Random mix Flashcards
AEDs which are also enzyme inducers?
carbamazepine, phenytoin, topiramate
Best contraception in epileptics on AEDs?
Copper coil, mirena, implant
Best emergency contraception in epileptics on AEDs?
Copper coil
EC with levonorgestrel or ullipristal acetate affected by enzyme inducers
Can also consider 3mg levonorgestrel (double dose)
What drug interaction can increase seizure risk?
lamotrigine and oestrogen containing contraceptives
(lamotrigine levels decrease)
Conditions which need bridging with treatment dose dalteparin prior to gynae procedures
VTE in past 3 months
AF + stroke in past 3 months
AF + previous stroke/TIA + CCF/HTN/>75y/DM
Mechanical heart valve
When to stop apixaban prior to surgery in normal renal function?
When can it be restarted?
24 hours before
6-12 hours after
When to stop warfarin prior to surgery?
When can it be restarted?
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.
Drugs that can be used for heart failure in pregnancy?
Beta blockers - metoprolol safest
Diuretics sparingly - furosemide, thiazides
Hydralazine with care (can cause uterine hypoperfusion)
Double bubble sign and poly on US is suggestive of?
Duodenal atresia (associated with chromosomal abnormality like Downs t21)
Causes of hyperprolactinaemia
Pituitary disease - prolactinoma, Cushing’s
Hypothalamic disease - tumours
Medication - methyldopa, TCAs, opiates,
Other - PCOS, pregnancy/lactation, metoclopramide
In women with history of mesh insertion, what can happen?
Erosion of mesh into bladder or urethra
Can have new urgency/frequency sx
Offer cystoscopy to assess
Trichomonas
Strawberry cervix, frothy yellow discharge
Flagellated protozoa
STI
NAAT swab for diagnosis
Suture and technique for
EAS?
IAS?
AM?
EAS? 3-0 PDS end to end
IAS? 3-0 PDS mattress/interrupted
AM? 3-0 vicryl continuous/interrupted
Interstitial pregnancy on USS?
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
Cornual pregnancy on USS?
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
When is expectant management of ectopic an option?
US diagnosis of ectopic and decreasing hCG level, initially >1500
When is MTX management appropriate for ectopic management?
Cervical ectopic management?
MTX
Surgical management has high failure rate, so only if bleeding +++
CS scar ectopic management?
MTX into GS + SEVAC
Interstitial pregnancy management?
MTX or surgical management by laparoscopic cornual resection or salpingotomy or hysteroscopic resection with lap/US guidance
Management of heterotopic pregnancy
Local injection of potassium chloride or hyperosmolar glucose with aspiration of the sac contents (e.g. transvaginally)
Surgical removal of the ectopic pregnancy
How to give MTX in ectopic management?
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
Success rate single dose MTX?
65-95%
Sensitivity and FPR - 1st trimester screening
90%, 5%
Sensitivity and FPR - 2nd trimester, quad test?
70-75%, 5%
WHO normal semen analysis parameters
Ejaculate volume >2ml
Total sperm number 15 million/ml
Normal forms 4%
Total motility 40%
When is cryoprecipitate blood product indicated?
fibrinogen <2 and ongoing bleeding
Which vaccines are contraindicated in pregnancy?
Live attenuated vaccines: MMR, chickenpox, BCG
Oral typhoid Ty21
Which vaccines are safe in pregnancy?
Cholera, yellow fever, inactive typhoid (parenteral inactivated Vi polysaccharide)
What is periventricular leukomalacia?
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
What is the best predictor of cerebral palsy/developmental delay?
Periventricular leukomalacia
When can periventricular leukomalacia be diagnosed on imaging?
2-6 weeks after injury can see cavitation and periventricular cyst formation on MRI
Acceptable fasting blood glucose in GDM?
3.6-5.3mmol/l
Acceptable BM 2 hours after eating?
<7.8mmol/l
Zika virus - how long should a female avoid pregnancy after travel?
2 months
Zika virus - how long should a male avoid pregnancy after travel?
3 months
Late maternal death is what duration after delivery?
42 days to 1 year
How to calculate RMI?
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
How to investigate RMI >200 and >1cm post-meno cyst?
CT scan, MDT review
How to investigate RMI <200 and <5cm post-meno cyst?
Repeat USS 4-6months
How to investigate RMI <200 and >5cm post-meno cyst?
Consider bilateral salpingo-oophorectomy
Which clotting factor increases in pregnancy?
Factor VII, VIII, X, fibrinogen
Antibodies found in SLE?
Anti-nuclear antibodies
Anti-ds DNA (specific)
In Haemophilia A, what level of factor VIII/IX levels should you aim for?
0.5 iu/ml for procedures
1.0 for treatment
Risk of congenital malformation with sodium valproate use in pregnancy?
10%
Risk of congenital malformation with anti-epileptic polytherapy use in pregnancy?
17%
Majority of DVTs occur in which leg?
left
Which period of pregnancy is most hyper-coagulable?
Puerparium
Consequences of fetal haemolytic anaemia
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.
Polyhydramnios definition?
DVP >8cm
AFI >15cm
Causes of polyhydramnios?
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
Polyhydramnios is idiopathic (no cause) in what proportion of cases?
50-60%
Low PAPP-A is
<0.4 MoM
Medical management of acute asthma?
Oxygen
Inhaled salbutamol
Oral steroids
Inhaled ipratropium
ITU help if appropriate
Listeria in pregnancy can cause?
Meconium and pre-term delivery
Montgomery case refers to what?
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
What is Fraser?
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.
What is Gillick?
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
Can a competent minor refuse treatment?
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.
When to deliver in uncomplicated GDM?
No later than 40+6
When to deliver in type 1 or 2 diabetes, if no complications?
37-39 weeks
When can diabetes insipidus occur in pregnancy?
3rd trimester
What is diabetes insipidus?
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.
In women with immune thrombocytopaenia purpura (ITP), the risk of neonatal thrombocytopaenia is
20%
Early neonatal death is ..
up to 7 days
Late neonatal death…
7-28 days
Post-natal death…
28 days - 1 year
What is Stein Leventhal AKA?
PCOS
What is swyer’s syndrome?
Complete gonadal dysgenesis in 46XY
Female phenotype
When to conceive after molar pregnancy treated with chemo?
1 year after
After partial molar pregnancy, when can you conceive?
After follow up complete
Fetal blood volume per kg, at term?
65-70ml/kg
Advantage of delayed cord clamping?
Increases fetal iron stores by 3 months worth
In IVF pregnancies you are more likely to get a false positive screening test result due to a change in which level?
PAPP-A
How to determine duration of neonatal PEP in HIV positive mothers?
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
What neonatal PEP is given if maternal HIV?
Zidovudine
Benthathine penicillin is treatment for
syphillis
1st line investigation in pregnant women with breast lump?
Ultrasound
Bleeding from episiotomy is coming from which vessel?
Perineal artery (branch of internal pudendal)
After CS, what is a burning sensation at the mons pubis/labia/thigh likely to represent?
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
When to deliver if previous classical CS?
37w by ELCS
When to delivery is previous myomectomy?
38w by ELCS
Analphylaxis treatment?
500 micrograms (0.5 ml) of 1:1000 adrenaline intramuscularly
Definition of sinusoidal pattern?
Amplitude of 10bpm in cycle of 2-5 per min, lasting at least 2 mins
May signify severe fetal anaemia
Risk of post-partum psychosis in BPD?
1 in 5
Risk of post-partum psychosis if BPD and mother or sister had?
1 in 2
What combined screening result confers high risk of down’s?
1 in 150
Antenatal care if low PAPP-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)
Genotype complete mole
46XX
Genotype partial mole
69XXY
Risk of acute fatty liver of pregnancy?
hypoglycaemia
Treatment dose enoxaparin?
1mg/kg
Treament dose tinzaparin?
175u/kg
Main risk of DCDA twins?
CS
Main risk vAMA?
CS
Main risk MZ twins?
pre-term labour
Proportion of women that are symptoms free 12 months after EAS tear?
60-80%
Ultrasound sensitive marker of TOA?
‘Cogwheel’ sign
How to distinguish between AFLP and HELLP
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
Neonatal resus algorithm?
5 inflation breaths
If HR<60 after 30secs of effective ventilation, commence chest compressions at 3:1 ratio
