Womens Flashcards
1
Q
What is lactation mastitis?
A
Inflammatory condition of the breast commonly caused by milk stasis which is due to overproduction or inefficient removal
2
Q
Presentation of lactation mastitis?
A
Breast pain with warm, tender, erythematous area
3
Q
Management of lactation mastitis?
A
1st line: Analgesia and effective milk removal including checking attachment
2nd line (if symptoms do not improve within 12-24 hours): 500mg Flucloxacillin 4 times a day for 14 days with continuing breastfeeding
4
Q
Investigation of choice of placenta praevia?
A
Transvaginal US
5
Q
When should pregnant women with a first degree relative with diabetes be screened for gestational diabetes?
A
24-28 weeks with Oral glucose tolerance test
6
Q
What is McRoberts manoeuvre?
A
Hyperflexing the legs tightly to the abdomen - used for shoulder dystocia
7
Q
What position should women adopt with suspected cord prolapse?
A
On all fours - knees and elbows
8
Q
If COC started within first 5 days of period, if any additional contraception needed?
A
No
9
Q
If COC started at any day within the cycle after first 5 days, should any additional contraception be used?
A
Yes for 7 days
10
Q
Cervical cancer risk factors?
A
- Increased parity
- Smoking doubles risk
- COCP
- Early first intercourse
11
Q
Which contraceptives become effective after 7 days?
A
COCP, Implant, Injection, IUS
12
Q
How quickly will the POP become effective?
A
2 days if started mid cycle
13
Q
How do you diagnose gestational diabetes?
A
Fasting - >5.6
2 hours level - >7.8
14
Q
What condition is it unacceptable to prescribe COCP for which women also have?
A
Migraine with aura
15
Q
First line for pre-term PROM?
A
Speculum examination to look for pooling of fluid in the posterior vaginal vault
16
Q
Pre-eclampsia triad?
A
- HTN
- Proteinuria
- Oedema
17
Q
High risk factors of pre-eclampsia?
A
- CKD
- HTN disease in previous pregnancy
- Autoimmune disease
- DM
18
Q
Moderate risk factors of pre-eclampsia?
A
- First pregnancy
- > 40
- BMI of 35 or more
- First degree relative with pre-eclampsia
- Multiple pregnancy
19
Q
When should a women be given eclampsia prophylaxis and what is it?
A
If 1 or more high, 2 or more moderate risk factors
75-150mg aspirin once daily from 12 weeks
20
Q
What is placental abruption?
A
Separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space
21
Q
Management of PA with no foetal distress < 36 weeks
A
Corticosteroids plus monitoring
22
Q
Management of PA with foetal distress <36 weeks
A
C-section
23
Q
Management of PA with foetal distress >36 weeks
A
C-section
24
Q
Management of PA with no foetal distress > 36 weeks
A
NVD
25
First degree tear?
Superficial damage with no muscle involvement - no repair needed
26
Second degree tear?
Injury to the perineal muscle not involving the anal sphincter - requires suturing by a experienced midwife/clinician
27
Third degree tear?
Injury to the perineum involving the external/internal anal sphincter - requires repair in theatre
28
Fourth degree tear?
Injury to the perineum involving anal sphincter and rectal mucous - requires repair in theatre
29
Risk factors for reduced foetal movements?
- Posture changes i.e. less prominent when sitting/standing
- Anterior placenta position may have less awareness < 28 weeks
- Alcohol/Sedatives
- Obese patients
- Oligo/Polyhydramnios
30
Management of RFM at > 28 weeks
Handheld doppler to confirm heartbeat - followed by CTG for 20 minutes
If no heartbeat, use ultrasound
31
Management of RFM at <28 weeks
Handheld doppler
32
First line for pregnancy HTN?
Labetolol
33
Indications for C-section
- Placentra praevia
- Pre-eclampsia
- IUGR
- Foetal distress
- Failure to progress
- Placental abruption
- Cervical cancer
34
Cat 1 C-section?
Immediate theatre to mother/baby e.g. uterine rupture, major abruption, cord prolapse etc
C-section within 30 mins
35
Cat 2 C-section?
Maternal/Foetal compromise which is not immediately threatening
C-section within 75 minutes
36
Cat 3 C-section?
Delivery is needed but mother and baby are stable
37
Risks of C-section
- Hysterectomy
- Bladder/Ureteric injury
- ICU admission
- Death
- Need for repeat C-section
- Infection
- Haemorrhage
38
What is Meigs syndrome?
A benign ovarian tumour (fibroma) associated with ascites and pleural effusion
39
Most common benign ovarian tumour in women under 25?
Dermoid cyst (teratoma)
40
Most common cause of ovarian enlargement in women of reproductive age
Follicular cyst
41
Cause of follicular cyst?
Non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle
42
Cause of corpus luteum cyst?
When corpus luteum is not broken down and may fill with blood/fluid - presents with intraperitoneal bleeding
43
What is a dermoid cyst?
A benign germ cell tumour lined with epithelial tissue
44
How do dermoid cysts present?
Asymptomatic!
45
What is the most common benign epithelial tumours?
Serous cystadeomna - arises from ovarian surface epithelium
46
Indications for induction of labour?
- Prolonged pregnancy
- pre-labour PROM
- Diabetic mother > 38 weeis
- Pre-eclampsia
47
Options for induction?
- Vaginal prostaglandin
- Oxytocin infusion
- Amniotomy
48
Management of HPV+ve sample + cystogically abnormal?
Colposcopy
49
Side effect of ovulation induction (GnR analogues)
Ovarian hyperstimulation syndrome
50
Presentation of OHSS?
- Nausea
- Vomiting
- Abdominal pain
- Bloating
- Diarrhoea
- SOB
- Peripheral oedema
51
Risk factors for hyperemesis gravidarum?
- Multiple pregnancy
- Hyperthyroidism
- Molar pregnancy
52
Why is multiple pregnancy a risk factor for HG?
Higher hCG which is associated with more severe N+V
53
3 main criteria for PCOS diagnosis?
- Infrequent/Absent periods
- Signs of Hyperandrogenism
- polycystic ovaries on ultrasound
54
Most common cause of respiratory distress in <72 hours and >72 hours?
<72 hours - Group B Strep
>72 hours - Staph aureus
55
Antibiotic of choice for GB Strep prophylaxis?
Benzylpenicillin
56
Risk factors for Gestational Diabetes?
- BMI > 30
- Previous macrocosmic baby
- Previous GD
- First degree relative with diabetes
- Family origin with high prevalence of diabetes
57
What is foetal fibronectin (fFN)
A protein released from the gestational sac which is associated with early labour
58
Most common SE of POPs?
Irregular vaginal bleeding
59
Complications of primary infection with varicella in pregnancy?
Life threatening such as pneumonitis
60
First line management of chickenpox exposure for pregnancy woman?
Check antibody levels
If not immune, give VZ immunoglobulins
61
UKMEC 3 contraindications for COCP? (Disadvantages generally outweigh advantages)
->35 years old and smoking < 15 cigs a day
- Controlled HTN
- Immobile
- FH of VTE disease in first degree relative < 45
- Gallbladder disease
62
UKMEC 4 contraindications for COCP?
- >35 with >15 cigs a day
- Migraine with aura
- History of VTE/Stroke/IHD
- Uncontrolled HTN
- Breast cancer
63
Why is trace glycosuria common in pregnancy?
Increased GFR and reduction in tubular reabsorption of filtered glucose
64
What cancer does unopposed oestrogen increase the risk of?
Endometrial cancer
65
Which cancer does combined oestrogen and progesterone HRT reduce risk of?
Endometrial cancer
66
What is placenta accreta?
Attachment of the placenta to the myometrium - will not separate properly so increased risk of PPH
67
What does female sex increase risk of?
Developmental dysplasia of the hip
68
First line for endometriosis?
3 month trial of analgesia (paracetamol + NSAIDs)
69
Second line for endometriosis?
COCP or progestogen
70
Definition of PPH
Loss of 500mls or more from the genital tract within 24 hours of birth
71
Causes of PPH?
Tone - uterine atony
Tissue - retained placenta
Trauma
Thrombin (coagulation problems)
72
Which type of tumour is associated with development of endometrial hyperplasia?
Granulosa cell tumours (due to unopposed oestrogen)
73
What is a late deceleration of CTG and what does it indicate?
Deceleration of HR which lags behind onset of contraction and does not return to normal until 30 seconds after contraction - indicates foetal distress
74
What should you do if late decelerations are seen on CTG?
Urgent foetal blood sampling to assess for hypoxia and acidosis
75
Management of breech position at 36 weeks +
External cephalic version - if unsuccessful, planned C-section
76
What is puerperal pyrexia?
Temp of >38 in the first 14 days after delivery
77
Causes of puerperal pyrexia?
- Endometriosis
- UTI
- Wound infection
- Mastitis
- VTE
78
Target Hb cut offs in pregnancy?
1st trimester - 110
2nd trimester - 105
3rd trimester - 100
79
What is the most effective method of emergency contraception?
Copper IUD
80
When should Levonorgestrel be taken?
Within 72 hours of UPSI - 1.5mg dose
81
When should Ulipristal (EllaOne) be taken?
Within 120 hours of UPSI
82
Management of PPH?
1st - Medical management including IV oxytocin, IM carboprost, uterine massage
2nd - Surgical management where intrauterine balloon tamponade is first line, uterine artery ligation and then hysterectomy as last resort
83
Primary mode of action of COCP?
Inhibits ovulation
84
Primary mode of action of implant?
Inhibits ovulation
85
Primary mode of action of IUD?
Decreases sperm motility and survival
86
Primary mode of action of POP?
Thickens cervical mucus
87
If a woman with known placenta praaevia goes into labour (with/without bleeding)
Emergency C-section
88
What are tocolytics used for?
Pre-term labour to relax the uterus and halt contractions/labour
89
When can women restart taking hormonal contraception after taking Levonorgestrel?
Immediately
90
When can woman restart taking hormonal contraception after taking Ulipristal?
5 days
91
First line investigation for endometrial cancer?
Trans-vaginal ultrasound to measure endometrial thickness
92
What does intrahepatic cholestasis increase the risk of?
Stillbirth
93
Management of intrahepatic cholestasis?
Induction at 37-38 weeks
94
Clinical presentation of placental abruption?
- Continuous abdominal pain
- Woody/Firm uterus
95
Painless APH?
Painful APH?
Placenta praaevia
Placental abruption
96
When should zoster immunoglobulin be offered to women exposed to chickenpox?
First 20 weeks
97
What should a woman >20 weeks be given with a chickenpox rash within 24 hours?
[guidelines have changed] give oral Aciclovir between days 7-14 post-exposure
98
First line for management of hyperemesis/N+V?
Anti-histamines such as cyclizine/promethazine
99
What increases the risk of ectopic pregnancy?
PID
100
Causes of secondary amenorrhoea in an athletic woman?
Hypothalamic hypogonadism
101
Management of thrush in pregnant?
Clotrimazole
102
Second line for endometriosis?
OCP or progestogen
103
What should not be used in elderly patients?
Oxybutynin due to increased risk of falls
104
Older woman with labial lump and inguinal lymphadenopathy
Vulval carcinoma
105
If a semen sample is abnormal, when should a repeat test be arranged?
3 months later
106
What cancer does combined HRT increase the risk of?
Breast cancer
107
What is the treatment for vaginal vault prolapse?
Sacrocolpopexy
108
What medications can be used to help infertility in PCOS?
1st: Clomifene
2nd: Metformin
109
First line for dysmennorhoea pains?
NSAIDs
110
2nd line medical management of stress incontinence
Duloxetine
111
What are uterine fibroids sensitive to?
Oestrogen and Progesterone
112
What should be used to reduce size of fibroids in short term management?
GnRh agonists
113
Risk factor for endometrial hyperplasia
Tamoxifen
113
Risk factor for endometrial hyperplasia
Tamoxifen
114
How does metformin help in PCOS?
Appetite reduction
Decreases androgen production
Decreases LH from the anterior pituitary
Decreases sex-hormone binding globulin in the liver
Increases peripheral insulin sensitivity
115
Third line for Endometriosis?
GnRh agnonists
116
Second line management for pre-menstrual syndrome
COCP
117
Third line management for pre-menstrual syndrome
SSRI e.g Fluoxetine
118
What is the drug of choice for medical management of ectopic?
Methotrexate
119
What type of neoplasm does Rokitansky's protuberance relate to?
Teratoma (dermoid cyst)
120
What is associated with a decreased incidence of hyperemesis?
Smoking
121
How does endometrial hyperplasia present?
IM bleeding, post menopausal bleeding, menorrhagia or irregular bleeding
122
What investigation should be done with menorrhagia with pelvic pain/IM bleeding/post-coital bleeding?
Transvaginal US
123
Which HRT should be used to reduce risk of VTE?
Transdermal HRT
124
What is the cause of primary amenorrhoea with cyclical pain?
Imperforate hymen
125
When should progesterone level be taken for fertility issues?
7 days before the expected next period
126
What should be excluded in patients with recurrent candidiasis?
Diabetes
127
What does raised FSH/LH with primary amenohhoea indicate?
Gonadal dysgenesis e.g. Turner's syndrome
128
What is Sheehan's syndrome?
Postpartum hypopituitarism - due to hypovalaemic shock following birth
129
What cancer does unopposed oestrogen increase the risk of?
Endometrial
130
What is HNPCC/Lynch syndrome a strong risk factor for?
Endometrial cancer
131
How long should Metoclopramide be used for?
No more than 5 days due to the risk of extrapyramidal effects?
132
In women with post-menopausal bleeding, what is the diagnosis until proven otherwise?
Endometrial cancer
133
What is a large cervical cone biopsy a risk factor for?
2nd trimester miscarriage
134
What is associated with whirlpool sign on US?
Ovarian torsion
135
What additional blood tests are part of the 'Confusion Screen'?
TSH, B12, Folate and Glucose
136
Where does Alzheimers cause cerebral atrophy?
Cortex and Hippocampus
137
What should be measured in women over 50 presenting with regular abdominal distension/loss of appetite/pelvic pain/urinary urgency?
CA125 due to the risk of ovarian cancer
138
How should women < 6 weeks with vaginal bleeding and no pain be managed?
Expectant management
139
Which area of the Fallopian tube presents the highest risk of rupture?
Isthmus
140
What is the preferred method for induction of labour?
Vaginal prostaglandins
141
What are the 3 components of the RMI in ovarian cancer?
CA125 levels, menopausal status and US findings
142
What should be given to women with a previous baby with early/late Group B Strep?
Maternal IV antibiotics during labour
143
What is the screening tool for postnatal depression?
Edinburgh scale
144
First line treatment of intrahepatic obstetric cholestasis?
Ursodeoxycholic acid
145
When should methotrexate be stopped before conception in men and women?
6 months before
146
Management of cord prolapse?
Push the presenting part of the foetus back into the uterus
147
Management of pregnant women with abdominal trauma
Rhesus testing
If negative, should be given anti-D
148
Risk factors for placental abruption
Increasing maternal age
Multiparity
Maternal trauma
149
Management of fasting glucose > 7 at diagnosis
Commence insulin
150
Results of combined test at 10-14 weeks which suggests Downs
- Increased hCG
- Thickened nuchal translucency
- Reduced PAPP-A
151
How much should the fundus height increase after 24 weeks?
1cm per week
152
What should HIV positive mothers not do w/r postpartum?
Breastfeed
153
When should induction of labour be offered for women with intrahepatic cholestasis?
37-38 weeks
154
Management of suspected cases of rubella in pregnancy
Discussion with local Health Protection Unit
155
What would be shown in quadruple test for Downs? Edwards?
- Low AFP
- Low unconjugated oestriol
- Raised b-hCG
- Raised inhibin A
Edwards - everything low but inhibin A
156
What should NOACs be changed to during pregnancy?
LMWH
157
Why should liver be avoided in pregnancy?
It contains high amounts of Vitamin A, a teratogen
158
When do pregnancy related BP problems occur?
20 weeks and later
159
Management of GORD in infants
1st: 2 week trial of alginate therapy
2nd: 4 week trial of PPI
160
Why does pre-eclampsia cause oligohydramnios?
Hypoperfusion of the placenta
161
What should be given to all women with PPROM
10 days of erythromycin
162
What is the treatment for postpartum thyroiditis?
Beta-blockers
163
When should CVS be performed?
11 - end of the 13th week
164
When should amniocentesis be performed?
Week 15 onwards
165
What could sudden increases in the size of the abdomen/breathlessness in someone with twins suggests?
Twin-twin transfusion syndrome
166
What is the medication of choice for suppressing lactation when cessation of breastfeeding is indicated?
Cabergoline
167
When can Copper IUD be inserted as a form of emergency contraception?
Within 5 days of earliest expected ovulation date
168
What is the pH for someone with bacterial vaginosis?
pH > 4.5
169
What are the drugs and in what order for pregnancy termination?
- Oral mifepristone
- Vaginal misoprostol
170
Signs of premature ovarian insufficiency?
- Secondary amenorrhoea
- FSH > 25
- Elevated LH
171
Management of premature ovarian insufficiency?
Sequential HRT until 51 (COCP)
172
Management of newborns with a minor risk factor for sepsis?
24 hour observations
173
What ages is cervical screening done every 3 years?
25-49
174
What ages is cervical screening done every 5 years?
50-64
175
When should mid-luteal progesterone be measured?
7 days before the end of the regular cycle
176
What is the diagnostic triad for hyperemesis gravidarum?
- 5% of pre-pregnancy weight loss
- Dehydration
- Electrolyte imbalance
177
What is a common complication of AROM?
Cord prolapse
178
What can patients who have had a gastric sleeve/bypass/duodenal switch not have?
Any oral contraception including emergency due to lack of efficacy
178
What can patients who have had a gastric sleeve/bypass/duodenal switch not have?
Any oral contraception including emergency due to lack of efficacy
179
What is urge incontinence?
Detrusor muscle overactivity - bladder retraining and oxybuynin
180
What is stress incontinence?
Weakening of the pelvic floor muscles - pelvic floor exercises and duloxetine
181
Definitive management of atypical endometrial hyperplasia in postmenopausal women?
Total hysterectomy with bilateral salpingo-oopherectomy
182
Features of threatened miscarriage?
- Painless vaginal bleeding in first trimester
- Closed cervical os
183
Features of missed miscarriage?
- Light bleeding with no pain
- Closed os
- Gestational sac which shows dead foetus
- When the gestational sac is > 25mm
184
Treatment for vaginal thrush?
Single dose of oral fluconazole
185
When can medical management of fibroid be used?
When it is <3cm in size
185
When can medical management of fibroid be used?
When it is <3cm in size
186
What does continuous dribbling incontinence with prolonged labour suggest?
Vesicovaginal fistula
187
How long is contraception needed for after the last period in women > 50?
12 months
188
How long is contraception needed for after the last period in women < 50
24 months
189
What is the hearing test for newborns? If abnormal what is next?
Otoacoustic emission test
Auditory brainstem response test
190
What form of contraception is assoicated with a delay to natural fertility?
Injectable contraceptives
191
What are the choice of anti-depressants in breastfeeding women?
SSRI / Paroxetine
192
Which form of contraceptive is associated with weight gain?
Injectable contraceptives
193
Which form of delivery has the highest risk of haemorrhage to the newborn?
Ventouse due to high pressure exerted by the vacuum
194
Which form of delivery has the highest risk of haemorrhage to the newborn?
Ventouse due to high pressure exerted by the vacuum
195
What should be tested to look for menopause?
FSH - raised in menopausal women
196
What are antiphospholipid antibodies a CI to?
COCP
197
When can the contraceptive implant be inserted after childbirth?
Immediately
198
What may be measured in some (obese) women on LMWH for VTE in pregnancy?
Anti-Xa activity
198
What may be measured in some women on LMWH for VTE in pregnancy?
Anti-Xa activity
199
What is Wood screw's manoeuvre?
Put your hand in the vagina and attempt to rotate the foetus by 180 degrees
200
What is needed if unprotected sex occurred after a missed POP and within 48 hours of restarting the POP
Emergency contraception
201
What does raised AFP in pregnancy suggest?
Foetal abdominal wall defects
202
Risk factors for placental abruption
Abruption previous
Blood pressure high
Ruptured membranes
Uterine injury
Polyhydramnios
Twins
Infection
Old age
Narcotic use
203
Risk factors for placenta accreta
- PID
- Previous C-section
- Placenta praaevia
204
When should Ulipristal be used with caution?
For those with severe asthma
205
When should women be offered resection of the polyp?
All post-menopausal women with polyps and premenopausal women who are symptomatic or have endometrial polyps more than 1 cm should have a resection.
206
What is imperforate hymen?
A congenital condition that is usually asymptomatic until puberty when amenorrhoea and cyclical pain due to outflow obstruction
207
When does primary dysmenorrhoea usually present?
6-12 months after starting periods
208
How does chorioamnionitis present?
- pre-term PROM
- Maternal fever
- Maternal tachycardia
- Foetal tachycardia
209
Main adverse effect of Nexplanon implant?
Irregular menstrual bleeding
210
When can the IUS/IUD be inserted following childbirth?
Within 48 hours of delivery otherwise should be delayed till 4 weeks after
211
Who should be given anti-D prophylaxis at 28 weeks?
Rhesus negative mothers who are not sensitised
212
Are ovarian cysts concerning in early pregnancy?
No, they are usually physiological and will resolve from 2nd trimester onwards
213
Why is cervical ectropion more common in those taking the COCP?
Due to higher oestrogen levels
214
Definition for premature ovarian failure?
Onset of menopausal symptoms and elevated gondatrophin levels at the age of <40
215
Which epilepsy medication is indicated for pregnancy?
Lamotrigine
216
What is first line for women with moderate/severe depression postpartum with no previous history of depression?
CBT then antidepressants if this is unsuccessful
217
What should be offered for people with premature ovarian insufficiency?
HRT or COCP should be offered to women until the age of 51 years
218
Do you need to take any precautions with POP and antibiotics?
No
219
What is the imaging of choice for diagnosing adenomyosis?
MRI
220
Treatment options for ovarian cancer?
Surgery and Chemotherapy
221
1st and 2nd line treatment for pre-menstrual syndrome
1. New COCP
2. SSRI
222
Symptoms of acute fatty liver of pregnancy?
- Abdominal pain
- N+V
- Headache
- Jaundice
223
Signs of acute fatty liver of pregnancy?
- Raised LFTs (ALT)
- Raised WBC
- Steatosis on liver US Doppler
224
Features of HELLP?
- Haemolysis
- Elevated liver enzymes
- Low platelets
225
What position should a women be in for McRoberts manoeuvre?
Supine with both hips fully flexed and abducted
226
Most common epithelial cell tumour?
Serous cystadenoma
227
What is Fitz-Hugh Curtis syndrome?
A complication of PID where the infection tracks up to the liver from the pelvis associated with N.Gonorrhoea
228
What blood test would be raised with malignant germ cell tumours
b-HCG
229
Where is hCG secreted from?
syncytiotrophoblast
230
COCP mode of action?
Inhibits ovulation
231
POP mode of action?
Thickens cervical mucus
232
Injectable and Implant contraceptive mode of action?
Primary: inhibits ovulation
2. thickens cervical mucus
233
IUD mode of action?
Decreases sperm survival and motility
234
IUD mode of action?
Prevents endometrial proliferation
235
How long is the window for taking desogestrel?
12 hours
236
What is secondary dysmenorrhoea?
Pain that starts 3-4 days before the onset of the period
237
What is catatonia?
Stopping of voluntary movement or staying still in an unusual position
238
What does Bishop score < 5 indicate?
Labour is unlikely to start without induction
239
What does Bishop score > 8 indicate?
Labour is likely to start spontaneously
240
What is the treatment of choice for postpartum thyroiditis?
Propranolol
241
When does postpartum thyroiditis most commonly present?
3-4 months after giving birth (can be upto 1 year)
242
What does Asherman's syndrome often occur after?
Dilation and curettage
243
Features of Sheehan's syndrome?
- Agalactorrhoea
- Amennohoea
- Hypothyroidism
- Hypoadrenalism
244
Features of Candida infection?
- Cottage cheese discharge
- Itching
245
Features of Trichomonas vaginalis?
- Offensive yellow-green, frothy discharge
- Strawberry cervix
246
Features of Bacterial Vaginosis?
- Offensive thin white/grey fishy discharge
247
What criteria is used to diagnose BV?
Amstel criteria:
- Thin, white discharge
- Vaginal pH > 4.5
- Positive whiff test
- Clue cells on microscopy (stippled vaginal epithelial cells)
248
What is severe asthma a contraindication to?
Ullipristal/EllaOne
248
Why should levongesterel dose be double?
If BMI > 26 or weight over 70kg
249
Which contraceptive is not recommended in over 50s?
Progesterone injection as it reduces mineral bone density
250
What is the contraceptive of choice for patients taking enzyme inducers e.g rifampicin?
IUD/Depo-Provera injection
251
What should be monitored and followed up with patients on SNRIs (duloxetine, venlafaxine)
Blood pressure - as can cause HTN
252
What should be monitored when patients are started on SSRI?
Sodium levels - can cause hyponatreaemia
253
What is breastfeeding protective against?
Ovarian cancer
254
When is red generation of fibroids more common?
2nd / 3rd trimester
255
What kind of drug is trimethoprim and when should it be avoided in pregnancy?
folate antagonist - 1st trimester
256
When should nitrofurantoin be avoided?
3rd trimester due to risk of haemolytic anaemia
257
2nd line for endometriosis in those where COCP is C/I?
Progesterone IUD
258
Management of pregnancy of unknown location?
Repeat b-HCG in 48 hours
259
Management of PPROM?
Abx for 10 days or until woman in active established labour
260
Chlamydia treatment?
100mg doxycycline for 7 days
261
Treatment for trichomonas
Metronidazole
262
Treatment for gonorrhoea
Ceftriaxone IM injection - one off
263
Signs of secondary syphillis?
widespread rash, neurological symptoms and glomerulonephritis
264
Cause of retrograde ejaculation?
Damage to internal urethral sphincter e.g. bladder surgery, tumour
265
Preferred contraceptive for PCOS?
COCP
266
What kind of contraceptive is Nexplanon?
Progesterone-only
267
Which HPV are most associated with developing cervical cancer?
HPV 16,18
268
Pan systolic murmur in child?
VSD
269
History of flu-like illness and painful vesicular lesions around the vagina?
Herpes virus -> oral aciclovir and C-section
270
First line tocolytic?
Oral nifedipine
271
What HRT should be given to women going through menopause with regular periods?
Monthly, cyclical HRT
272
White patches/skin on the labia?
Lichen sclerosis
273
Treatment for lichen sclerosus?
Strong topical steroids e.g. Dermovate
274
Why should dextrose solutions be avoided in hyperemesis?
Can cause Wernickes
275
What does progesterone do?
smooth muscle relaxation in the digestive system, urinary system and uterus
276
What medication should lithium be switched to?
Atypical antipsychotic
277
Risks of bacterial vaginosis in pregnancy?
- Preterm delivery
- Late miscarrriage
278
Itchy, red patches over the abdomen, normal LFTs?
Polymoprhic eruption of pregnancy
279
Sign of placental separation?
Lengthening of the umbilical cord with gush of blood
280
Mid-cycle ovulatory pain?
Mittleschmertz
281
Most common analgesia for labour pain?
Entonox - inhaled NO + O2
282
3a vs 3b perineal trauma?
3a - <50% of involvement of the external sphincter
283
Nabothian cysts
Common cysts on the cervix in women who have had children
284
What endometrial thickness would warrant more investigation?
>5mm
285
Lump coming forward?
- Coming from posterior vaginal wall
- Rectocele
- Often assoicated with constipation
286
Cystocele vs Rectocele?
Cystocele would cause urinary symptoms
287
What does combined HRT reduce the risk of?
Osteoporosis
288
What should be given to women before C-section?
PPI - to reduce risk of gastric reflux and aspiration during surgery
289
What is an absolute contraindication to ECV?
APH in the last 7 day s
290
Management of meconium aspiration syndrome?
Admission to NICU for O2 and Abx
291
Management of meconium aspiration syndrome?
Admission to NICU for O2 and Abx
292
Management of GBS?
Intrapartum Abx and during delivery
293
What condition is mononeuritis multiplex associated with?
Diabetes Mellitus
294
Indications for LLETZ?
Persistent CIN or high grade CIN (2,3)
295
What is breastfeeding a risk factor for?
Neonatal jaundice
296
When should uterus return to pre-pregnancy size?
4 weeks post partum
297
Treatment to prevent further miscarriages?
Aspirin + Heparin
298
Treatment of asymptomatic bacteruria?
Oral Abx
299
What is abnormal pH and lactate of foetal blood sample?
pH - 7.20 and below
Lactate - 4.9 and above
300
Blood or clots visible in the vaginal vault with abdominal/back pain in 3rd trimester?
Placental abruption
301
Acute management of herpes?
Abstain from all sexual activity until asymptomatic
302
Surgical management of ectopic with previous damage to other fallopian/infection?
salpingostomy
303
Initial screening tool for syphillis?
Enzyme immunosorbent Assay
304
Primary syphillis features?
- Painless, genital/perianal lesions
305
Secondary syphillis features?
- Maculopapular symmetrical rash on palms legs face
- Ulcers
- Neurological symptoms
306
Tertiary syphillis features?
- Granulomatous lesions on shins
- Cardiac complications e.g. aortic regurg
- Neuro complications e.g. meningovascular sphillis, dementia
307
Management of caput succedaneum?
Reassure that this will clear up within a few days
308
What nerve is blocked in instrumental delivery?
Pudendal
309
Criteria for lactational amenorrhoea?
- The woman has complete amenorrhoea.
- The woman is fully, or nearly fully (>85% of feeds are breast milk) breastfeeding.
- It has been six months or less since the birth of the baby
310
Psammoma bodies
Serous cystadenocarcinoma
311
Most common type of epithelial ovarian tumour?
Serous cystadenoma
312
Follow up of CIN1?
Discharge and screen again in community at 12 months
313
Commonest cause of vaginal cancer?
Metastases from cervix/endometrium
314
Risk factors for placenta praevia?
- multiple pregnancy (e.g twins- multiple placentas)
- smoking
- intrauterine fibroids
- maternal age >35
315
Order of foetal descent?
Descent, engagement, flexion, internal rotation, crowning, extension of
presenting part, external rotation of head, delivery
316
Management of asymptomatic bacteriuria?
tx urgently w nitro
317
Diagnoses of polyhydramnios?
n AFI of >24cm (or 2000ml+)
318
Diagnoses of oligohydramnios?
AFI of <5cm (or under 200ml)
319
Most common cause of polyhydramnios?
Idiopathic
320
blue and bulging membrane with a mass protruding from behind
Imperforate hymen
321
What is the most likely US finding with someone with endometriosis?
Normal US
322
What is Naegele's rule?
Method for working out EDD: 9 months from last menstrual period + 7 days
323
What does C-section increase the risk of for future pregnancies?
Placental abnormalities e.g. accreta
324
How often should patients with severe pre-eclampsia have blood tests?
3 times a week
325
Partial vs Complete molar pregnancy?
Complete will have the snowstorm appearance of US, partial has foetal tissue in uterine sac
Complete - 2 sperm cells fertilise an ovum with no genetic material
Partial - 2 sperm cells fertilise a normal ovum - 3 sets of genetic material
326
What analgesia is safe in pregnancy?
- Paracetamol
- Codeine phosphate at low doses
327
What is assessed in the Bishop score assessment?
Position of the cervix
Length of the cervix
Consistency of the cervix
Dilatation of the cervix
Station of the presenting part (distance in cm in relation to the ischial spines)
328
What is Kleinhauer test?
Used to detect haemorrhage in sensitising event to work out if anti-D is needed
329
When can tocolytics and corticosteroids be used for pre-term labour
24-34 weeks
330
When would you start fertility investigations for someone who was on the COCP?
18 months of trying (6 months needed for fertility to return to normal)
331
What can happen if CVS performed before 11 weeks?
Foetal limb abnormalities
332
When is CVS and amniocentesis performed?
CVS - 11th - 13 weeks
Amnio - 15 weeks onwards
333
Tense fontanelle + uveitis?
Congenital Toxoplasmosis
334
Suction evacuation of miscarriage is not generally reccommended after what gestation?
13 weeks
335
Ovarian torsion vs cyst rupture?
Cyst rupture will be following physical activity/sex with sudden onset pain, haemodynamic instability
336
When is anaemia screening in pregnancy?
Booking + 28 weeks
337
Lamotrigine in pregnancy?
- Safe but may need increase dose as lamotrigine levels can fall during pregnancy
338
Incomplete vs Inevitable miscarriage?
- Incomplete will have products of conception being passed
339
Incomplete vs Inevitable miscarriage
- Incomplete will have products of conception being passed
340
Main complication of induction of labour?
Uterine hyperstimulation
341
Lifestyle changes for pre menstrual syndrome?
2-3 hourly small balanced meals rich in complex carbohydrates
342
What is Potter syndrome?
Bilateral renal genesis -> Oligohydramnios
- Flattened 'parrot-beaked' nose
- Recessed chin
- Downward epicanthal folds
- Low-set, cartilage-deficient ears (known as 'Potter's ears')
343
Criteria for expectant management of ectopic?
1) An unruptured embryo
2) <35mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <1,000IU/L and declining
344
When should monochorionic twin ultrasounds monitor for twin-twin transfusion?
Between 16 and 24 weeks
345
Tx options for vasomotor symptoms of menopause (hot flushes, sweats etc)
fluoxetine, citalopram or venlafaxine
346
sudden collapse occurring soon after a rupture of membranes
Amniotic fluid embolism
347
Management of more advanced cervical cancer to preserve fertility?
Radical Trachelectomy
348
When would postpartum blue normally resolve?
Within 10 days
349
PCOS increases the risk of which cancers?
Endometrial and Ovarian
350
Management of vomiting in HG looking unwell?
IM Antihistamines
351
If mum has Hx of previous depression and presents with postpartum depression, what should you do?
Start medical treatment early on
352
What is frank breech presentation?
the legs are extended up to head, the buttocks are the presenting part
353
What is complete breech presentation?
the hips and knees are flexed, buttocks are the presenting part
354
What is incomplete breech presentation?
one or both hips are extended, knee or foot is the presenting part
355
Women with uncomplicated monochorionic twin pregnancies should be offered elective birth when?
36 weeks onwards
356
Women with dichorionic twin pregnancies should be offered elective birth when?
37 weeks onwards
357
Bartholin gland cyst vs abscess?
Abscess occurs when cyst becomes infected, resulting in extreme pain, lymphadenopathy, erythema
358
Symptoms of stress incontinence and prolapse?
Cystocele
359
Treatment of cystocele?
Anterior colporrhaphy
360
Hormones presentation in premature ovarian failure?
High FSH, LH
361
Ovarian neoplasms features?
Hirsutism due to testosterone secretion
▪ Acute abdomen due to ovarian torsion
▪ Rupture or haemorrhage
▪ Thyrotoxicosis as in struma ovarii, and
▪ Amenorrhea
362
haematocolpos – an accumulation of the blood in the vagina
Imperforate Hymen
363
PCOS Horones
Normal/high LH, high Testosterone, FAI high
364
Ovarian failure hormones
High FSH, LH
365
Fluids physiological changes of pregnancy?
- Increase in total plasma volume (more ECF, reduced plasma osmolality, reduced threshold for thirst and reduced plasma oncotic pressure)
366
Renal physiological changes of pregnancy?
- Increase in kidney size (dilation)
- Increased renal blood flow, GFR, creatinine clearance
367
Cardiac physiological changes of pregnancy?
- BP: Decreases initially due to reduced resistance then rises again in later
- Increase in cardiac output, HR, Stroke volume, plasma volume, red cell vollume, WCC, clotting factors
- Decrease in haemoglobin concentration, haematocrit
368
Respiratory changes in pregnancy?
- Increased oxygen consumption
- Reduced expiratory reserve volume, residual volume and increased tidal volume -> total lung volume reduced
- Compensated respiratory alkalosis
- O2 uptake favoured at alkaline pH by foetus - Double Bohr effect
369
GI/Liver changes in pregnancy?
- Delayed gastric emptying and cardiac sphincter relaxation
- Reduced secretion of CCK, gall bladder motility
- Increased gut transit time due to increased nutrient uptake and increased water reabsorption
- Reduced gastric pH
370
Metabolic changes in pregnancy?
- Early pregnancy: maternal plasma peak lower leading to efficient glucose uptake and fat deposition
- Late pregnancy: maternal plasma glucose peak stays higher for longer
- Increase in progesterone, oestrogen and hPL (similar to growth hormone)
- Increase in pituitary gland size and thyroid
371
Reproductive changes in pregnancy?
- Increase in uterine mass: smooth muscle hyperplasia and hypertrophy
- Increased softness and vascularity of cervix with increased gestation
- Blue tinge (oestrogen) -> Chadwick sign
- Increased breast volume with fast deposition and increased serum prolactin
372
Stages of Labour
Latent: contractions, mucoid plug, cervix begins to efface (thinning) and dilate upto 4cm
Active - cervix dilates upto 10cm
Stage 2 - full dilatation to the birth of the foetus
Stage 3 - from birth of the foetus to delivery of the placenta
373
Where do contractions start?
In the fundus of the uterus
374
Flexion in labour
- Contraction put pressure down the spine and force the occiput to come into contact with the pelvic floor
- This leads to flexion which allows the circumference of the head to reduce and aid passage through the pelvis
375
Benefits of delayed cord clamping?
- Allows time to transition to extra-uterine life
- Increase in RBC, iron and stem cells which aid growth for 6 months
- Reduced need for inotropic support
376
Types of Fibroids?
Intramural - confined to the myometrium
Submucosal - Protrudes the uterine cavity and develops underneath the endometrium
Subserosa - Protrudes through the outer surface of the uterus
377
Prolactinoma
Benign tumur of pituitary resulting in excess prolactin
- Oligomenorrhoea, galactorrhoea
- Tx with cabergoline
378
Tx for PID
- IM Ceftriaxone one dose
- Doxycycline
- Metronidazole
379
Pathophysiology of Lichen Sclerosis
Atrophy of cells leaving behind a thin layer of stratified squamous
380
Androgen insesitivity syndrome?
- X linked recessive
- Raised LH, normal/raised FSH, normal/raised testosterone, rasied oestrogen
381
Tx for Ashermans?
Dissection during hysteroscopy
382
Vasa Praevia
- Foetal vessels are within the foetal membranes and travel across the internal os -> prone to bleeding when membranes rupture
383
criteria for continuous CTG monitoring?
suspected chorioamnionitis or sepsis, or a temperature of 38°C or above
severe hypertension 160/110 mmHg or above
oxytocin use
the presence of significant meconium
fresh vaginal bleeding that develops in labouur
