Obs Gyne - Flinders Med School

Front 1

always take a Pap smear when doing a speculum examination unless

Back 1

results are likely to be obscured by blood or unless a normal smear was obtained recently.

Front 2

what do you do with a young woman with amenorrhoea or menstrual irregularity who presents with pain and bleeding

Back 2

always do a pregnancy test and exclude ectopic pregnancy

Front 3

dx low abdo pain in female

Back 3

non gynaecological: appendix, urinary tract infection
gynaecological: pelvic inflammatory disease, endometriosis, miscarriage (threatened, missed, complete), ectopic

Front 4

what additional hx of low abdo pain in a female do you need

Back 4

prior occurences, details of loss (postcoital), hx pain, symptoms, bladder/bowel change, temp, menstral hx, contraceptive use

Front 5

What is the cellular cause of a positive pregnancy test?

Back 5

a trophoblast producing HCG somewhere.

Front 6

majority of extrauterine pregnancies are located in

Back 6

the uterine tube (97%)

Front 7

what do you do if ectopic pregnancy is suspected?

Back 7

urgent assessment in hospital to either confirm or exclude ectopic pregnancy

Front 8

whose life is at stake with ectopic preg?

Back 8

there is no way in which fetus can be preserved and no chance of the pregnancy developing normally. The issue here is mother's life

Front 9

ectopic pregnancy - how to exclude

Back 9

urgent vaginal ultrasound examination to see whether there is an intrauterine pregnancy or not, whether it is developing normally or not, or whether the pregnancy is outside the uterus.

Front 10

What is involved in taking an informed consent for a laparoscopy?

Back 10

risk anaesthetic, damage vessel/bladder/ureter/stomach/intestine 1 in 2k, haemorrhage -> transfusion, gas embolism, infection

Front 11

laparoscopy description

Back 11

GA, co2 in abdo via verres needle, laproscope (camera), accessory ports +-, instruments via ports, resid. co2 may cause shoulder pain

Front 12

preop preparation for ectopic surgery

Back 12

complete blood picture (FBE), group and save, antid if rhD neg, iv access, fasting time (nill mouth 6 hrs), advise staff

Front 13

Where does the progesterone come from?

Back 13

Trophoblast itself or the corpus luteum. The life span of the corpus luteum is limited unless it is sustained by HCG produced by the trophoblast (a corpus luteum that lasts for 17 days or more indicates pregnancy until proven otherwise).

Front 14

risk factors for ectopic

Back 14

anything hinders or delays tx of ovum to uterine cavity or implantation in uterine cav
PID, prior tubal surgery, tubal sterilisation, progesterone contraceptives, IUCDs, incr materal age, smoking

Front 15

ectopic symptom triad

Back 15

­ amenorrhoea
­ abdominal pain
­ irregular vaginal bleeding

Front 16

most specific findings on clinical examination for ectopic

Back 16

peritoneal signs and cervical motion tenderness

Front 17

clear evidence of ectopic pregnancy would be the combination of:
­

Back 17

HCG level in excess of 1,000 milliunits/mL and empty uterus on transvaginal ultrasound.

Front 18

HCG levels at 5, 6 and 7 weeks

Back 18

1k, 2.5k and 13k mIU/mL

Front 19

ectopic management 3 ways

Back 19

conservative (i.e. wait and see)
, medical (i.e. methotrexate systemically), surgical: laparoscopically or by laparotomy salpingostomy or salpingectomy

Front 20

methotrexate -> what does it do to fetus?

Back 20

methotrexate is a folate antagonist and cytotoxic agent. It blocks DNA synthesis in rapidly dividing cells, such as the rapidly growing trophoblast - abortant

Front 21

endometriosis is

Back 21

Students frequently define it as 'endometrium outside the uterus', which excludes cervical endometriosis and adenomyosis from the definition. Correct is: 'endometrium outside its normal location'

Front 22

When do you administer anti-D gammaglobulin during pregnancy

Back 22

after checking antibodies - baby rh+ and mother rh-
if mother rh- then administer prophylacticly

Front 23

Describe the components of informed consent for anti D maternal administration

Back 23

anti-D is blood product, vanishing small risk of blood-borne disease, anti-d admin will not affect this baby, will prevent rh sensit if this baby is rh pos, offers protection against rh disease in subseq pregnancies, may need to repeat periodically t/o preg (3 times?)

Front 24

preterm baby is imminent -> what should mum be administered

Back 24

commence course of corticosteroids betamethasone 11.4 mg intramuscular, 2 doses, 24 hours apart

Front 25

what does a GBS carrier mum need in birth

Back 25

antibiotics in labour 3 gram loading dose of benzyl penicillin IV, then 1.2 gram 4–hourly IV; if allergic for penicillin: azithromycin 500 mg IV daily

Front 26

why would one artificially rupture the membranes

Back 26

to induce labour

Front 27

is a 950 gram baby normal

Back 27

Nari, it's extremly low birthweight (< 1kg)

Front 28

What is the Kleihauer test and what does it measure?

Back 28

The Kleihauer test (described by Kleihauer, Braun and Betke in 1957) is used to detect and quantify fetal red cells in the maternal circulation.
The test does not test for Rh D positive cells, but tests for the presence of red cells containing Hb F (fetal haemoglobin); to judge whether fetomaternal transfusion occurred in a woman who is still pregnant and therefore may be causing fetal anaemia

Front 29

Low birthweight immediate risks for baby (x3)

Back 29

a)­ respiratory morbidity (associated with preterm birth and passive smoking) b)sudden infant death (associated with preterm – growth restriction – smoking)
c) deficit in cognitive and neurological development

Front 30

In later life low birthweight has associations with:
­

Back 30

increased insulin resistance
­ elevated cholesterol
­ hypertension
­ diabetes
­ cardiovascular disease
­ obstructive lung disease
­ renal impairment

Front 31

risks for "cervical intraepithelial neoplasia," or "CIN."

Back 31

young age at coitarche (two-fold increase with coitarche less than 16 years), multiple sexual partners (epidemiologically, multiple is considered to be > 10), ‘high risk’ male partners, HPV infection (especially oncogenic strains: HPV types 16/18 and also 31/33/35), smoking, high parity (developing nations)

Front 32

what if lab confirms aberrant CIN from swab results

Back 32

colposcopic assessment of the cervix

Front 33

what is LLETZ

Back 33

large loop excision of the transformation zone (< than 7mm deep)

Front 34

colposcopic procedure to determine CIN deep in os

Back 34

surgical cold knife cone biopsy

Front 35

is a pap smear a diagnostic or screening test

Back 35

Pap smear screening is aimed at preventing cervical cancer by detecting (and leading to the treatment of) pre-cancerous lesions. Pap smear screening is less reliable for the detection of cervical cancer. It is not a diagnostic test

Front 36

What is cervical carinoma stages 0 and II

Back 36

• stage 0 carcinoma in situ (preinvasive)
• stage I confined to the cervix
I-A only microscopically visible
I-B clinically visible
• stage II extends beyond the cervix but does not extend to the pelvic walls
II-A without parametrial involvement
II-B with parametrial involvement
• stage III extends to side wall but does not extend beyond the pelvis
• stage IV invades bladder or rectum or extends (or spreads) beyond the pelvis

Front 37

How does cervical cancer spread?

Back 37

local spread to surrounding structures + lymphatic (haematogenous is usually later)

Front 38

What treatment options are available for the management of cervical carcinoma?

Back 38

Surgery and radiation. Rad can be used in all stages of disease whereas surgery is generally limited to patients with stage I and II-A disease

Front 39

what is a radical hysterectomy

Back 39

a useless term in medicine due to lack of precision.

Front 40

How do you describe a hysterectomy accurately

Back 40

1. refer to hysterectomy as total or subtotal depending on whether the cervix is removed or not.
2. add "with (unilateral or bilateral) ovariectomy" (or oophorectomy) depending on whether ovaries are removed.
3. add "with lymphadenectomy" for extension of the surgery to the upper vaginal cuff, parametria and lymph nodes.

Front 41

maternal hypertension is defined as

Back 41

• hypertension is diagnosed if systolic blood pressure is ≥ 140 mm Hg and/or diastolic blood pressure is ≥ 90 mm Hg on two separate occasions at least 4 hours apart (some consider a single diastolic reading ≥ 110 mm Hg as equivalent)

Front 42

significant material proteinuria is defined as

Back 42

≥ 300 mg per 24 hours or ≥ 30 mg per mmol creatinine in a spot sample (some consider two or more 2+ proteinuria readings by dipstick in clean-catch specimens at least 4 hours apart as equivalent

Front 43

Gestational hypertension is defined as

Back 43

hypertension arising after 20 weeks gestation which is not associated with other features of a multisystem disorder and which resolves within 3 months after pregnancy

Front 44

preeclampsia is

Back 44

gestational hypertension associated with features of a multisystem disorder:
- proteinuria (the most common, but not an obligatory sign)
- abnormal renal function
- abnormal liver function
- neurological problems (e.g. hyperreflexia)
- haematological disturbances (e.g. low platelets, haemolysis)
- utero-placental compromise (e.g. fetal growth restriction)

Front 45

Eclampsia is

Back 45

convulsions and / or coma in a woman with preeclampsia

Front 46

risks of pregnancy with IUCD in situ:

Back 46

Given pregnancy with IUCD in place, spontaneous miscarriage arises 50%, Significant risk of septic abortion necessitates removal of IUCD if pregnancy is confirmed and strings are visible.

Front 47

if maternal BP > 170mm or > 110 diastolic represents a

Back 47

med emerg -> admission to a hospital immediately and treatment to prevent eclampsia and cerebral haemorr

Front 48

maternal complications of preeclampsia

Back 48

• Eclampsia (can occur up to 48 hours postpartum)
• Multiple organ dysfunction (hepatic, renal, vascular)
• Bleeding: mainly cerebral and hepatic
• Coagulation disorders (beware: operative bleeding)
• Maternal death (most frequently related to cerebral bleeding)

Front 49

infant complications of preeclampsia

Back 49

Infant uteroplacental vascularisation is threatened and thus:
• Fetal growth restriction (mainly with superimposed preeclampsia)
• Fetal death
• Need for preterm delivery (with its consequences)

Front 50

what tissue causes preeclampsia and eclampsia?

Back 50

It occurs only in the presence of a placenta and is resolved by its removal.

Front 51

prophylactic magnesium sulphate is used to prevent

Back 51

eclampsia in women with preeclampsia

Front 52

magnesium sulphate should be administered whenever

Back 52

there is a genuine risk of an eclamptic fit.

Front 53

what is better treatment of eclampsia, magnesium sulfate or diazempam?

Back 53

MgSO4

Front 54

when explaining to mum, do you use the term fetus or babs?

Back 54

Nein

Front 55

What do variable decelerations indicate

Back 55

Decelerations are variable if there is no consistent relation with contractions - severe variable decelerations are likely to exhaust fetal reserves if they are not already a sign of it.

Front 56

What is a good cure for eclampsia?

Back 56

an emergency caesarean section if near term

Front 57

what is an unripe cervix

Back 57

one with unfavourable induction prospects

Front 58

What general factors does the Bishop score consider

Back 58

cervical dilation, effacement in %, consistency of cervix (eg firm/soft), position of cervix in pelvis (eg anterior or posterior), descent of fetal head in relation to spines

Front 59

How do you resolve the conflict between maternal and fetal rights?

Back 59

The mother has the right to choose management.

Front 60

Describe categories for informed consent for caesarean sections

Back 60

anaesthetic risks, operative risks, post operative risks, infant risks, and long term risks

Front 61

risk of recurrence of pre-eclampsia is about

Back 61

25% (probably higher after early onset disease or after eclampsia); recurrences tend to occur later in pregnancy and be less severe.

Front 62

List the effects of obesity in pregnancy?

Back 62

increased risks
• miscarriage
• fetal malformations (mainly, but not only neural tube defects)
• hypertension (pre-existent, gestational, and also preeclampsia)
• gestational diabetes
• caesarean section (both elective and unplanned – approximately 2-fold increase)
• operative and postoperative complications of caesarean section, including:
- anaesthetic risks
- prolonged operation time
- excessive bleeding
- thromboembolism
- impaired wound healing
- wound infection
- urinary tract infection
• macrosomia (with risk of shoulder dystocia)
• thromboembolism
• maternal infectious morbidity (especially postpartum and postoperative)
• all obstetric intervention including induction and augmentation of labour
• prolonged labour
• perineal trauma
• back pain
• asthma
• obstructive sleep apnoea
• depression (in and after pregnancy)
• breastfeeding difficulties

Front 63

Contrast a glucose challenge test vs a glucose tolerence test

Back 63

GTT is a diagnostic test and a GCT is a screening test. GCT - 50g glucose venous blood after one hour > 7.8mmol/L needs GTT , GTT 75 g glucose after 8hrs fast. GTT fasting gluc > 5.5 or 2hr gluc > = 7.8.

Front 64

postpartum bleeding is caused by

Back 64

uterine atony (> 90 %) until the uterus contracts well enough to crush spiral arteries to arrest flow and let coagulation occur

Front 65

describe the placental bed - how much blood does it transmit?

Back 65

The placental bed basically consists of a large area of open arteries (spiral arteries) fed by uterine arteries with a blood flow of about 500 mL per min at term (i.e. about one tenth of the entire blood volume)

Front 66

Unprotected regular intercourse will achieve pregnancy within a year in:

Back 66

­ ± 90% at age 25
­ ± 60% at age 38

Front 67

infertility is defined as

Back 67

failure to conceive within one year (with regular intercourse).

Front 68

How do you calculate expected date of delivery given 30 day cycle and an IVF pregnancy?

Back 68

266 days after fertilisation
OR
• Fertilisation plus (+) 280 days minus (-) 14 days

Front 69

what is an abortion

Back 69

a term that should not be used due to psychological and precision reasons - the clinical terms are either miscarriage or termination of pregnancy.

Front 70

What is oligospermia? How is it remedied?

Back 70

semen with a low concentration of sperm - a potential cause of infertility - may be increased (possibly) if there was insufficient period of abstinence

Front 71

What is a breech presentation?

Back 71

The baby enters the birth canal with the buttocks or feet first as opposed to the normal head first presentation. The majority of breech babies born are delivered by Caesarean section.

Front 72

OH NO, a woman has a breech presentation at 32 weeks, what to do?

Back 72

Breech presentation is frequent at 32 weeks (± 20%). No action required. Plan caesarean section if breech presentation persists

Front 73

What is the most reliable method to determine a baby's sex?

Back 73

Childbirth.

Front 74

What does it mean when the baby's head is crowning?

Back 74

It means you feel as thought not only a crown but the entire throne is trying to make it's way out of you.

Front 75

describe the three estrogens and when they occur

Back 75

estradiol (non-pregnant)
estriol (pregnancy)
estrone (menopause)

Front 76

what happens on days 0, 3 and 6 post conception

Back 76

day 0 --> fertilization in the distal oviduct
day 3 --> entry of morula into uterine cavity
day 6 --> implantation of the blastocyst onto endometrium, formation of trophoblast (placenta) and embryonic cells

Front 77

would you give coumadin to a pregnant woman?

Back 77

category X teratogen, verboden in pregnancy incls. isotretinoin, danocrine, pravachol, coumadin, cafergot

Front 78

what have lithium, streptomycin, tetracyclin, thalidomide, trimethodione and valproic acid got in common?

Back 78

teratogens

Front 79

What are the following risk factors for :
antiphospholipid syndrome, maternal diabetes, maternal trauma, severe maternal isoimmunization, fetal aneuploidy, fetal infection

Back 79

fetal demise

Front 80

what's the name of the procedure :
performed after 15 weeks; needle is placed under ultrasound; guidance ; amniotic fluid is aspirated; amniocytes are sent for karyotyping; neural tube defects are screened with alphafetoprotein and acetylcholinesterase

Back 80

amniocentesis

Front 81

name the technique used to visualize the endometrium under magnification

Back 81

hysteroscopy - abnormal areas of endometrium can be seen and biopsied indicated by endometrial carcinoma / dysfunctional uterine bleeding

Front 82

name the method of obtaining endometrial tissue for examination

Back 82

Dilation and curettage. Largely a diagnostic tool in the managementof dysfunctional uterine bleeding. Can be used to treat endometrial polyps.

Front 83

name the surgical method of removing body of uterus conserving cervix

Back 83

subtotal hysterectomy

Front 84

name the method : enucleation of the tumour from its capsule of ovairan tissue, which is then rolled into a little bundle and held together with sutures, thus preserving ovarian function”

Back 84

ovarian cystectomy