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122 Cards in this Set

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What is the name of the newborn screening test?
Guthrie test
What does the newborn screening test, test for?
CF
PKU
Galactosemia
Congenital hypothryoidism
Amino acid disorder
Fatty acid metabolism disorders
What are two factors which can invalidate the results of the newborn screening test?
Antibiotics
Lack of enteral feeding
List the benefits of the OCP?
1. Decreases menorrhagia and dysmenorrhea
2. Acne
3. Ovarian and endometrial CA
4. PID
5. Regulation of menstral cycle
6. Benign cystic breast disease
7. Endometriosis
8. Contraception
List the side effects of the OCP?
1. DVT
2. PE/Stroke
3. Hypertension
4. Weight gain
5. Nausea
6. Decreases libido
What are some types of emergency contraception?
1. Combo pill (100ug estrogen+0.75mg levonorgestrel) 2 doses 12 hrs apart
2. Progestin only (levonorgestrel 2 doses 12 hrs apart)
3. Mifepristone (abortifacent)
4. IUD
What are the major fetal complications of multiple gestations?
1. increased mortality (5-10x higher)
2. prematurity
3. Twin-twin transfusion
4. Cord accidents (twisting)
5. Conjoined twins
6. IUGR
7. Low birth weight
8. Operative delivery
9. Placenta previa/abruption more common
What is the name of the drug which is given to stimulate ovulation in infertility (esp in PCOS)
Clomiphene
What are the major maternal complications of multiple gestations?
1. HTN
2. PPH
3. Pre-eclampsia
What are the most common infectious agents in mastitis?
1. Staph aureus
2. Streptococcus species
What is the treatment for mastitis?
1. Continue breast feeding or pumping
2. Warm, moist heat
3. NSAIDs
4. Dicloxacillin
5. Surgical drainage in the case of breast abscess
What are the benefits of breast feeding?
1. Maternal-fetal bonding
2. IgA
3. Decreases PPH (uterus contraction)
4. Economical
5. Ideal solute load for kidneys
6. ?prevent diabetes?
7. Contraception
8. Decreases risk of breast cancer and ovarian cancer
9. Decreased AOM in baby
10. Decreased SIDS
11. Get to know baby quicker
12. Decreases infections (esp GI)
13. lower antigenicity than cows milk (cow's milk protein allergy or eczema)
What are the risk/complications of breast feeding?
1. Infection transfer (HIV)
2. Difficult to quantify amount of each feed
3. NO Vit D or Fe
4. Longer feeding times
5. Sore cracked nipples
6. Oral candidiasis
In a glucose challenge test what is considered abnormal at 1 hour?
50g glucose load
>7.7mmol/L
If >11mmol/L then diagnose with GDM
In a glucose tolerance test what is the diagnostic criteria?
0hrs?
1hr?
2hrs?
3hrs?
0hrs >5.5 mmol/L
1hr >10.0 mmol/L
2hrs >8.0mmol/L
What are the fetal effects of GDM?
1. Macrosomnia
2. Increased risk of shoulder distocia
3. Neural tube defects
4. Atrial/Ventricular septal defects
5. Transposition of vessels
6. Hypoglycemia after birth
7. Renal anomalies
8. Stillbirth
What are the maternal risks/effects of GDM?
1. predisposition to DM in later life (50%)
2. Increases C/S rate
3. infection
4. PPH
5. HTN/pre-eclampsia
What are the beneficial effects of HRT?
1. Hot flushes control
2. Osteoporosis
3. Urogenital symptoms
4. Vaginal dryness
5. Sleep improvements
6. Colorectal cancer
What are the risks of HRT?
1. DVT/PE/Stroke
2. Breast cancer
3. Endometrial/Ovarian cancer (estrogen only HRT)
What is a non-hormonal drug given to treat menorrhagia?
Tranexamic acid
What is the Bishop score and what are the components?
Measure of favourability for induction of labour
1. Consistency of cervix
2. Position of cervix
3. Dilitation of cervix
4. Effacement
5. Station
What screening questions should be asked to screen for pre-eclampsia?
Swelling of face or hands?
Headache?
Blurry vision?
Definition of antepartum hemorrhage?
Bleeding after 20 weeks gestation to before delivery
Major causes of antepartum hemorrhage?
1. Placental abruption (30%)
2. Placenta previa (20%)
3. Uterine rupture (rare)
4. Vasa previa (rare)
5. Coagulopathy
6. Cervical incompetence
7. Threatened premature labour
Risk factors for antepartum hemorrhage?
Previous abruption
Trauma
HTN
Cigarette smoking
Parity (increased)
Maternal age
Cocaine
PROM
Coagulopathies
Multiple pregnancies
Types of placenta previa?
1. complete
2. partial
3. marginal
4 low lying (withing 2cm of os)
Risk factors for placental previa?
Endometrial scarring (increased parity, LSCS, maternal age, prior curette)

Increased demand for placental surface area ie increased oxygen demand(maternal smoking, multiple gestation, higher altitudes)

Early gestational age
Initial management of mod to severe abruption
1. 2 large canulas
2. maternal vitals and hemodynamic status
3. Continuous CTG
4. IV fluid resus
5. Bloods: FBC, G&H cross match, QFMH, DIC screen, Coags
Management of PPH? (non-initial)
1. All initial managment stuff (vitals, bloods etc)
2. Oxytocin infusion
3. Direct uterine massage
4. Correction of DIC
5. Prostaglandins
6. B-lynch suture
7. Uterine embolization
8. Hysterectomy
What are some commonly used medications for overactive bladder?
Ditropan (Oxybutynin)
Detrusitol (Tolterodine)
Tofranil (Imipramine)
What are the risks associated with maternal smoking?
Lower birth weight
Perinatal mobidity and mortality (PROM, abruption, preterm delivery, stillbirth and SIDS)
What is the criteria for Fetal Alcohol Syndrome?
1. Prenatal alcohol exposure
2. Growth restriction pre and postnatally
3. Facial malformation (short palpebral fissures, thin upper lip, abnormal philtrum and hypoplastic midface
4. Neurdevelopmental disorders (language, motor, learning)
S&S of Endometriosis?
Recurrent dysmenorrhea
Dyspareunia
Low back pain
Infertility
Adnexal mass
Bowel/bladder symptoms
What are some risk factors for Endometriosis?
Early menarche
Late menopause
Shorter menstral cycle length
Longer duration of menstral flow
Not on OCP (is protective)
What are some medical treatments for endometriosis?
1. NSAIDs
2. OCP
3. IUD
4. Danazol (ovarian suppression)
5. GnRH analogue
What are some causes of post-menopausal bleeding?
1. HRT
2. Atrophic changes (endometritis, cervicitis, vaginitis)
3. Cancer (endometrial, cervical, vaginal, vulvar)
4. Polyps
5. Endometrial hyperplasia
6. Trauma
7. Bleeding disorder
What are the risk factors for endometrial cancer?
Medications - estrogen, tamoxifen
Family hx
Low parity, infertile
Endometrial hyperplasia
PCOS
HNPCC
Obesity
What endometrial thickness is considered abnormal in a post-menopausal women?
>4mm (if not on HRT)
What investigations would you perform in a women with PMB?
Pap smear
Endometrial biopsy
Transvaginal U/S (uterus, endometrial thickness, pelvic masses and free peritoneal fluid)
Hysteroscopy D&C
What pts would you book for colposcopy ?
1. 2 LGSIL smears in 12 months
2. Any HGSIL
3. Any glandular abnormality on smear
4. Persistent post-coital bleeding
5. Abnormal appearing cervix
What strains of HPV are implicated in Low grade cervical dysplasia?
HPV 6 and 11
What strains of HPV are implicated in High grade cervical dysplasia?
HPV 16 and 18
What % of LGSIL regress?
60-70%
What % of LGSIL progress to HGSIL?
4%
<0.1% progress to cancer
What % of CIN 2 regress?
43%
What % of CIN 2 progress?
22%
What % of CIN 3 progress?
14%
What % of CIN 3 regress?
32%
What are the risk factors for cervical cancer?
Preinvasive disease
smoking
HPV infection
Multiple sexual parters
Early age of first intercourse
Immunosuppression
What is the treatment for bacterial vaginosis (gardnerella vaginalis)?
Metronidazole 400mg bd x7days
What is the treatment for Chlamydia?
Azithromycin 1g stat dose OR
Doxycycline 100mg bd x 10days
No sex for 10days
Treat partners from last 6/12
What is the timeframe of post-partum blues?
First 10days
(peak 5 days)
What is the timeframe of post-partum depression?
First 6 months
(first 90 days greatest risk)
Define lie
Long axis of the fetus to the long axis of the uterus.
(Transverse or longitudinal)
Define presentation
Part of fetus felt on vaginal examination
Define position
The rotational relationship defined by the presenting part as the denominator ie normally cephalic = occiput
(OA, OP, L or R OT
Define Engagement
The station at which the maximum diameter of the presenting part is through the pelvic inlet. If vertex 1/5 palpable above symphsis pubis
Describe the mechanisms of labour (stages)
1. Descent
2. Flexion
3. Internal rotation
4. Crowning
5. Restitution
6. External rotation
7. Lateral flexion
What are some common signs of the begining of the second stage of labour?
Feeling of wanting to push or have bowels open
Perineal flattening
Vaginal gaping
Large mucoid show
Anal pouting
No cervix felt on examination
What are the common causes of bleeding in early pregnancy?
1. Misscariage
2. Ectopic
3. Normal bleeding
4. Non pregnancy related (cancer, trauma, urethra/UTI)
What are the treatment options for an ectopic pregnancy?
Surgical: Laparoscopy or Laparotomy

Methotrexate IM (if small and stable)
What is the normal rate of misscariage?
1:5
What is the mechanism of action of the progesterone only pill?
Viscous, hostile cervical mucous
Atrophic endometrium
How does depo-provera work?
Inhibits ovulation (progestogen containing)
How long does depo-provera last for ?
12 weeks
What are the side effects/disadvantages of depo-provera?
Change in periods (irregular bleeding, amenorrhea)
Cannot be removed (side effects for 3 months
Delay in return of fertility
Weight gain
Depression
Mood swings
Headaches
Acne
Breast tenderness
How long does Implanon last for?
3 years
How does Implanon work?
Inhibits ovulation
Thickens cervical mucous
Thinning of endometrium (atrophic)
How does the copper IUD work?
Impede sperm transport (copper kills sperm)
Blocks fertilization
Blocks implantation
How does the Mirena work?
Suppresses endometrium
Thickens cervical mucous
(inhibs ovulation in 50%)
At what gestational age is a fetal morphology scan done?
18-20 weeks
What is the overall incidence of trisomy 21?
1:660
What is the risk of trisomy 21 with a maternal age of 40years
Approx 1:100
What is the detection rate of trisomy 21 using free bHCG, PAPPA, NT and age?
90%
Which anesthetic is commonly used in epidurals?
Low conc long acting (bupivacaine aka Marcane)
What are the potential complications of epidurals?
Dural puncture with post dural puncture headache
Hypotension
N/V
Shivering
Failure
Neurological injury
Epidural abcess
Epidural hematoma
What is the definition of heavy menstral bleeding?
>80ml lost per cycle
How many pads or tampons used over a single mentral period is normal?
<21 pads/tampons
What are some causes of heavy menstral bleeding?
Uterine causes
- Fibroids, polyps, adenomyosis, dysfunctional uterine bleeding

- thyroid, coagulation abnormal.
- IUD
- Cancer
What are the treatments available in menorrhagia where sinister abnormality is suspected?
IUD
Transexamic acid
NSAIDs
OCP
Depot provera
What are some common causes of intermenstral bleeding?
Polyps
Cancer
Fibroids
Clotting disorders
HPA dysfunction
HRT
What conditions should be ruled out before a diagnosis of PCOS is made?
- Congenital adrenal hyperplasia
- Cushing syndrome
- Androgen producing tumors
- Hyperprolactemia
- Acromegaly
What is the diagnostic criteria for PCOS?
2 of the following 3:
1. S&S of androgen excess (hirsuitism, acne, alopecia)
2. Oligo/amenorrhea
3. Polycystic ovaries
What are some contradindications to medical termination of pregnancy?
1. >9 weeks gestation
2. Known or suspected ectopic
3. Allergy to mifepristone/misoprostol
4. Adrenal failure
5. Hemorrhagic disorder or anticoagulant therapy
6. IUD in place
After medical TOP, how should a pt be counciled regarding side effects and symptoms?
N/V
Diarrhea
Fever/chills
Cramping pain
Bleeding for 9-12 days
If soaking more than 2 pads/hr for more than 2 hours this is a warning sign
What are some common causes of respiratory distress in newborns?
1. RDS
2. TTN
3. Sepsis
4. Mec aspiration
5. Asphyxia (acidosis)
What combination of tumor markers produces higher sensitivity/specificity for ovarian cancer?
CA -125
HE4
Name some infections which impact mainly on the fetus
TORCH
B19
GBS
LIsteria
Yersinia
Name some infections which impact mainly on the Mother
Mastitis
Endometritis
Wound infection
Perineum
Pneumonia
Name some infections which impact both on the fetus and mother
VZV
HBV
HCV
HIV Chorioamnionitis
UTI
What are some causes of neonatal hypoglycemia?
Maternal GDM
Sepsis
Hypothyroidism
In-borne errors of metabolism
IUGR
Chorioamnionitis
Prematurity
What are some common causes of female infertility?
Ovulation abnormalities
Endometriosis
Pelvic adhesions
Cervical pathology
Uterine pathology
What are some complications associated with placenta previa?
1. Hemorrhage
2. Preterm delivery
3. Congenital malformations
4. Malpresentation
5. Placental abruption
6. Endometritis
What is the most common cause of IUGR?
Chronic hypertension
What is the diagnostic criteria for pre-eclampsia?
Pregnancy induced HTN that develops after 20weeks AND
>300mg of proteinuria in 24 hrs
What are some of the findings in pre-eclampsia?
Edema
Proteinuria
Rapid weight gain
Headache
Epigastric abdominal pain
Visual disturbances
Hyperreflexia
Increased Cr
Pulmonary edema
Elevated LFTs
What are the types of cephalic presentations and what are their diameters?
1. Vertex (9.5cm)
2. Deflexed vertex (11.5cm)
3. Brow (13.5cm)
4. Face (9.5cm)
What are some medications which can be used in HTN disease of pregnancy?
Hydralazine
Methyldopa
Labetalol
Nifedipine
What is HELLP syndrome
H- hemolysis
EL - elevated liver enzymes
LP - low platelets
What is the reccomended daily intake of folate in a women (with no risk factors) trying to fall pregnant?
0.5mg folate daily (at least 3 month prior and 3 months post falling pregnant)
What is the reccomended daily intake of folate in a women with a high risk of neural tube defects, trying to fall pregnant?
5mg daily (at least 3 months prior and 3 months post falling pregnant)
What are some S&S of neonatal withdrawal?
High pitched cry
Restlessness
Hypertonia
Jitterness
Tremors
Myoclonic jerks
Frequent yawning
Increased resp rate (>60/min)
What is the name of the scale for assessing neonatal withdrawal?
Finnegan scale
What is the difference in Complete breech and Frank breech?
Complete - Hips and knees flexed

Frank - Hips flexed, knees EXTENDED
What dates correspond to the 1st trimester?
0-12weeks
What dates correspond to the 2nd trimester?
13 - 28 weeks
What dates correspond to the 3rd trimester?
29weeks-birth (~40)
What is the average weight range of a neonate born at 40weeks?
2.5 kg to 4.0 kg
What are 3 signs of PROM?
1. Pooling of vaginal fluid in the posterior fornix
2. +ve Nitrazine test paper pH>6.0-6.5 (normal vag pH is 4.5-6)
3. Ferning on a slide prepared from a thin layer of fluid obtained from vaginal wall.
What is the cause of symmetric IUGR?
Usually secondary to an early gestational insult
What is the normal range of the menstral cycle?
21 to 35 days
What is the prevalence of the post-partum blues?
70%
What is the prevalence of the post-partum depression?
10-15%
What is the prevalence of the peurperal psychosis?
0.1%
What is the maternal death rate in Australia?
10:10,000
What physiological changes occur during pregnancy?
1. Cardiac output
2. Blood pressure (initially)
3. Stroke volume
1. CO - Increases 40%
2. BP - Decrease slightly
3. SV - Increases (10-30%)
In neonatal resus. what should the rate of chest compression be per minute?
Ratio of 3 compressions to 1 breath

90 compressions/ minute
30 breaths/minute
What are the stages in the progression of lochia?
1. Lochia rubra
2. Lochia serosa
3. Lochia alba
What physiological changes occur during pregnancy?
Respiratory
1. RV
2. ERV
3. FRC
4. TV
1. RV - decreases
2. ERV - decreases
3. FRC - decreases
4. TV - Increases
What physiological changes occur during pregnancy?
Renal
1. Renal plasma flow
2. BUN
3. Cr
4. GFR
1. RPF - increase
2. BUN - decrease
3. Cr - decrease
4. GFR - increases by 40%
In a sperm count what is considered normal:
1. Number/ml
2. Motility %
3. Volume
4. Morphology %
5. pH
6. WBC
1. Number/ml
>20million/ml
2. Motility %
>50% adequate motion
3. Volume
2-5ml
4. Morphology %
30% normal forms
5. pH
7.2 - 7.8
6. WBC
<10^6 WBC/ml
Why is pregnancy a hypercoagulable state?
1. Protein S decreases
2. Plasminogen activator inhibitor (PAI) increases
3. Fibrinogen increases