Knowledge revision - O&G

Question 1

What are the important parts of a Gynae history?

Answer 1

o LMP
o Painful periods, bleeding after sex/between periods
o Last cervical smear
o Sexual history inc STI testing

Question 2

What is a miscarriage?

Answer 2

Spontaneous loss of an intra-uterine pregnancy before 24 weeks

Question 3

What is the most common cause of early miscarriage (before 13 weeks)?

Answer 3

Chromosomal abnormality

Question 4

What is the most common cause of late miscarriage (between 13 and 24 weeks)?

Answer 4

Cervical incompetence

Question 5

What are the two key examination/investigations to diagnose miscarriage?

Answer 5

Speculum examination and TV USS

Question 6

What are the management options for miscarriage?

Answer 6

Surgical - MVA/surgical evac
Medical - misoprostol
Expectant

Question 7

What follow-up is required in expectant management of miscarriage?

Answer 7

Preg test 3 weeks later – if positive, need to investigate for retained POC

Question 8

Give some potential causes of recurrent miscarriage.

Answer 8

 Genetics
 Thrombophilia
 Endocrine disorders
 Structural abnormalities

Question 9

TOP is legal up til what gestation?

Answer 9

23+6 weeks

Question 10

What legislation are TOPs conducted under?

Answer 10

Abortion Act 1967

Question 11

Under what circumstances can terminations of pregnancy be offered?

Answer 11

Where continuing the pregnancy involves a greater risk for the physical or mental health of the woman or her existing children

Question 12

What are the two main options for TOP?

Answer 12

Medical or surgical

Question 13

How are medical abortions conducted?

Answer 13

Mifepristone (anti-progestogen)
Misoprostol (prostaglandin analogue) 1-2 days later

Question 14

What are the two surgical abortion options?

Answer 14

MVA and surgical evac

Question 15

At what gestations can MVA and surgical evac be performed?

Answer 15

o MVA – usually up to 14 weeks
o Surgical evac – usually 14-24 weeks

Question 16

In which circumstances should Anti-D be given in TOP?

Answer 16

Rh -ve woman AND
Surgical abortion or medical abortion > 10 weeks

Question 17

What is the first screening test available for Down’s Syndrome?

Answer 17

Combined test

Question 18

When can the combined test be administered?

Answer 18

10-14 weeks

Question 19

What is involved in the combined test?

Answer 19

o Maternal age
o bHCG
o PAPP-A
o Nuchal translucency (NT)

Question 20

What is involved in the quadruple test?

Answer 20

o Maternal age
o AFP, bHCG, inhibin-A, uE3

Question 21

When can the quadruple test be administered?

Answer 21

14 - 20 weeks

Question 22

What is the quoted miscarriage rate for CVS/amniocentesis?

Answer 22

1 in 200

Question 23

What is usually recommended in high-risk of Down’s syndrome pregnancies?

Answer 23

NIPT

Question 24

What are the main methods of emergency contraception?

Answer 24

Levonorgestrel
UPA
Copper IUD

Question 25

How long after UPSI can Levonorgestrel be used?

Answer 25

Within 72 hours

Question 26

How long after UPSI can UPA be used?

Answer 26

Within 5 days

Question 27

How long after UPSI can Copper IUD be used?

Answer 27

Within 5 days of UPSI or within 5 days of estimated date of ovulation

Question 28

What is the most effective method of emergency contraception?

Answer 28

Copper IUD

Question 29

‘Fishy smelling white/watery PV discharge’ suggests...

Answer 29

BV

Question 30

What is the treatment for BV?

Answer 30

Metronidazole

Question 31

‘Thick, white itchy PV discharge’ suggests...

Answer 31

Thrush/candidiasis

Question 32

How is thrush treated?

Answer 32

anti-fungal – clotrimazole cream/pessary or single fluconazole tablet

Question 33

How are chlamydia and gonnorhoea investigated?

Answer 33

Swabs for NAAT testing

Question 34

What is the treatment for chlamydia?

Answer 34

doxycycline 100mg twice a day for 7 days

Question 35

What is the treatment for gonorrhoea?

Answer 35

Single dose IM ceftriaxone

Question 36

Trichomonas vaginalis is treated with...

Answer 36

Metronidazole

Question 37

How is syphillis diagnosed?

Answer 37

Blood test - antibody

Question 38

How is syphillis treated?

Answer 38

Single dose IM Penicillin

Question 39

Painful, blistering genital lesions suggests...

Answer 39

Genital herpes

Question 40

Which type of HSV is most associated with genital herpes?

Answer 40

HSV-2

Question 41

How is breech presentation managed?

Answer 41

Most women offered ECV at 37 weeks if still breech, or planned c-section - can have SVD if counselled regarding risks

Question 42

What are the management options for ectopic pregnancy?

Answer 42

Expectant Medical Surgical

Question 43

Which women with ectopic pregnancy may be offered expectant management?

Answer 43

Clinically stable GS < 35mm bHCG < 1000

Question 44

Which women with ectopic pregnancy should be offered surgical management first-line?

Answer 44

Significant pain Adnexal mass > 35mm Foetal heartbeat on USS bHCG > 5000

Question 45

What are the initial management options for PPH?

Answer 45

Mechanical Medical - oxytocin/ergometrine Surgical - intra-uterine balloon

Question 46

What is the advice in the case of one missed COCP pill?

Answer 46

take as soon as realise - protected

Question 47

What is the advice in the case of two or more missed COCP pill?

Answer 47

Use extra contraception for 7 days Only use emergency contraception if missed in week 1

Question 48

What is the advice for missed POP?

Answer 48

Take as soon as realise Not covered for next 2 days - use extra contraception