#passmed 2023 > O & G > Flashcards

O & G Flashcards

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1
Q

If a girl hasn’t had menarche (aka doesn’t bleed or have periods) but has cyclical pain, what’s the Dx?

A

Imperforate hymen

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2
Q

What is the FIRST line tx for Infertility bs PCOS, with NORMAL BMI?

A

Clomifene

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3
Q

What Tx can you give for infertility bc PCOS in OBESE pt?

A

Metformin

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4
Q

How does Ovarian Cancer usually spread?

A

Local invasion within pelvic region

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5
Q

When a woman with PPH has Uterine atony (aka soft uterus after giving birth) what should you do to stop bleeding?

A
  1. Bimanual compression
  2. Oxytocin (encourages contractions –> stops bleeding)
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6
Q

When should you do continuous CTG monitoring in labour? (6 things)

A

Any of these present / arise @ labour:
1. Sus chorioamniotis / sepsis
1. Temp 38C+
1. HTN 160/110
1. Oxytocin use
1. Meconium present
1. Fresh vaginal bleeding

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7
Q

What are the SSRI’s of choice for breastfeeding women? (2 things)

A
  1. Sitalopram
  2. Paroxetine
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8
Q

What is extreme N + V in pregnancy called?

A

Hyperemesis gravidaparum
(life threatening preg complication)

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9
Q

Why is Hyperemesis gravidaparum dangerous?

A

Causes:
1. Dehydration
1. Elec imbalance

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10
Q

What are the Tx options for Hyperemesis gravidaparum? (3 things)

A
  1. Anti-histamines (FIRST LINE)
  2. Ondansetron / metoclopramide (2nd)
  3. IV fluids
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11
Q

What are the complications of Hyperemesis gravidaparum? (3 things)

A
  1. Wernicke’s encephalopathy
  2. Mallory-Weiss tear
  3. Small baby / pre-term birth
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12
Q

How will a preg woman w Wernickes enephalopathy 2ndary to (Hyperemesis gravidaparum) present? (2 things)

A
  1. Diplopia (double vision)
  2. Ataxia (slurred speech + poor balance aka drunk)
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13
Q

What is the Tx for Wernickes enephalopathy 2ndary to (Hyperemesis gravidaparum)?

A

Pabrinex (IV vit B + C)

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14
Q

What meds are CI during breastfeeding? (9 things)

A
  1. Psych drugs (lithium / benzos)
  2. Abx (x3)
  3. Sulphonamides
  4. Sulfonylureas
  5. MTX
  6. Aspirin
  7. Carbimazole
  8. Cytotoxic drugs
  9. Amiodarone

PASS MACCA

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15
Q

What abx are CI during breastfeeding? (3 things)

A
  1. Ciprofloxacin
  2. TTC
  3. Chloramphenicol
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16
Q

When should you refer to Obstetrician if preg woman can’t feel baby kick?

A

24 weeks

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17
Q

What is the FIRST line med for Gestational HTN?

A

Oral labetalol

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18
Q

What CF / Hx would make you sus Ovarian cancer? (4 things)

A
  1. Old age
  2. Abd pain
  3. Bloating
  4. FHx of breast / ovarian cancer (BRCA involvment)
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19
Q

What med should you give in preparation of Hysterectomy for Fibroid removal?

A

GnRH agonist (e.g Leuprolide)

(Reduces fibroid size)

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20
Q

What should you give a pregnant woman w fever of 38+ C?

A

Benzylpenicillin

(for GBS prophylaxis)

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21
Q

What bac causes GBS in pregnant women?

A

Streptococcus agalacticae

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22
Q

What type of bacteria is Streptococcus agalacticae?

A

Gram positive

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23
Q

What can GBS cause in pregnant mother?

A

Usually asymptomatic

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24
Q

What can GBS cause in newborn? (3 things)

A
  1. Pneumonia
  2. Meningitis
  3. Sepsis
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25
What is Lochia?
Passing blood / mucus / uterine tissue for 6 weeks after pregnancy
26
When should you do further investigation (US) for Lochia?
If persists past 6 weeks post-partum
27
What is a common cause of itchiness in 3rd trimester of pregnancy?
Intrahepatic cholestasis of pregnancy
28
What are the CF of Intrahepatic cholestasis of pregnancy? (3 things)
1. Itch 2. Jaundice 3. No rash
29
What will the bloods say in Intrahepatic cholestasis of pregnancy? (3 things)
1. Raised LFTs 1. Raised bilirubin 1. Anaemia
30
What is the Mx of Intrahepatic cholestasis of pregnancy? (3 things)
1. Ursodeoxycholic acid (symptom relief) 2. Weekly LFTs 3. Induce @ 37 wks
31
What are the CF / Hx of Sheehan's syndrome (aka post-partum pituitary necrosis)? (4 things)
1. Hx of PPH 1. Hypothyroidism (bc hypopituiary) 1. Problems w milk prod 1. Amenorrhoea
32
What blood results in pregnancy suggest the foetus has Downs syndrome? (3 things)
1. ↑ HCG 1. ↓ PAPP-A 1. Thickened nuchal translucency (defo pregnant, low pappa, thick nuchas)
33
What does a US finding of Retroplacental blood in pregnant woman mean?
Placental abruption
34
How do you Mx Placental abruption if foetus alive + well and less than 36 weeks? (2 things)
1. Admit pt + monitor 2. IV Corticosteroids
35
What is the Dx measurement for Gestation DM? (2 things)
1. FBG 5.6+ 1. 2 hour glucose: 7.8+ (either one)
36
What should you monitor when you give Magnesium sulphate? (2 things)
1. Reflexes 2. Resp rate (bc resp depression)
37
What does the Bishop score tell you?
Need for induction
38
What do the numbers of Bishop score tell you?
* Less than 5: Needs induction bc labour won't start * More than 9: Labour will happen spotaneously
39
What can a high AFP in pregnancy mean? (3 things)
1. NTD (e.g anencephaly) 2. Abd wall defects (e.g omphalocele) 3. Multiple pregnancy
40
What can a low AFP in pregnancy mean? (3 things)
1. Downs syndrome 1. Trisomy 18 1. Maternal DM
41
What can women who stop breastfeeding sometimes get?
Galactocele (grape sized lump on breast)
42
What are the CF / Hx of Galactocele?
1. Recently stopped breastfeeding 1. Well circumscribed 1. Aspiration --> white fluid (milk) 1. Painless 1. No local / systemic inf signs
43
What are some funny named Placenta disorders in pregnancy? (3 things)
1. Placenta accreta (least severe) 2. Placenta increta 3. Placenta percreta (most severe)
44
What can the Placenta increta / percreta lead to?
PPH
45
What happens in Placenta accreta?
Chorionic villi attach to Myometrium but DON'T invade
46
What happens in Placenta increta?
Chorionic villi invade Myometrium --> cause PPH
47
What happens in Placenta percreta?
Chorionic villi invades Perimetrium
48
What are the folic acid req in pregnancy?
* All women: 400mcg daily * High risk women: 5mg daily
49
Who are the High risk women that require 5mg folic acid daily? (4 things)
1. Obese 2. On epilpetics 3. DM / Coeliac disease / Thalassaemia 4. Either partner has Hx / FHx of NTD
50
When should Folic acid be taken until in the pregnancy?
First 12 weeks
51
What are the Vit D requirements in pregnancy?
Vitamin D 400IU once daily For whole pregnancy (all women)
52
What is the FIRST line SURGICAL Mx of PPH if all medical options fail?
IU Bakri catheter (aka balloon tamponade)
53
What are the CF of Turners syndrome? (4 things)
1. Primary amenorrhoea (aka no menarche) 2. No 2ndary sexual characteristics 3. Widely spaced nipples 4. Raised FSH / LH
54
What is the Mx if an ectopic pregnancy feotus has a HEART BEAT?
Surgical Mx aka Salpingectomy
55
Do you need to investigate with swabs if Vaginal candidiasis CF are obvious?
No
56
What should you do if you sus Vaginal candidiasis?
Give Oral fluconazole
57
What will Ovarian torsion show in US?
Whirpool pattern in R/L IF
58
When you have Cord prolapse what should you do to avoid compression? (5 things)
1. Use Tocolytics 2. Push foetus back in 3. Advise pt to go on all 4s 4. Do not push cord back in 5. Immediate C section
59
If a pt has HTN before 20 weeks, what the Dx?
Pre-existing HTN, because you can’t get pregnancy induced HTN / Pre-eclampsia before 20 weeks
60
What should you check for in US for Monochronic (aka one placenta) Twins between 16-24 weeks?
* Twin to Twin Transfusion Syndrome (TTTS) * Because one twin can take all the blood
61
What is a FIRST degree tear in delivery according to RCOG? (2 things)
1. Superficial damage w NO muscle involvement 2. DOESN’T require repair
62
What is a SECOND degree tear in delivery according to RCOG? (3 things)
1. Perineal muscle torn 2. NOT involving anal sphincter 3. Requires suturing on WARD (midwife can do, remember Stella said she done it)
63
What is a THIRD degree tear in delivery according to RCOG? (3 things)
1. Perineal muscle torn 2. Anal sphincter complex involved 3. Requires repair in THEATRE (Th for Th)
64
What is a FOURTH degree tear in delivery according to RCOG? (4 things)
1. Perineal muscle torn 2. Anal sphincter complex involved 3. Rectal mucosa also involved 4. Requires repair in THEATRE (Th for Th)
65
What is the FIRST line tx for Pregancy Cholestasis (presents with itching)?
Ursodeoxycholic acid
66
What meds can you give to shrink Fibroids?
GnRH agonists
67
What are the side fx of GnRH agonists? (3 things)
1. Loss of bone mineral density 2. Hot flushes 3. Vaginal dryness
68
What is the screening tool for Post-natal depression?
Edinburgh scale (nas scotlanda mudapriseen ya)
69
What are the FIRST line anti-emetics in Pregnancy? (2 things)
1. Promethazine 2. Cyclizine
70
What is the FIRST line Tx for Fibroids (as long as no uterine cavity distortion)?
Levonorgestrel intrauterine system (LNG-IUS)
71
What is the only effective Tx for infertility caused by Large fibroids?
Myomectomy
72
What should you do if baby in Breech before 36 weeks?
Wait until 36 weeks and see (if still breech do external cephalic version ECV)
73
What should you sus if a 50+ yr old woman has IBS CF (cramping, bloating, diarrhoea)?
Ovarian cancer (check CA-125 levels)
74
When should you sus Ovarian cancer? (4 things)
Over 50 with: 1. LOA 2. Bloating 3. Pelvic / abd pain 4. Urgency / Frequency
75
What is the normal level of CA-125?
35 (less than that) (i7na sakneen wen fil Sudan)
76
What does adding progestogen to HRT increase the risk of?
Breast cancer
77
What type of HRT doesn’t increase risk of VTE?
Transdermal HRT
78
What is a RT for Hyperemesis Gravidarum (N+V in preg)?
Twin pregnancy
79
If the foetus is having decelerations in CTG, with pre-eclampsia of mother, what should you do?
Emergency C section (not induction of labour)
80
What is a long term complication of Vaginal hysterectomy w Ant-Post repair?
Vaginal vault prolapse
81
If a pregnant woman has exposure to Chicken box before 20 weeks what should you do?
Give VZIG
82
When should you start Active Mx in labour?
3rd stage
83
How long does Active Mx in labour last?
30 mins
84
What does Active Mx in labour involve? (3 things)
1. Uterotonic drugs (oxytocin / ergometrine) 2. Defer clamping + cutting cord (for 1 minute, but b4 5 mins) 3. Controlled cord traction after signs of placental separation (aka first gush of blood)
85
When is Ergometrine CI in Active Mx in labour?
HTN
86
What is the CI for using Epidural anaesthesia ring labour?
Coagulopathy (3ashan 7ashikook, n ur gonna bleed)
87
What should you do with a pregnant woman with abd trauma?
Rhesus testing (ASAP) (if Rh negative give anti-D)
88
How do you differentiate between Placenta Praevia and Placental Abruption?
Placental Praevia = PAINLESS bleeding
89
What comes first in Placental Abruption, pain or bleeding?
Pain (SEVERE)
90
What are the NORMAL lab findings in pregnancy? (3 things)
1. Reduced urea 2. Reduced creatinine 3. Increased urinary protein loss
91
What heart signs are NORMAL in pregnancy? (3 things)
1. Ejection systolic murmur (96%) 2. Third heart sound (84%) 3. Peripheral oedema
92
What are the CF of Vasa Praevia? (2 things)
1. Painless vaginal bleeding 2. Fetal bradycardia
93
Who does Vasa Praevia effect? (2 points)
1. Can kill baby 2. No major maternal risk
94
What STI does gram-negative diplOcOccus cause?
GOnOrrhoea (O O and O O)
95
What STI gives a musty green discharge?
Trichomonas vaginalis | (mustee like a treechomonas)
96
What is the first step in Chickenpox exposure in pregnancy?
Check antibodies
97
What do you do if Chickenpox antibodies are positive?
She’s immune so reassure
98
What do you do if Chickenpox antibodies are negative (aka not immune) and less than 20 wks?
VZIG
99
What do you do if Chickenpox antibodies are negative (aka not immune), and more than 20 wks?
VZIG or oral aciclovir
100
What is a obv CF of Endometriosis?
DEEP dyspareunia
101
What is the cause of Primary amenorrhoea if the girl has breast tissue, but no axillary / pubi hair, but has elevated testosterone?
Androgen insensitivity syndrome
102
What is the point of doing a Kleihauer test? (3 things)
1. Done after heavy bleeding @ pregnancy 2. Estimates volume of FMH (foeto-maternal haemorrhage) 3. This tells you dose of additional anti-D you need to give
103
What is the Dx when PID develops to RUQ pain (and referred shoulder pain)?
Fitz-Hugh-Curtis Syndrome
104
What increases the risk of breast cancer?
HRT
105
What should you do when you sus Obstetric cholestasis?
Check LFT
106
What is the Combined Triple Test to see chances of foetus having Downs?
1. b-HCG = High 2. PAPP-A = Low 3. Nuchal translucency on US = Thickened
107
What do you do if Combined Triple Test says high chance of Downs syndrome?
* Invasive: Amniocentesis * Non-invasive: Non-Invasive Prenatal Screen Test (NIPT)
108
What dose of Folic acid do you give if Epilepsy + Pregnant?
5mg
109
Why should Metoclopramide not be used for more than 5 days in Hyperemesis Gravidum?
Because risk of extrapyramidal side fx (tremor / increased tone)
110
Who should have high dose Folic acid 5mg (apart from Epilepsy ppl)?
Obese (mara kabeera lazim dose Kabeer)
111
What is a side fx of Phenytoin?
Folic acid deficiency
112
How do you differentiate between stages of labour?
* Stage 1: Onset of true labour --> cervix fully dilated (10cm) * Stage 2: Full dilation to delivery of foetus * Stage 3: Until placenta completely delivered
113
What is a common inf you get in pregnancy?
Vaginal candidiasis
114
What are the CF of Vaginal candidiasis? (4 things)
1. Cottage cheese thick discharge (not smelly) 2. Vulvitis (superficial dyspareunia) 3. Vulval erythema 4. Itch
115
What is the Tx for Vaginal candidias?
Clotrimazole pessary
116
What surprisingly decreases risk of Hyperemesis gravidarum?
Smoking (zab6aha be sijara)
117
What is the Mx for only SYMPTOMATIC relief of Obstetric cholestasis?
Ursodeoxycholic acid (but evidence unclear)
118
What is the definitive Mx for of Obstetric cholestasis?
Induction of labour @ 37 weeks
119
What is the cut off to start Tx for Iron deficiency Tx?
110
120
What additional measure can help in McRoberts manoeuvre?
Suprapubic pressure (not fundal pressure)
121
When can you do US scan to check for Down syndrome, aka see nuchal screening?
11 - 13+6 weeks
122
When is the booking clinic done?
8-12 weeks (even tho I said before 10 weeks)
123
When can you refer to Colposcopy despite 3 NORMAL cytology but HPV positive?
After 3 successive HPV positives (aka you send her away and back after 1 year, 3 times)
124
How many Inadequate samples of Cervical smears (aka send them and come back after 3 months) can you get before you send for Colposcopy?
2 inadequate samples
125
What food should you avoid Pregnancy?
Cooked liver (bc vit A = teratogen)
126
What increases the risk of Placental abruption? (3 things)
1. Maternal age 2. Multiparity 3. Maternal trauma
127
What are the options if HIV pt in labour has a viral load of less than 50?
Normal vaginal delivery (0-50 normal range)
128
What are the options if HIV pt in labour has a viral load of OVER than 50?
C section (0-50 normal range)
129
What should you do if you are delivery via C section bc HIV viral load is over 50?
Start antiretroviral infusion
130
What should you do if you are delivery via C section bc HIV viral load is over 50?
Start antiretroviral infusion
131
How long does bleeding carry on after vaginal delivery / C section?
2 weeks
132
What is the name of the normal bleeding that happens for 2 weeks after delivery?
Lochia
133
What are the characteristics of Lochia? (2 things)
1. Bright red --> brown 2. Pt stable (aka no temperature or anything)
134
What is the Mx of GBS for delivery?
Intrapartum abx (aka when labour starts)
135
What is the abx given @ GBS delivery?
IV benzylpenicillin
136
What types of bleeding suggest Cervical cancer? (2 things)
1. Post-coital bleeding 2. Intermenstrual bleeding
137
What can happen to fibroids during pregnancy?
They can grow
138
Why can fibroids grow in pregnancy?
Bc increased oestrogen
139
Apart from Post partum depression, what MH thing can happen after birth?
Post Partum Psychosis (they go crazy)
140
What is the Mx for Post Partum Psychosis?
Admit into hospital
141
What are the stages of MH illnesses Post Partum? (3 things)
1. Blues (60-70%) 2. Postnatal depression (10%) 3. PP Psychosis (0.2%)
142
What are the complications of giving Ondansetron in pregnancy?
Small risk of Cleft lip / palate (but weigh risks to see)
143
What are the timing for administering MgS for a pt who is having seizures in labour?
Give MgS until 24 hours after delivery OR 24 hours after last seizure
144
What is the GOLD standard imaging for diagnosing Adenomyosis?
MRI
145
What is the GOLD standard investigation for diagnosing Endometriosis?
Laparscopy
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