Check for tone, breathing and heart rate
iii) If not breathing - Open airway + 5 inflation breaths
iv) reassess for increase in heart rate
v) if no increase assess whether resuscitation breaths are causing the chest to rise
vi) If the chest ISNT moving (inadequate resuscitation breaths) then recheck head position and repeat the resus breaths with help
vii) Compressions at ratio of 3:1 if heart rate is 60 or less - Reassessing the heart rate every 30 seconds
Pre menstrual migraine prophylaxis?
Frovatriptan or Zolmitriptan
Migraine treatment in women of child bearing age:
propanolol versus topiramate
Propanolol
Topiramate is associated with teratogenicity
When is vaginal bleeding considered a rhesus sensitising event?
<12 weeks if Painful, Heavy or Persistent
>12 weeks (always)
Other sensitising events:
- ectopic
- ERPC/ Evacuation of molar pregnancy
- Chorionic villus sampling/ aminocentesis
- antepartum haemorrhage
- abdominal trauma
- External Cephalic version
- Intra-uterine Death
- Post-delivery
When should prophylactic anti- d be given?
I) 28 weeks
iI) 34 weeks
Best possible answer:
When is a serum progesterone most useful?
What is it most useful for?
Serum progesterone should be taken 7 days before the end of a cycle. This is because the luteal phase is always 7 days and the beginning of this marks ovulation. Follicular phase is variable between women.
Useful for measuring ovulation.
Ultrasound scan with one smaller twin:
Found that the smaller twin is getting suboptimal blood flow.
Diagnosis?
Treatment?
Dx: Twin to Twin Transfusion Syndrome
Tx:
i) Indomethacin to reduce foetal urine output
ii) Laser obliteration of placental vascular communications
iii) selective foetal reduction
iv) postnatal blood transfusion to donor twin/ exchange transfusion and cardiac treatment for the recipient twin
Cervical cytology schedule for HIV positive women?
Annual cervical cytology
- Increased risk of CIN
- Due to: i) decreased immune response/ clearance of HPV ii) Increased disease progression iii) increases risk of false negative cytology
Ovarian Tumours:
Benign ovarian tumour
Cysts lined by ciliated cells
Serous Cystadenoma
Ovarian Tumours:
Malignant tumour - often bilateral
Psammoma bodies seen
Serous Cystadenocarcinoma
Ovarian Tumours:
Cyst lined by mucous secreting epithelium
Mucinous Cystadenoma
- Benign
Ovarian Tumours:
Malignant cyst lined by mucous secreting epithelium
- associated with pseduomyxoma peritonei
Mucinous Cystadenocarcinoma
Ovarian Tumours:
Benign Clusters of epithelial cells
Coffee Bean Nucleu
Brenner Tumour
- Benign
Ovarian Tumours:
Combination of ectodermal, mesodermal and endodermal tissue
Teratoma (dermoid cyst)
- Mature are usually benign
- Immature are malignant
Ovarian Tumours:
Androgen Producing tumour
- What condition is it associated with
Sertoli-Leydig Cell Tumour:
Benign
Associated with peutz- jegher syndrome
Ovarian Tumours:
Solid tumour consisting of bundles of spindle shaped fibroblasts
Fibroma
- Associated with meig’s syndrome
- Occur around menopause where they cause a pulling sensation in the pelvis
Ovarian Tumours:
Metastases from GI tumour causing mucin-secreting signet-ring cell adenocarcinoma
Krukenberg Tumour
Treatment for BV:
Features of BV:
Oral Metronidazole 400 mg bd for 7 days
Alternatively - intravaginal metronidazole/clindamycin.
Features:fishy offensive discharge, clue cells, >4.5 vaginal pH, wiff test
Treatment for thrush:
Pregnant/ Non Pregnant
Non Pregnant: Oral itricanazole/ flucanozole PO stat
Pregnant: Local clotrimazole pessary
Medical Management of menopause:
6 Medicines
i) Hormonal therapy - most effective. Special notice with tibolone –> Don’t use until after 12 months following last period due to irregular bleeding
ii) SSRIs - vasomotor
iii) Clonidine - Vasomotor. associated with dry mouth, dizziness and nausea
iv) Progesterones (Norethisterone) - Vasomotor
v) Toical Oestrogens - Vaginal symptoms
vi) Vaginal lubricant / moisturizer - Vaginal dryness
FGM:
Definition?
FGM: Procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons.
Types:
i) Partial/or total removal of the clitoris
ii) Partial or total removal of the clitoris + labia minora. (with/without labia majora excision)
iii) Narrowing of vaginal orifice wth creation of a covering seal by cutting and appositioning the labia minora +/- majora. +/- clitoridectomy
iv) All other harmful procedures ot female genitalia for non-medical purposes - pricking, piercing, incising, scraping and cauterisation
What is type 1 FGM?
i) Partial/or total removal of the clitoris
Clitoroidectomy
What is type 2 FGM?
ii) Partial or total removal of the clitoris + labia minora. (with/without labia majora excision)
(Excision)
What is type 3 FGM?
iii) Narrowing of vaginal orifice wth creation of a covering seal by cutting and appositioning the labia minora +/- majora. +/- clitoridectomy
(infibulation)
What is type 4 FGM ?
iv) All other harmful procedures ot female genitalia for non-medical purposes - pricking, piercing, incising, scraping and cauterisation
Cyclical vs Continuous HRT
Cyclical if perimenopausal
Continuous iF:
i) Cyclical for 1 year or more
ii) if last period was greater than year ago
iii)If last period was greater than 2 years ago in early menopause (before 40)
Safest antiepilepics in pregnancy?
Carbamezapine
Lamotrigine
Anti-D dosing
<20 weeks 250 + NO kleihauher test
> 20 weeks 500 + Kleihauher test (and more given accordingly)
Prophylaxis (500 if given at 28 and 34 of 1000-1600 if just at 28 weeks)
28 weeks - Antibody screen also undertaken for second check of antibody status
34 weeks
Intraoperative cell salvage during c section - 1500 IU of anti- D + Kleihauher test to determine if more should be given
How would you assess fetal aneamia?
Cut off point?
Next investigation?
How would you manage?
Fetal Anaemia is suspected when USS evidence of ascites and heart failure are noticed (hydrops fetalis) but ASSESSMENT is through MCA DOPPLER
Doppler cut off:
> 1.5 MOM(Multiples of median) PSV ( Peak Systolic Velocity )
Next investigation:
Fetal blood sampling
Management:
Intrauterine blood transfusion
