O&G

Question 1

Ix for Trichomonas vaginalis

Answer 1

Women: Wet mount (microscopy and direct visualisation - ‘pear shaped trichomonads’)
High vaginal swab
NAAT is a GOLD STANDARD

Men: NAAT GOLD STANDARD
Urine sample +/ urethral swab - send for culture +/ microscopy

In both F+M, test for chlamydia, gonorrhoea, HIV, syphilis, hepatitis (if high risk)

Question 2

Key S+Sx of Trichomonas vaginalis (4)

Answer 2

Vulval itching, burning
Dysuria, dyspareunia, post-coital bleeding
Offensive odour + frothy, yellow/green discharge
Cervicitis O/E (strawberry cervix - punctuate haemorrhages)
p.H >4.5

Question 3

Mx of Trichomonas vaginalis

Answer 3

Ideally managed in genito-urinary medicine clinic (GUM) or specialised sexual health clinic
Give written info on the condition
Oral metronidazole 400mg BO,PO
Current sexual partners + previous from the preceding 4 weeks period treated
Avoid sexual intercourse for at least 1 week or until Tx completion

Question 4

What can Trichomonas in pregnancy lead to?

Answer 4

Low birth weight
Prematurity

Question 5

When and why is delivery indicated in a gestational diabetes patient?

Answer 5

37+0 and 38+6 weeks gestation
Because closer to full term, there is increased risk of stillbirth, fetal macrosomia, excessive growth

Question 6

Mx of diabetes PRE-CONCEPTION

Answer 6

Avoid unplanned pregnancies through planning and conception - to avoid pregnancy in poorly controlled diabetes
5mg folic acid daily, dietician review
Stop all medication except metformin
Stop ACEi, statins

Question 7

Mx of diabetes during pregnancy

Answer 7

Aim for <5.6mmol/l fasting, <7.8mmol/l 2hrs after meal
Educate on good glycaemic control (reduce the risk of complications)
Measure CBG 4-6 times a day
Renal function assessment at 16wks
Growth scan monitoring from 28wks
Discuss mode of delivery at 36wks
Early delivery may be indicated if poor glycaemic control/concerns regarding fetal growth/health

Question 8

Mx of GDM

Answer 8

Advice on diet, maintain steady weight, exercise increase
If on Tx, delivery planned for 37-38wks
If only on diet, induction/CS considered before 40+6wks
note: CS indicated for >4.5kg babies to avoid shoulder dystocia

Question 9

Mx for delivery in DM mothers

Answer 9

Normal babies: cutting cord results in a fall in glucose, so they switch to other fuels
SGA: low fat and glucose storage so vulnerable to hypothermia, high insulin levels

Babies are at risk of high insulin –> neonatal hypoglycaemia

To prevent this: attempt regular feeds (3hrly), prioritise skin-skin warmth

Question 10

Mx of diabetes during post-natal care

Answer 10

Support breastfeeding
Plan the next pregnancy and discuss contraception
Ophthalmology review in 6m if there is pre-proliferative retinopathy
Random CBG monitoring on Day 1 and consider stopping med as GDM resolves after delivery
HbA1c in 12wks to investigate conversion to T2DM

Question 11

Prognosis of GDM

Answer 11

50% of GDM - at some point will develop T2DM
Increased chance of GDM in subsequent pregnancies if they have had it once

Question 12

What medication is used if metformin isn’t tolerated?

Answer 12

Glibenclamide

Question 13

What is luteoma of pregnancy?

Answer 13

Benign, solid ovarian tumour that develop during pregnancy and disappear after delivery. Sometimes causes excess androgen production leading to hirsutism and virilisation.

Question 14

HTN in first trimester of pregnancy that has never been pregnant before

Answer 14

Molar pregnancy

Question 15

Why does molar pregnancy lead to multiple cysts forming in the ovaries?

Answer 15

High levels of hCG can result in growth of ovarian follicles (theca leutin cysts)

Question 16

RFs for vulval Ca

Answer 16

Advancing age
HPV infection
Skin conditions of the vulva (lichen sclerosis)
Smoking

Question 17

Key S+Sx of vulval Ca

Answer 17

Vulval itching, irritation or pain
May notice lump, bleeding/discharge
Possibly: ulceration, enlarged groin nodes

Question 18

What history would stop you from offering expectant management of a miscarriage?

Answer 18

Infection, coagulopathies, presentation in late first trimester, previous stillbirth/traumatic experience

Question 19

What is used in medical Mx of miscarriage?

Answer 19

Vaginal misoprostol (synthetic E1 PG, binds onto myometrium to expel products of conception)

Question 20

List 3 RFs for IUGR

Answer 20

Smoking
Hypertension
Poorly controlled DM

Question 21

Difference between symmetrical/asymmetrical growth retardation

Answer 21

Symmetrical: start/early preg, small head + short length
Asymmetrical: advanced preg, abdominal growth reduced compared to head circumference (due to selective shunting of blood to brain)

Question 22

Define urogenital prolapse

Answer 22

Descent of pelvic organs into vagina (uterus, bladder, uterus, small bowel or rectum)

Question 23

RFs for urogenital prolapse (6)

Answer 23

Childbirth, menopause, chronic cough, obesity, constipation, suprapubic surgery for incontinence

Question 24

Pelvic Organ Prolapse Quantification (POPQ)

Answer 24

VIP
1st degree: descent of cervix with Vagina
2nd degree: descent of cervix to Introitus
3rd degree: descent of cervix outside introitus
4th degree: ulceration of cervix

Question 25

DDx of oligomenorrhoea

Answer 25

PCOS
POF
Hypothyroidism
Hyperprolactinaemia, prolactinoma
Simple obesity

Question 26

What other conditions are associated with GTD?

Answer 26

First sites of metastatic disease - lungs
Thyroid dysfunction

Question 27

RFs of cervical ca

Answer 27

Smoking, low socio-economic status
COCP
Early sexual activity
Co-infection with HIV / other forms of immunodeficiency
FHx

Question 28

Initial Mx of PPH

Answer 28

Initial assessment: 2 large bore cannulae, send blood for FBC, g&s, clotting and crossmatch 4units of blood, IV fluids
Foley catheter inserted to empty and monitor UO
Massage fundus + oxytocin infusion (ergometrine contraindicated in HTN)
Intrauterine balloon
Final - transferred to theatre for exploration and hysterectomy