Gap deck

Question 1

Which test is thebest way to detect ovulation

Answer 1

Day 21 progesterone

serum progesterone level will peak 7 days after ovulation has occurred. The length of the follicular phase of the menstrual cycle can be variable, however, the luteal phase (after ovulation) remains constant at 14 days. Therefore, in a 35-day cycle, given that the luteal phase always lasts for 14 days, the follicular phase will be 21 days (ovulating on day 21). Therefore, the progesterone level will be expected to peak on day 28.

Question 2

Atrophic vaginitis is treated with?

Answer 2

Topical oestrogen creams along with lubricants and moisturisers

Question 3

Which drugs can help premenstrual syndrome?

Answer 3

SSRI

. They can be taken continuously or just during the luteal phase (for example days 15–28 of the menstrual cycle, depending on its length). The prescription should be for an initial 3 month period and patients should be monitored closely during initiation.

Question 4

Most common type of ovarian pathology associated with Meigs’ syndrome

Answer 4

Fibroma

Question 5

Most common benign ovarian tumour in women under the age of 25 years

Answer 5

Dermoid cyst (teratoma)

Question 6

The most common cause of ovarian enlargement in women of a reproductive age

Answer 6

Follicular cyst

Question 7

Treatment for vaginal candidiasis (thrush) in pregnancy

Answer 7

Local treatment - clotrimazole pessary (e.g. clotrimazole 500mg PV stat)

oral treatments are contraindicated in pregnancy

Question 8

Contraindicated antibiotics in pregnancy

Answer 8

ciprofloxacin, tetracycline, chloramphenicol, sulphonamides

Question 9

Contraindicated psych drugs in pregnancy

Answer 9

lithium, benzodiazepines

Question 10

6 drugs (AACCMS) contraindicated in pregnancy

Answer 10

Aspirin
Amiodarone (arrhythmias)
Carbimazole (antithyroid)
Methotrexate (rheumatoid arthritis, psoriasis)
Sulfonylureas (T2DM)
Cytotoxic drugs (cancer tx)

Question 11

how does preeclampsia cause oligohydramnios

Answer 11

due to hypoperfusion of the placenta.

Question 12

why does diabetes cause polyhydramnios

Answer 12

there is foetal polyuria due to foetal hyperglycaemia.

Question 13

5 causes of oligohydramnios

Answer 13

premature rupture of membranes

fetal renal problems e.g. renal agenesis

intrauterine growth restriction

post-term gestation
pre-eclampsia

Question 14

Primary treatment of stage2-4 ovarian cancer

Answer 14

surgical excision of tumour +/- chemotherapy

Question 15

woman is >50 years old, amenorrhoeic for >12months. Does she need contracpetion

Answer 15

no, she is assumed menopausal

Question 16

woman is <50years old, amenorroeic for 16months. does she need contraception

Answer 16

yes - contraception neesd to continue until amenorrhoeic for 24months

Question 17

what forms of contraception are safe to use alongside sequential HRT

Answer 17

all progesterone-only methods

Question 18

What combination of results from combined test at 12wk US would have indicated a higher chance of Down’s syndrome?

Answer 18

Down’s syndrome is suggested by ↑ HCG, ↓ PAPP-A, thickened nuchal translucency

Question 19

When are offered triple/quadruple test?

Answer 19

15-20wks if women book later in pregnancy and havent had 11-13+6week combined test screening

Question 20

What is the most common identifiable cause of postcoital bleeding?

Answer 20

Cervical ectropion

Question 21

Main complication of induction of labour and its tx

Answer 21

Uterine hyperstimulation which is characterised by too frequent or prolonged uterine contractions that can cause significant foetal distress. The treatment of uterine hyperstimulation requires administering tocolytic agents to relax the uterus and slow contractions.

Question 22

First line method of inducing labour

Answer 22

Vaginal prostaglandins (ripen cervix and stimulate contractions)

Question 23

VBAC is contraindicated in…

Answer 23

patients with

• previous vertical (classical) caesarean scars
• previous episodes of uterine rupture
• patients with other contraindications to vaginal birth (e.g. placenta praevia).

Question 24

Characteristic sign of placenta praevia & diagnositc investigation?

Answer 24

painless vaginal bleeding.

definitive diagnosis of placenta praevia is through ultrasound scan imaging.Transvaginal ultrasound scans be safely performed at 20 weeks, in addition to the abdominal ultrasound scan to help improve the accuracy of localisation and RCOG guidelines state that they should be used to confirm the diagnosis of placenta praevia.

Question 25

<9wks Medical termination of pregnancy uses what?

Answer 25

Mifepristone (anti-progesterone) & at least one dose 48hrs later of prostaglandins to stimulate uterine contractions (misoprostol)

Question 26

<13wks Medical termination of pregnancy uses what?

Answer 26

surgical dilation and suction of uterine contents

Question 27

> 15wks Medical termination of pregnancy uses what?

Answer 27

surgical dilation and evacuation of uterine contents or late medical abortion (induces ‘mini-labour’)

Question 28

When is combined hormonal contraception (inc pill, patch and vaginal ring) absolutely contraindicated

Answer 28

(UKMEC 3/4)

> 35yrs old and smoking 15 or more cigs a day or <15 cigs
BMI >35
personal hx or fam hx thromboembolic disease in first degree relatives <45yrs
controlled/uncontrolled HTN
hx of stroke/IHD
breast feeding <6wks postpartum
immobility
current breast cancer/carrier of known gene mutations associated with breast cancer (BRCA1/2)
current gallbladder disease
migraine with aura

Question 29

In HRT, adding progesterone increases risk of which cancer?

Answer 29

breast cancer

The risk is, however, very minimal and it’s important to stress this to patients. The Women Health Institute suggests that if 1000 women on HRT for 5 years were compared to 1000 women not on HRT for 5 years, there would only be 4 more cases of breast cancer.

Question 30

What should be done for a woman at high risk of VTE requesting HRT

Answer 30

NICE state women requesting HRT who are at high risk for VTE should be referred to haematology before starting any treatment (even transdermal)

Question 31

Woman presenting with PMB - what must be ruled out

Answer 31

endometrial cancer

Question 32

Diagnosis of cord prolapse?

Answer 32

when the fetal heart rate becomes abnormal and the cord is palpable vaginally, or if the cord is visible beyond the level of the introitus

Question 33

Management of cord prolapse

Answer 33

‘To prevent cord compression, it is recommended that the presenting part be elevated either manually or by filling the urinary bladder.’

tocolysis (i.e. terbutaline) can be considered while preparing for caesarean section if persistent fetal heart rate anomalies are detected after using mechanical methods of preventing compression.

Question 34

Risk factor for miscarraige

Answer 34

• AGe: >35
• Previous miscarraige, esp if 2/more consecutive
• Chronic conditions: eg unconctrolled diabetes
• uterine/cervical problems: eg mullerian duct abnormalities, large cervical cone biopsies
• Smoking, alc, illicit drugs
• High/low BMI
• Invasive prenatal tests eg CVS and amniocentesis

Question 35

First line treatment for menorrhagia in someone that needs contraception

Answer 35

Mirena IUS

other options then are COCP or long-acting progestogens