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MRCOG Part 2 Exam > Module 15 - Sexual & Reproductive Health > Flashcards

Module 15 - Sexual & Reproductive Health Flashcards

1
Q

Delayed puberty occurs in approximately what percentage of children?

A

3%

It is more common in boys

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2
Q

Precocious puberty is defined as the development of secondary sexual characteristics at what age?

A

<8 years old

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3
Q

How is delayed puberty defined in boys and girls?

A

Lack of testicular development or testicular volume <4ml in boys >14 yrs

Lack of breast development in girls >13 yrs

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4
Q

How common is expulsion of an IUCD (over 5 years)?

A

Occurs in 1 in 20 women over 5 years

Most common within the first 3 months of insertion

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5
Q

What is the incidence of premature ovarian failure in women under 40?

A

1%

Premature ovarian failure affects 1% of women under 40

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6
Q

A 25 year old woman has unprotected SI with her husband D25 post ELCS. She is breatsfeeding sporadically. She opts for Ulliprostal acetate 30mg. She asks about the risks to breastfeeding?

A

Discard breast milk for 1 week after taking ullipristal acetate

Women who breastfeed should be advised not to breastfeed and to express and discard
milk for a week after they have taken UPA-EC

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7
Q

A 25 year old woman has unprotected SI with her husband D25 post ELCS. She is breatsfeeding sporadically. She opts for Levonorgestrel 1.5mg. She asks about the risks to breastfeeding?

A

No risks, she can continue

Women who breastfeed should be informed that available limited evidence indicates that
LNG-EC has no adverse effects on breastfeeding or on their infants.

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8
Q

Can women who breastfeed effectively use lactational amenorrhoea method (LAM) as
contraception?

A

If <6 months postpartum, fully breastfeeding and amenorrhoeic then lactational amenorrhoea method is a highly effective form of contraception

If reducing breastfeeding, starting using supplemental feeds, menstruating or >6 months postpartum it is less effective and other forms of contraception are recommended

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9
Q

What marks the start of puberty for girls?

A

The ability to sexually reproduce

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10
Q

What is the definition of precocious puberty in girls?

A

The development of secondary sexual characteristics <8 years old

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11
Q

What is the definition of precocious puberty in boys?

A

The development of secondary sexual characteristics <9 years of age

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12
Q

What is the definition of delayed puberty in girls?

A

The absence of breast development by age 13

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13
Q

What is the definition of delayed puberty in boys?

A

The absence of testicular development, or testicular volume <4ml by age 14

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14
Q

What is the normal range of puberty for girls?

A

Age 8 - 13

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15
Q

What is the normal range of puberty for boys?

A

9-14

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16
Q

You are discussing contraception with a 22 year old woman. She is interested in the Nexplanon® contraceptive implant. What would you advise her is the commonest reason for discontinuing with the implant?

A

Irregular/prolonged vaginal bleeding

20% (1 in 5) women will discontinue nexplanon due to irregular/prolonged vaginal bleeding

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17
Q

What proportion of women will have amenorrhoea after using Nexplanon?

A

20% (1 in 5)

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18
Q

What is the failure rate with typical use of nexplanon?

A

0.05%

Failure rate close to zero (0.05%) with typical use i.e. most effective reversible contraceptive

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19
Q

What is the background risk of VTE in non contraceptive users who are not pregnant?

A

2 per 10,000

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20
Q

What is the risk of VTE in pregnancy?

A

10 per 10,000

Pregnancy gives a 5x fold increase in VTE risk

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21
Q

What is the VTE risk of women taking CHC containing ethinylestradiol plus levonorgestrel, norgestimate or norethisterone?

A

5-7 per 10,000

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22
Q

What is the VTE risk of a woman taking CHC containing ethinylestradiol plus gestodene, desogestrel or drospirenone?

A

9-12 per 10,000

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23
Q

What is the most common cause of genital ulceration worldwide?

A

Chancroid

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24
Q

What is the recurrence rate of BV?

A

58%
(50-60%)

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25
Q

What is the most common cause of infective vaginal discharge?

A

Bacterial vaginosis

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26
Q

What is the second most common cause of infective vaginal discharge?

A

Vulvo-vaginal candidiasis

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27
Q

What is Amsel’s criteria?

A

Used to diagnose BV. Require 3/4 of the following:

1) Vaginal pH >4.5
2) Homogenous, white, non-viscous discharge
3) Positive ‘whiff’ test
4) >20% clue cells

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28
Q

OCP is protective for which cancers?

A

Ovarian cancer
Endometrial cancer
Colorectal cancer

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29
Q

OCP is a risk factor for which cancers?

A

Breast cancer
Cervical cancer

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30
Q

You are discussing contraception with a 21 year old woman. She is interested in the Nexplanon® contraceptive implant. What would you advise her regarding the failure rate of Nexplanon® with typical use in 1 year?

A

0.05%

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31
Q

What percentage of women will discontinue Nexplanon due to heavy or irregular bleeding?

A

20% (1 in 5)

32
Q

What is the risk of uterine perforation following IUD insertion?

A

0.2%

33
Q

What is the risk of ectopic pregnancy if pregnancy occurs with an IUD in-situ?

A

1 in 20

34
Q

A 49 year old woman comes to see you in clinic. She is perimenopausal and has been started on cyclical (sequential) hormone replacement therapy. She tells you she is in a new relationship and asks if the HRT will be contraceptive. Cyclical HRT inhibits ovulation in what percentage of patients?

A

40%

Cyclical HRT only inhibits ovulation in 40% of women so there is still a risk of pregnancy. Contraception should therefore be prescribed in addition to cyclical HRT

35
Q

What proportion of pregnancies in women >40 years old are unplanned?

A

20%

36
Q

What proportion of pregnancies in women >40 years old end in termination?

A

28%

37
Q

In women >50 years old using non-hormonal contraception when can you stop contraception?

A

After 1 year of amenorrhoea

38
Q

In women <50 years old using non-hormonal contraception when can you stop contraception?

A

After 2 years of amenorrhoea

39
Q

If >50 years old and using progestogen-only contracpetion, when can you stop contraception?

A

1 year after recording 2x FSH levels >30 at least 6 weeks apart

You can use 2x FSH levels 4-6 weeks apart to diagnose menopause in women <50 years old, but cannot use it to stop contraception in women <50 years old

40
Q

How long do you need to stop the COCP for before testing FSH to diagnose menopause?

A

2 weeks

41
Q

How long do you need to stop the depot injection for before testing FSH to diagnose menopause?

A

12 months

42
Q

You are discussing postpartum contraception with a 32 year old woman. She has expressed an interest in the copper intrauterine device (IUCD). She is breastfeeding and is concerned about the risk of perforation. What is the risk of perforation in breastfeeding women compared to non-breastfeeding?

A

6x higher in breastfeeding women

43
Q

What is the risk of VTE in non-pregnant women not taking hormonal contraception?

A

1-2 in 10,000

44
Q

What is the risk of VTE in pregnancy?

A

8-10 in 10,000

Relative risk of VTE in pregnancy is increased 4 to 6 fold compared to non-pregnancy

45
Q

What is the absolute risk of VTE in pregnancy?

A

1-2 in 1,000

46
Q

What is the risk of VTE in women taking CHC containing ethinylestradiol plus levonorgestrel, norgestimate or norethisterone?

A

5-7 in 10,000

47
Q

What is the risk of VTE in women taking CHC containing etonogestrel (ring) or norelgestromin (patch)?

A

6-12 in 10,000

48
Q

What is the risk of VTE in women taking CHC containing ethinylestradiol plus gestodene, desogestrel or drospirenone?

A

9-12 in 10,000

49
Q

What is the risk of VTE in women taking POP or prostogen-only contraception?

A

2 in 10,000

50
Q

There is a suspicion that a serious sexual assault on a 30-year-old bar woman was drug facilitated. Up to when after the assault can a blood sample be taken for forensic tests?

A

3 days

51
Q

There is a suspicion that a serious sexual assault on a 30-year-old bar woman was drug facilitated. Up to when after the assault can a vaginal sample be taken for forensic tests?

A

7 days

52
Q

There is a suspicion that a serious sexual assault on a 30-year-old bar woman was drug facilitated. Up to when after the assault can a peri-anal sample be taken for forensic tests?

A

3 days

53
Q

There is a suspicion that a serious sexual assault on a 30-year-old bar woman was drug facilitated. Up to when after the assault can an oral sample be taken for forensic tests?

A

2 days

54
Q

There is a suspicion that a serious sexual assault on a 30-year-old bar woman was drug facilitated. Up to when after the assault can a urine sample be taken for forensic tests?

A

14 days

55
Q

What proportion of women diagnosed with tubo-ovarian abscess are nulliparous?

A

60%

56
Q

What proportion of cases of TOA/PID are polymicrobial?

A

30-40%

57
Q

What proportion of cases of PID will develop a TOA?

A

15-35%

58
Q

What are the features of MRKH (Mayer Rokitansky Kuster Hauser) Syndrome?

A

Incidence: 1 in 1,5000 births
Mullerian agenesis
Absent of uterus and vagina
Short or blind-ended vagina
Normal sexual characteristics
Primary amenorrhoea
40% have renal abnormalities
12% have one kidney
3% have hearing hoss

Treatment: Vaginal dilators and psychological support. 95% success rates with sexual intercourse
Surgery also an option

59
Q

What are the features of complete androgen insensitivity syndrome?

A

Previously known as Testicular Feminisation syndrome
Genotype: 46XY (male)
Phenotype: Female
X-linked recessive inheritance. Passed down maternal line
Insensitivity of testosterone receptor

Features:
- Inguinal hernias with testes - lap orchidectomy after puberty complete. Risk of malignancy is 20% by 4th decade of life
- Sparse pubic hair
- Short vagina
- Absent uterus, cervix, tubes and upper 1/3 of vagina
- Abdominal pain
- Normal sexual intercourse
- Normal secondary sexual characteristics (female body habitus, breast development)
- Primary amenorrhoea

60
Q

What is the most common cause of ambigious genitalia?

A

Congenital adrenal hyperplasia

61
Q

A woman with chlamydia delivers her baby by SVD. When does chlamydia conjunctivitis develop in newborns?

A

5-12 days after delivery

62
Q

Which cancers does the COCP put you at risk of?

A

Breast cancer
Cervical cancer

63
Q

What proportion of transgender people are sexually abused at some point of their lives?

A

1/2
50%

64
Q

When do you give PEPSE as prophylaxis after sexual assault?

A

ASAP, but within 72 hours
Continue for 4 weeks

65
Q

What proportion of sexual assaults result in genital injuries?

A

1/4
25%

66
Q

What are the two most common psychosexual complaints women have?

A

1) Lack of desire/interest in sex
2) Lack of orgasm

To qualify as sexual dysfunction needs to be present for >75% of the time for >6 months

67
Q

What is the effectiveness of the coitus interruptus (withdrawal method)?

A

Perfect use - 96%
Typical use - 78%

68
Q

What is the effectiveness of the COCP?

A

Perfect use - 99.7%
Typical use - 91%

69
Q

What is the treatment of acute candidiasis in pregnancy?

A

Clotrimazole 500mg p.v. for 7 days

70
Q

What is the treatment of recurrent candidiasis in pregnancy?

A

Clotrimazole 500mg p.v. for 10-14 days then weekly

71
Q

What is the treatment of acute candidiasis in non-pregnant women?

A

Fluconazole 150mg pv stat

72
Q

What is the treatment of recurrent candidiasis in non-pregnant women?

A

Fluconazole 150mg pv every 3 days for 3 doses then weekly for 6 months

73
Q

What is the definition of recurrent candidiasis?

A

≥4 episodes in 12 months

74
Q

What proportion of women experience recurrent thrush?

A

6%

75
Q

What proportion of women will experience at least 1 episode of thrush in their lifetime?

A

75%

76
Q

What proportion of candidiasis is caused by candida albicans?

A

80-90%

MRCOG Part 2 Exam (18 decks)

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