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O&G > Random Passmed O&G Cards > Flashcards

Random Passmed O&G Cards Flashcards

1
Q

Group B Streptococcus (GBS) and Intrapartum Antibiotic Prophylaxis

A
  • GBS positive women should be offered intrapartum antibiotic prophylaxis.
  • Swabs offered at 35-37 weeks or 3-5 weeks prior to delivery date.
  • Indications for offering prophylaxis: previous baby with GBS disease (early or late onset), preterm labour, pyrexia during labour.
  • Antibiotic of choice: Benzylpenicillin.
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2
Q

Premenstrual Syndrome (PMS) Treatment

A
  • Moderate PMS should be treated with Combined Oral Contraceptive Pills (COCP).
  • Severe PMS should be treated with Selective Serotonin Reuptake Inhibitors (SSRIs).
  • Contraindication for COCP = migraine with aura.
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3
Q

Menopause Contraception

A

Menopause contraception criteria: >50 years (12 months without a period), <50 years (24 months without a period).

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4
Q

Emergency Contraception

A

Emergency contraception options: IUD (120 hours most effective), Levonorgestrel (12 hours, no later than 72 hours), Ulipristal acetate (120 hours).

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5
Q

Hypertension in Pregnancy

A
  • Hypertension criteria: >140mmHg systolic, >90mmHg diastolic.
  • Severe hypertension criteria: >160/100mmHg + proteinuria, admit to hospital.
  • New onset hypertension after 20 weeks (>160/110mmHg), admit for close monitoring.
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6
Q

COCP associated risks

A

Increases risks of breast and cervical cancer, decreases risk of ovarian and endometrial cancer.

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7
Q

Induction of Labour in a normal pregnancy

A

Offer induction of labour between 41-42 weeks of uncomplicated pregnancy to avoid risks of prolonged labour

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8
Q

DVT management

A
  • Suspected pregnant woman with DVT: Commence LMWH immediately unless strong contraindications.
  • Monitor anti-Xa activity when managing obese or severely underweight pregnant women for DVT.
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9
Q

Premature Rupture of Membranes

A

Premature rupture of membranes: Oral erythromycin for 10 days, antenatal corticosteroids, deliver at 34 weeks of gestation

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10
Q

What is the tumour marker for ovarian cancer?

A

CA125

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11
Q

What are the doses of folic acid to take?

A
  • Folic acid dose when trying to conceive and taking antiepileptics: 5mg
  • 400 micrograms of folic acid for all women trying to conceive
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12
Q

When should the IUS be fitted after pregnancy?

A

within 48 hours of birth or 4 weeks after birth

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13
Q

What are the guidelines for taking methotrexate and conception?

A

Methotrexate must be stopped for at least 6 months (by both partners) before conception

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14
Q

What’s the most common cause of vulval itching?

A

Contact dermatitis

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15
Q

Which antihypertensives should be stopped immediately in pregnancy?

A

ARBs and ACEi

Risk of renal impacts in the foetus leading to oligohydramnios, pulmonary hypoplasia and renal damage

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16
Q

What should be monitored if an expectant mother is prescribed magnesium sulphate?

A

Reflexes and respiratory rate (<16/min could indicate toxicity)

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17
Q

What is the medical management of intrahepatic cholestasis of pregnancy?

A

Ursodeoxycholic acid

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18
Q

What is the management of magnesium sulphate induced respiratory depression?

A

Calcium gluconate

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19
Q

When is the initial booking visit with a midwife?

A

8-12 weeks

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20
Q

When is cephalic version offered if the baby is breech?

A

36 weeks

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21
Q

When would vulval itch prompt 2 week wait referral?

A

Unexplained:
- Vaginal lump
- Ulceration
- Bleeding
- Itching, burning lesion
- Raised, well defined skin lesion

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22
Q

What are the risk factors for vulval intraepithelial neoplasia?

A
  • HPV 16&18
  • Smoking
  • HSV2
  • Lichen sclerosus
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23
Q

What are the criteria for PCOS?

A

2 out of 3:
- Oligomenorrhoea
- Clinical and/or biochemical signs of hyperandrogenism
- Polycycstic ovaries on USS, oligomenorrhoea or amenorrhoea and hirsutism

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24
Q

When should methotrexate be stopped before conception?

A

At least 6 months by both males and females

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25
Q

What is the gram stain of gonorrhoea?

A

Gram negative diplococci

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26
Q

What is the managment of gonorrhoea?

A

IM ceftriaxone 1g single dose

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27
Q

What is the management of gonorrhoea if the organism is sensitive to ciprofloxacin?

A

Single dose oral ciprofloxacin 500mg

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28
Q

What is the GO-CHAMP memory technique for the differences between gonorrhoea and chlamydia?

A

Gonorrhoea (GO CHA):
- Gram-negative diplococci (neisseria gonorrhoeae)
- Odoroud discharge (purulent)
- Coitus painful
- Handsome green discharge (mainly in men)
- Antibiotic resistance (higher tendency for antibiotic resistance)

Chalymidia (CHAMP):
- Chlamydia trachomatis (intracellular)
- However, often Asymptomatic
- Mucopurulent discharge
- PID

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29
Q

What is the management of vaginal candida?

A
  • Fluconazole 150mg oral single dose
  • Clotrimazole 500mg intravaginal pessary single dose if 1st line contraindicated
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30
Q

When does foetal cardiac activity start?

A

4-5 weeks gestation

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31
Q

What is a missed miscarriage?

A

Aka delayed
- Gestational sac <20 weeks containing a dead foetus
- Closed cervical os
- Crown rump length >7mm and no cardiac activity

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32
Q

What dose of folic acid should a patient with BMI >=30kg/m2 take?

A

5mg folic acid daily until 13th week of pregnancy

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33
Q

How many weeks is each trimester?

A

1st: 1-12 weeks
2nd: 13-27 weeks
3rd: 28-40+ weeks

34
Q

What is the next best step for a pregnant woman >=20 weeks who develops chickenpox?

A

Oral acyclovir if they present within 24 hours of the rash

35
Q

What is the next best step for a pregnant woman who has come into contact with chickenpox and is asymptomatic?

A

Urgent blood test for varicella antibody status

If lacking immmunity, VZIg

36
Q

When can hormonal contraception be started after taking levonogestrel as emergency contraception?

A

Immediately

37
Q

What is the mechanism of enoxaparin?

A

Low molecular weight heparin (anticoagulent safe to take in pregnancy)

38
Q

Why should you do a urinalysis for someone with urinary incontinence?

A

Rule out UTI and diabetes mellitus

39
Q

What vitamin should pregnant woman take?

A

10mcg vitamin D

40
Q

What are the risk factors for placental abruption?

A

ABRUPTION:
- Abruption previously
- Blood pressure (hypertension or PET)
- Ruptured membranes (premature or prolonged)
- Uterine injury
- Polyhydramnios
- Twins
- Infection in the uterus (chorioamnionitis)
- Older age (>35)
- Narcotic use

41
Q

How should pregnant women with SLE be advised re medication in pregnancy?

A

Take 75mg (low dose) aspirin from 12 weeks to term of pregnancy due to increased risk of PET

42
Q

Which two anti-emetics are contraindicated in pregnancy?

A

Ondansetron (increased risk of congenital malformations avoided in the 1st trimester) and Metoclopramide (met only considered after other options have failed)

43
Q

Which antiemetic is safe to use in pregnancy?

A

Promethazine (H1-antihistamine)

44
Q

What is the only surgical management for fibroids that preserves fertility?

A

Myomectomy

45
Q

When is one previous c-section a contraindication for a vaginal delivery?

A

Classical c-section scar

46
Q

What’s the main complication of induction of labour?

A

Uterine hyperstimulation

High contraction frequency (tachysystole) and duration for >20 minutes (>4 contractions in 10 minutes)

47
Q

How can uterine hyperstimulation lead to foetal distress?

A

Foetal hypoxia induced by compression of the umbilical and placental blood vessels

48
Q

What is the maximum duration that metoclopramide should be given in hyperemesis gravidarum?

A

5 days due to the risk of EPSEs

DRD2 antagonist, should only be trialled after unsuccessful trial of antihistamines

49
Q

Which investigation should be done first in a woman with reduced fetal movements?

A

Handheld Doppler

CTG once foetal heart beat has been established

50
Q

What is placenta accreta?

A

Attachment of the placenta to the myometrium due to defective decidua basalis

Placenta doesn’t separate properly during the 3rd stage of labour leading to increased risks of PPH

51
Q

What are the 3 types of placenta accreta?

A
  • Accreta: chorionic villi attach to the myometrium rather than the decidua basalis
  • Increta: chorionic villi invade into the myometrium
  • Percreta: chorionic villi invade through the perimetrium
52
Q

What is the lactational amenorrhoea method of contraception?

A

98% effective contraception method for people who are fully breast-feeding (no supplementary feeds), amenorrhoeic and <6 months post-partum

53
Q

What are the risks associated with inter-pregnancy interval of <12 months between childbirth and conceiving?

A
  • Increased risk of preterm birth
  • Low birth weight
  • Small for gestational age babies
54
Q

What’s the first step for someone with a positive pregnancy test and either abdominal, pelvic or cervical motion tenderness?

A

Immediate referral to the early pregnancy assessment unit

55
Q

What is cervical ectropion?

A

Elevated oestrogen levels result in a larger area of columnar epithelium being present on the ectocervix

  • Vaginal discharge
  • Post-coital bleeding
56
Q

What is the biggest risk factor for cord prolapse?

A

Artifical rupture of membranes

57
Q

When is external cephalic version indicated

A

If babies are still breech at 36 weeks

58
Q

What is the cut off for the Bishop’s score?

A

> 8 spontaneous labour is likely
<8 induction may be needed

59
Q

What is the most appropriate blood test to diagnose premature ovarian failure?

A

FSH levels, significantly raised in menopausal patients

Ovarian function ceases, decreased negative feedback, increased FSH

Can’t be diagnosed with one blood test, must be repeated at 4-6 weeks

60
Q

How long does the IUS take to become effective?

A

7 days

61
Q

How long does the POP take to become effective?

A

2 days

62
Q

What is PPROM?

A

Preterm (<37 weeks) prelabour rupture of membranes

63
Q

What is ankyloglossia?

A

Tongue tie, affecting ~10% infants

64
Q

What is ankyloglossia characterised by?

A

Short, thickened frenulum restricting tongue movement

65
Q

What is anterior tongue tie?

A

Attachment of the tongue to the floor of the mouth, with a short frenulum at the tongue close to the tip

Frenulum will be visible

66
Q

What is posterior tongue tie?

A

Lifting the tongue produces a heart-shaped notch and the frenulum cannot be visualised

67
Q

What are the symptoms of tongue tie in a neonate?

A
  • Prolonged feeding
  • Irritability
  • Weight loss
  • Pain and nipple injury in the mother
68
Q

What volume of amniotic fluid is consistent with polyhydramnios?

A

> 2-3L of amniotic fluid

69
Q

What is the managment of 2cm unilateral, invasive vulvular carcinoma with no lymph node involvement?

A

Simple vulvectomy and bilateral inguinal lymphadenectomy

Lymphatic drainage of the vulva is to the inguinal lymph nodes therefore they should be removed even if there is no evidence of involvement

70
Q

What is vulvodynia?

A

A chronic condition characterised by unexplained pain in the vulvovaginal area lasting at least 3 months

Can be provoked or unprovoked

71
Q

What are the side effects of taking 5mg folic acid?

A
  • Nausea
  • Appetite reduction
  • Pernicious anaemia exacerbation
72
Q

How are neural tube defects categorised?

A

Open:
- expsing brain or spine to amniotic fluid (eg. anancephaly, encephalocele, spina bifida)

Closed (skin covered):
- Eg. lipomeningocele, tethered cord

73
Q

What is the management for postnatal hypertension in the community?

A

Blood pressure should be checked every other day (community midwives) until targets are achieved eg. <150/100mmHg

Once this is met, bp checked weekly and wean antihypertensives

Once 130/80mmHg stop the antihypertensives and check bp every 2 weeks

74
Q

What is the regimen of cyclical HRT?

A

Daily oestrogen tablets for 3 months and progesterone for the last 14 days

75
Q

Where does spermatogenesis occur?

A

Seminiferous tubules

76
Q

What are the physiological changes during pregnancy?

A
  • Tidal volume increases
  • Minute ventilation increases

75% of women, especially in the first trimester

77
Q

Why does tidal volume increase in pregnancy?

A

Increased metabolic CO2 production due to high serum progesterone

78
Q

Which form of oestrogen increases during pregnancy?

A

Oestriol (needed to surpress FSH and LH and stimulate growth of the placenta)

79
Q

Why is the T4 surge in early pregnancy essential for the foetus?

A

Because the foetus relies on maternal thyroixine until the thyroid developes at week 12

80
Q

What are the risks of unmanaged hypothyroidism in pregnancy?

A
  • Neurodevelopmental delay
  • Poor perinatal outcomes
  • Gestational diabetes
  • Placental abruption
  • Foetal loss
81
Q

Where does spermatogenesis occur?

A

Seminiferous tubules

82
Q
A

O&G (11 decks)

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