Random mix Flashcards by Saba Salim

AEDs which are also enzyme inducers?

carbamazepine, phenytoin, topiramate

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Best contraception in epileptics on AEDs?

Copper coil, mirena, implant

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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)

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What drug interaction can increase seizure risk?

lamotrigine and oestrogen containing contraceptives
(lamotrigine levels decrease)

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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

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

When can it be restarted?

24 hours before

6-12 hours after

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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.

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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)

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Double bubble sign and poly on US is suggestive of?

Duodenal atresia (associated with chromosomal abnormality like Downs t21)

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Causes of hyperprolactinaemia

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

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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

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Trichomonas

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

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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

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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

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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

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When is expectant management of ectopic an option?

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

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When is MTX management appropriate for ectopic management?

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Cervical ectopic management?

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

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CS scar ectopic management?

MTX into GS + SEVAC

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Interstitial pregnancy management?

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

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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

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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

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Success rate single dose MTX?

65-95%

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Sensitivity and FPR - 1st trimester screening

90%, 5%

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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?

Main risk vAMA?

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