year 5 obs and gynae

Question 1

Trophoblastic disease is hydatiform mole are risk factors for

Answer 1

hypermesis grvidarum

Question 2

what other tx in addition to saline 0.9% for hypermemis can we give

Answer 2

IV vit b and C - pabrinex - prevent wernickes

Question 3

uterus size greater than expected for gestational age and abnormally high serum hCG

Answer 3

complete hydatiform mole

Question 4

Menorrhagia, anaemia, bulk-related symptoms e.g. bloating/urinary frequency →? uterine fibroids how to manage

Answer 4

COCP

Question 5

is Undiagnosed vaginal bleeding is a contraindication for hrt

Answer 5

yes

Question 6

A 49-year-old patient presents with hot flushes and mood swings. She has no previous medical history or family history. She has been amenorrheic since her Mirena (levonorgestrel) coil was placed 2 years ago. She would like to consider HRT with the least side effects

Answer 6

oestrogen patch

The patient requires combined HRT as she has a uterus, so requires progesterone for protection of the endometrial lining against estrogen. However, the patient has a Mirena coil in situ, which is the only form of contraception licensed to be used as the progesterone component in HRT. It is licensed for 4 years if used as HRT.

Therefore the patient only requires oestrogen preparation only.

Transdermal oestrogen such as patches and gels do not have an increased risk of deep vein thrombosis, compared to oral oestrogen preparations

Question 9

when do you give SSRI in premenstrual syndrome

Answer 9

Sertraline during the 14 days before her period starts

SSRIs, either continuously or during the luteal phase, may help premenstrual syndrome

lutueal phase is second half of the menstrual cycle

Question 9

how much vit d should pregnant women be taking

Answer 9

10micrograms of vitamin D

Question 10

first-line eclampsia

Answer 10

MgSO4

treatment should continue for 24 hours after last seizure or delivery (around 40% of seizures occur post-partum)

Question 11

risk factor for placental abruption

Answer 11

ABRUPTION:
A for Abruption previously;
B for Blood pressure (i.e. hypertension or pre-eclampsia);
R for Ruptured membranes, either premature or prolonged;
U for Uterine injury (i.e. trauma to the abdomen);
P for Polyhydramnios;
T for Twins or multiple gestation;
I for Infection in the uterus, especially chorioamnionitis;
O for Older age (i.e. aged over 35 years old);
N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)

Question 12

A woman at moderate or high risk of pre-eclampsia should take

Answer 12

aspirin 75-150mg daily from 12 weeks gestation until the birth

Question 13

difference between cholestasis or acute fatty liver of preg

Answer 13

Clinically, cholestasis of pregnancy is characterised by severe pruritis, whereas acute fatty liver of pregnancy has predominantly non-specific symptoms (e.g. malaise, fatigue, nausea

Question 14

how low should hb be in a patient with postpartum bleeding to detmine iron supplementation

Answer 14

A cut-off of 100 g/Lshould be used in the postpartum period to determine if iron supplementation should be taken

Question 15

PPH mx

Answer 15

mechncial - palpate fundu s
medical - IV oxytocin , ergometrine IM , ( not asthma), misoprostol sublingual, surgical , intrauterine balloon tamponade then suuture and ligaton - hysterectomy is life saving

Question 16

when does placenta prevaemia occur

Answer 16

2nd and 3rd trimester

Question 17

vasa preaevia triad

Answer 17

Vasa praevia would typically present with sudden and potentially severe vaginal bleeding, rupture of membranes and fetal bradycardia

Question 18

If a breastfed baby loses > 10% of birth weight in the first week of life what do you do

Answer 18

referral to a midwife-led breastfeeding clinic may be appropriate

Question 19

At what gestation is further investigation required if there are not foetal movements felt by this time?

Answer 19

24weeks

Question 20

Pregnant women ≥ 20 weeks who develop chickenpox are generally treated with

Answer 20

oral aciclovir if they present within 24 hours of the rash

Question 21

The requirements for instrumental delivery can be easily remembered by the mnemonic FORCEPS:

Answer 21

Fully dilated cervix generally the second stage of labour must have been reached
OA position preferably OP delivery is possible with Keillands forceps and ventouse. The position of the head must be known as incorrect placement of forceps or ventouse could lead to maternal or fetal trauma and failure
Ruptured Membranes
Cephalic presentation
Engaged presenting part i.e. head at or below ischial spines the head must not be palpable abdominally
Pain relief
Sphincter (bladder) empty this will usually require catheterization

Question 22

what is bishops score

Answer 22

Evaluating cervical readiness for labour

Question 23

What normally happens to blood pressure during pregnancy?

Answer 23

Falls in first half of pregnancy before rising to pre-pregnancy levels before term

Question 24

Bishop score is ≤ 6

Answer 24

Vaginal PGE2 or oral misoprostol is the preferred method of induction of labour

Question 25

puerperal sepsis (postpartum infection) temp over 38 following 14 days post delivery cx

Answer 25

urinary tract infection wound infections (perineal tears + caesarean section) mastitis venous thromboembolism Management if endometritis is suspected the patient should be referred to hospital for intravenous antibiotics (clindamycin and gentamicin until afebrile for greater than 24 hours)

Question 26

abx of choice in GBS

Answer 26

Benzylpenicillin

Question 27

what do you need to monitor when giving magnesium in eclmapsia

Answer 27

Respiratory rate as risk of resp depression

Question 28

in cord prolapse - if the cord is past the level of the introsius can you put it back in

Answer 28

For the management of cord prolapse, the presenting part of the fetus may be pushed back into the uterus to avoid compression. Tocolytics may be used. If the cord is past the level of the introitus, it should be kept warm and moist but should not be pushed back inside. no all fours tocolytics retrofilling of the bladder

Question 29

induction of labour

Answer 29

sweep, vag prost, oral prost, oxytoicn, amniotomy, baloon , under 6 vag over 6 -amnitomy or infusion

Question 30

pph list of things to do

Answer 30

mechnical - rub medical - oxytocin, ergom, carbopost, srugical - ballon, b lynch suture , ligation of ialiac and uterine hysterectomy if uncontrolled

Question 31

Premature ovarian insufficiency should not be diagnosed on the basis of one raised FSH level - a further sample should be taken when

Answer 31

4-6 weeks later

Question 32

management of POI

Answer 32

hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of the average menopause (51 years)

Question 33

mx endometriosis

Answer 33

Nsaid and paracetoalm COCP or progesterone only GnRH analogues - low oestoegne levels - although fertility rates redue surgery - lap excision/ablation Ovarian cystectomy (for endometriomas) is also recommended

Question 34

is candida a clinical dx

Answer 34

yes

Question 35

incomplete and missed mscarriage differ how in mx

Answer 35

missed need both mifepristone and misoprosti incomplete only misoprostol

Question 36

if metoclopramide is used in preg how long should it be used for

Answer 36

Metoclopramide is an option for nausea and vomiting in pregnancy, but it should not be used for more than 5 days due to the risk of extrapyramidal effects

Question 37

omplications of PPROM

Answer 37

fetal: prematurity, infection, pulmonary hypoplasia maternal: chorioamnionitis

Question 38

what should be given at PPROM and when is delivery consideed

Answer 38

oral erythromycin should be given for 10 days antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome 34 weeks

Question 39

spontanoeus bacterial peritonitis - gastro q

Answer 39

e.coli

Question 40

what single lab finding y