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MRCOG part 2 * > Random mix > Flashcards

Random mix Flashcards

1
Q

AEDs which are also enzyme inducers?

A

carbamazepine, phenytoin, topiramate

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2
Q

Best contraception in epileptics on AEDs?

A

Copper coil, mirena, implant

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3
Q

Best emergency contraception in epileptics on AEDs?

A

Copper coil
EC with levonorgestrel or ullipristal acetate affected by enzyme inducers
Can also consider 3mg levonorgestrel (double dose)

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4
Q

What drug interaction can increase seizure risk?

A

lamotrigine and oestrogen containing contraceptives
(lamotrigine levels decrease)

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5
Q

Conditions which need bridging with treatment dose dalteparin prior to gynae procedures

A

VTE in past 3 months
AF + stroke in past 3 months
AF + previous stroke/TIA + CCF/HTN/>75y/DM
Mechanical heart valve

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6
Q

When to stop apixaban prior to surgery in normal renal function?

When can it be restarted?

A

24 hours before

6-12 hours after

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7
Q

When to stop warfarin prior to surgery?

When can it be restarted?

A

5 days prior, and check INR day before. If INR >1.5 can give vit K (phytomenadione)

12-24 hours after. Start LMWH to bridge until taregt INR achieved.

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8
Q

Drugs that can be used for heart failure in pregnancy?

A

Beta blockers - metoprolol safest
Diuretics sparingly - furosemide, thiazides
Hydralazine with care (can cause uterine hypoperfusion)

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9
Q

Double bubble sign and poly on US is suggestive of?

A

Duodenal atresia (associated with chromosomal abnormality like Downs t21)

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10
Q

Causes of hyperprolactinaemia

A

Pituitary disease - prolactinoma, Cushing’s
Hypothalamic disease - tumours
Medication - methyldopa, TCAs, opiates,
Other - PCOS, pregnancy/lactation, metoclopramide

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11
Q

In women with history of mesh insertion, what can happen?

A

Erosion of mesh into bladder or urethra
Can have new urgency/frequency sx
Offer cystoscopy to assess

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12
Q

Trichomonas

A

Strawberry cervix, frothy yellow discharge
Flagellated protozoa
STI
NAAT swab for diagnosis

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13
Q

Suture and technique for
EAS?
IAS?
AM?

A

EAS? 3-0 PDS end to end
IAS? 3-0 PDS mattress/interrupted
AM? 3-0 vicryl continuous/interrupted

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14
Q

Interstitial pregnancy on USS?

A

empty uterine cavity, POC/GS located laterally in the interstitial (intramural) part of the tube and surrounded by <5mm of myometrium and presence of interstitial line sign

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15
Q

Cornual pregnancy on USS?

A

visualisation of a single interstitial portion of fallopian tube in the main uterine body, gestational sac/products of conception seen mobile and separate from the uterus and completely surrounded by myometrium, and a vascular pedicle adjoining the gestational sac to the unicornuate uterus

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16
Q

When is expectant management of ectopic an option?

A

US diagnosis of ectopic and decreasing hCG level, initially >1500

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17
Q

When is MTX management appropriate for ectopic management?

A
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18
Q

Cervical ectopic management?

A

MTX
Surgical management has high failure rate, so only if bleeding +++

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19
Q

CS scar ectopic management?

A

MTX into GS + SEVAC

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20
Q

Interstitial pregnancy management?

A

MTX or surgical management by laparoscopic cornual resection or salpingotomy or hysteroscopic resection with lap/US guidance

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21
Q

Management of heterotopic pregnancy

A

Local injection of potassium chloride or hyperosmolar glucose with aspiration of the sac contents (e.g. transvaginally)

Surgical removal of the ectopic pregnancy

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22
Q

How to give MTX in ectopic management?

A

MTX usually single IM dose of 50 mg/m2.
Serum β-hCG levels are measured on days 4 and 7 post methotrexate.
If the β-hCG level decreases by more than 15% between days 4 and 7, β-hCG levels are then measured weekly until less than 15 iu/l.
If the level does not decrease by 15%, a repeat transvaginal ultrasound should be considered to exclude ectopic fetal cardiac activity and the presence of significant haemoperitoneum. Consideration may then be given to administration of a second dose of methotrexate

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23
Q

Success rate single dose MTX?

A

65-95%

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24
Q

Sensitivity and FPR - 1st trimester screening

A

90%, 5%

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25
Q

Sensitivity and FPR - 2nd trimester, quad test?

A

70-75%, 5%

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26
Q

WHO normal semen analysis parameters

A

Ejaculate volume >2ml
Total sperm number 15 million/ml
Normal forms 4%
Total motility 40%

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27
Q

When is cryoprecipitate blood product indicated?

A

fibrinogen <2 and ongoing bleeding

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28
Q

Which vaccines are contraindicated in pregnancy?

A

Live attenuated vaccines: MMR, chickenpox, BCG
Oral typhoid Ty21

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29
Q

Which vaccines are safe in pregnancy?

A

Cholera, yellow fever, inactive typhoid (parenteral inactivated Vi polysaccharide)

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30
Q

What is periventricular leukomalacia?

A

White-matter brain injury, characterized by the necrosis of white matter near the lateral ventricles
Causes motor control problems/developmental delay e.g. in cerebral palsy

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31
Q

What is the best predictor of cerebral palsy/developmental delay?

A

Periventricular leukomalacia

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31
Q

When can periventricular leukomalacia be diagnosed on imaging?

A

2-6 weeks after injury can see cavitation and periventricular cyst formation on MRI

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32
Q

Acceptable fasting blood glucose in GDM?

A

3.6-5.3mmol/l

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33
Q

Acceptable BM 2 hours after eating?

A

<7.8mmol/l

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34
Q

Zika virus - how long should a female avoid pregnancy after travel?

A

2 months

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35
Q

Zika virus - how long should a male avoid pregnancy after travel?

A

3 months

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36
Q

Late maternal death is what duration after delivery?

A

42 days to 1 year

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37
Q

How to calculate RMI?

A

Ultrasound x Menopausal status x Ca125
U = 0/1/3
0=none, 1=1 feature, 3=2-5 features
Menopausal status - 1=pre-meno, 3=post-meno

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38
Q

How to investigate RMI >200 and >1cm post-meno cyst?

A

CT scan, MDT review

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39
Q

How to investigate RMI <200 and <5cm post-meno cyst?

A

Repeat USS 4-6months

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40
Q

How to investigate RMI <200 and >5cm post-meno cyst?

A

Consider bilateral salpingo-oophorectomy

41
Q

Which clotting factor increases in pregnancy?

A

Factor VII, VIII, X, fibrinogen

42
Q

Antibodies found in SLE?

A

Anti-nuclear antibodies
Anti-ds DNA (specific)

43
Q

In Haemophilia A, what level of factor VIII/IX levels should you aim for?

A

0.5 iu/ml for procedures
1.0 for treatment

44
Q

Risk of congenital malformation with sodium valproate use in pregnancy?

A

10%

45
Q

Risk of congenital malformation with anti-epileptic polytherapy use in pregnancy?

A

17%

46
Q

Majority of DVTs occur in which leg?

A

left

47
Q

Which period of pregnancy is most hyper-coagulable?

A

Puerparium

48
Q

Consequences of fetal haemolytic anaemia

A

Hydrops
Metabolic acidosis - red cells are the principal fetal buffer
Hyper lactaemia
Fetal cardiac dysfunction secondary to hypoxaemia
Hyperbilirubinaemia - this is predominantly unconjugated as the fetus and neonate have low levels of glucoronyl transferase, the enzyme responsible for conjugation - risk of kernicterus.

49
Q

Polyhydramnios definition?

A

DVP >8cm
AFI >15cm

50
Q

Causes of polyhydramnios?

A

GI obstructions - duodenal atresia, diaphragmatic hernia
Impaired swallowing - muscular dystrophies
Congenital infx - parvo, syphillis, torch
Chromosomal - T13, 21, 18
Cardiac failure secondary to anaemia
Hb Barts - alpha thal
TTTS

51
Q

Polyhydramnios is idiopathic (no cause) in what proportion of cases?

A

50-60%

52
Q

Low PAPP-A is

A

<0.4 MoM

53
Q

Medical management of acute asthma?

A

Oxygen
Inhaled salbutamol
Oral steroids
Inhaled ipratropium
ITU help if appropriate

54
Q

Listeria in pregnancy can cause?

A

Meconium and pre-term delivery

55
Q

Montgomery case refers to what?

A

Ensuring patients have adequate information about the risks/benefits so they can make an informed choice

Original case was because woman didn’t receive info about risk of shoulder dystocia with an LGA baby

56
Q

What is Fraser?

A

Fraser guidelines specific to contraception
<16 year olds can be prescribed contraception if they understand advice, can’t be persuaded to inform parents, physical/mental health at risk, young person’s best interests, likely to continue havign sex regardless.

57
Q

What is Gillick?

A

GIllick competence can be applied to anything - <16yo can consent to treatment if they can understand risks, benefits, other options.
Gillick competence determined by HCP.
Based on child’s maturity and capacity

58
Q

Can a competent minor refuse treatment?

A

Where a competent young person refuses treatment, the harm caused by violating a young person’s choice must be balanced against the harm caused by failing to treat.

In these cases the courts have said that children and young people have a right to consent to what is being proposed, but not to refuse it if this would put their health in serious jeopardy

If a competent young person refuses treatment, it would be advisable to seek legal advice and it may be necessary to take the matter to court.

59
Q

When to deliver in uncomplicated GDM?

A

No later than 40+6

60
Q

When to deliver in type 1 or 2 diabetes, if no complications?

A

37-39 weeks

61
Q

When can diabetes insipidus occur in pregnancy?

A

3rd trimester

62
Q

What is diabetes insipidus?

A

Failure of the renal tubules to conserve water, causing polydipsia, dilute polyuria, and potentially hypernatraemic dehydration with weakness, confusion and seizures

Caused by low anti-diurectic hormonem, due to:

Neurogenic DI is the commonest form in non-pregnant patient - inadequate synthesis of ADH usually from trauma
Nephrogenic DI occurs because of renal insensitivity to ADH typically due to renal failure
Gestational DI is a result of the metabolism of ADH by placental vasopressinase.

63
Q

In women with immune thrombocytopaenia purpura (ITP), the risk of neonatal thrombocytopaenia is

A

20%

64
Q

Early neonatal death is ..

A

up to 7 days

65
Q

Late neonatal death…

A

7-28 days

66
Q

Post-natal death…

A

28 days - 1 year

67
Q

What is Stein Leventhal AKA?

A

PCOS

68
Q

What is swyer’s syndrome?

A

Complete gonadal dysgenesis in 46XY
Female phenotype

69
Q

When to conceive after molar pregnancy treated with chemo?

A

1 year after

70
Q

After partial molar pregnancy, when can you conceive?

A

After follow up complete

71
Q

Fetal blood volume per kg, at term?

A

65-70ml/kg

72
Q

Advantage of delayed cord clamping?

A

Increases fetal iron stores by 3 months worth

73
Q

In IVF pregnancies you are more likely to get a false positive screening test result due to a change in which level?

A

PAPP-A

74
Q

How to determine duration of neonatal PEP in HIV positive mothers?

A

2 weeks IF viral load <50 on 2 occasions 4 weeks apart and at 36w and established on cART for >10 weeks
4 weeks IF viral load <50 at/after 36 weeks

75
Q

What neonatal PEP is given if maternal HIV?

A

Zidovudine

76
Q

Benthathine penicillin is treatment for

A

syphillis

77
Q

1st line investigation in pregnant women with breast lump?

A

Ultrasound

78
Q

Bleeding from episiotomy is coming from which vessel?

A

Perineal artery (branch of internal pudendal)

79
Q

After CS, what is a burning sensation at the mons pubis/labia/thigh likely to represent?

A

Iliohypogastric / ilioinguinal nerve entrapment due to suture at the lateral borders of low transverse incisions that extend beyond the lateral border of the rectus abdominis muscle

80
Q

When to deliver if previous classical CS?

A

37w by ELCS

81
Q

When to delivery is previous myomectomy?

A

38w by ELCS

82
Q

Analphylaxis treatment?

A

500 micrograms (0.5 ml) of 1:1000 adrenaline intramuscularly

83
Q

Definition of sinusoidal pattern?

A

Amplitude of 10bpm in cycle of 2-5 per min, lasting at least 2 mins
May signify severe fetal anaemia

84
Q

Risk of post-partum psychosis in BPD?

A

1 in 5

85
Q

Risk of post-partum psychosis if BPD and mother or sister had?

A

1 in 2

86
Q

What combined screening result confers high risk of down’s?

A

1 in 150

87
Q

Antenatal care if low PAPP-A?

A

Growth scans from 28w
No need for aspirin (according to RCOG guidelines, but often given in practice as PAPP-A is RF for SGA)

88
Q

Genotype complete mole

A

46XX

89
Q

Genotype partial mole

A

69XXY

90
Q

Risk of acute fatty liver of pregnancy?

A

hypoglycaemia

91
Q

Treatment dose enoxaparin?

A

1mg/kg

92
Q

Treament dose tinzaparin?

A

175u/kg

93
Q

Main risk of DCDA twins?

A

CS

94
Q

Main risk vAMA?

A

CS

95
Q

Main risk MZ twins?

A

pre-term labour

96
Q

Proportion of women that are symptoms free 12 months after EAS tear?

A

60-80%

97
Q

Ultrasound sensitive marker of TOA?

A

‘Cogwheel’ sign

98
Q

How to distinguish between AFLP and HELLP

A

AFLP - HYPOglycaemia, clotting is MORE abnormal, antithrombin deficiency, progresses to encephalopathy, US-bright liver/ascites, biopsy - micro vesicular steatosis, use Swansea criteria

HELLP - raised BP, low platelets, abnormal LFTs

99
Q

Neonatal resus algorithm?

A

5 inflation breaths
If HR<60 after 30secs of effective ventilation, commence chest compressions at 3:1 ratio

MRCOG part 2 * (54 decks)

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