72 - abnormal vaginal bleeding, 78 - menstrual disturbance, 79 - pelvic pain, 87 - vaginal discharge

Question 1

initial Ix in 1st trimester spotting?

Answer 1

USS and exam

Question 2

who gets cervical screening and how often

Answer 2

Screens women 25-64 for dysplastic changes (dyskaryosis) and HPV

every three years (25-49) and five years beyond that. Smear test.

Question 3

If there is dyskaryosis on screening whats the next Ix?

Answer 3

colposcopy

Question 4

define miscarriage

Answer 4

TOP before 20/52

Question 5

rfs for miscarriage

Answer 5

ectopic risks, previous miscarriage, antiphospholipid syndrome, smoking, obesity, chromosomal abnormalities,

Question 6

What can help evacuate remaining contents in miscarriage

Answer 6

misprostol

surgical

Question 7

Mx of miscarriage

Answer 7

ABCDE
if shocked -> admit

Abdo + pelvic exam
USS, B-HCG

Question 8

Miscarriage types 
threatened?
inevitable?
complete? 
incomplete? 
septic? 
missed?

Answer 8

Threatened - Os: CLOSED. Foetus: alive. Bleeding often present. <20 weeks gestation. 25-50% miscarry.

Inevitable - Os: OPEN. Foetus: alive/dead. <20 weeks gestation. Miscarriage imminent.

Complete - Os: CLOSED. Complete expulsion of ‘products of conception’

Incomplete - Os: OPEN. Incomplete expulsion of products. Bleeding ++.

Septic - Os: Open/Closed. Mother has serious intrauterine infection (PID) with fever. Causes: unsafe abortion, tissue remnant from previous miscarriage, STI etc.

Missed - Os: CLOSED. Foetus: dead. <20 weeks gestation.

Question 9

Most common cause of vaginal bleeding ?

Answer 9

fibroids

Question 10

What is dysfunctional vaginal bleeding?

mx?

Answer 10

Abnormal vaginal bleeding caused by changes in hormone levels.
Not caused by pregnancy, miscarriage, cancer or fibroids.
Caused by low levels of progesterone.
Diagnosis of exclusion.

Replace progesterone.

Question 11

Rfs placental abruption?

Answer 11

pre-eclampsia, HTN, PROM, thrombophilia, multiple pregnancy, multiparity, smoking,

Question 12

What is placental abruption?

Sx?

Answer 12

Pregnancy complication where the lining of the placenta seperates from the uterus.

Sudden onset abdo pain, contractions, bleeding, decreased foetal movement and heart rate

Question 13

Mx abruption

Answer 13

Urgent blood volume replacement and delivery. Vaginal birth is preferred, especially in DIC.

Question 14

Rfs for placenta previa

Answer 14

c-section, d&c, multiparity, twin pregnancy

Question 15

types of emergency contraception

Answer 15

Levonelle within 72 hours.
ellaOne within 120 hours.
IUD within 5 days.

Question 16

Some causes of secondary amenorrhea

Answer 16

breastfeeding, pregnancy, menopause, drug-induced, pituitary, Sheehan’s and Asherman’s

Question 17

Ix in amenorrhoea

Answer 17

Check FSH/LH levels, pelvic exam, USS, b-HCG!

Question 18

Causes of menorrhagia

Answer 18

endometriosis, fibroids, ovarian cysts, coagulation defects, cancers, PID, adenomyosis, contraceptives

Question 19

What is PID? sX?

Answer 19

Ascending infection of upper section of female reproductive tract.

May be silent. Discharge, dysuria, fever, dyspareunia, dysmenorrhea,

Question 20

PID ->?

Answer 20

infertility, ectopic, cancer and chronic pain.

Question 21

Mx of PID

Answer 21

Test for STIs (Chlamydia and gonorrhoea a common cause). Pain relief.

If gonococcal risk low: Oral ofloxacin 400 mg twice daily plus oral metronidazole 400 mg twice daily, both for 14 days.

If gonococcal risk high: Ceftriaxone 500 mg as a single intramuscular dose, followed by oral doxycycline 100 mg twice daily plus oral metronidazole 400 mg twice daily, both for 14 days.

Question 22

What is the normal vaginal flora? function

Answer 22

Lactobacilus

inhibit pathogenic bacteria
maintaining normal pH.

Question 23

BV caused by what?

sx?

Answer 23

Excessive growth of bacteria in the vagina. Most common vaginal infection in young women.
Smelly discharge, dysuria, may be silent.

Question 24

Rfs for BV

Answer 24

douching, promiscuity, ABX, IUDs,

Question 25

Mx BV

Answer 25

Clindamycin or metronidazole.