O&G Flashcards
Woman with a little bit of pink post-coital bleeding on wiping. Smear is fine, ultrasound is clear. What is the next investigation?
Hysteroscopy with biopsy
How to handle miscarriages, stillbirths, abortions and twins in gravidity parity calculations?
Stillbirths count as P
Twins as 1 G and 1 P
Abortions and miscarriages are added after P as a +
Lady who had a tear after delivering baby, a few days later has offensive discharge, no fever or other symptoms
Perineal wound breakdown/infection - lochia can be smelly but probably not offensive discharge?
Girl with dyskaryosis has colposcopy and biopsy showing CIN1 – no treatment is given. When should next colposcopy be?
12 months
HIV with undetectable viral load. what is contraindicated in labour? Forceps, ventouse, foetal blood sampling, c section
foetal blood sampling
A 47 year old woman with a 2 cm simple ovarian cyst seen on USS, as well as 12mm endometrium. What do you do next?
Pipelle biopsy (Pipelle if more than 10mm in pre, and 4mm in post menopause)
Woman had a contraceptive implant inserted but she’s getting it removed. What is the most likely reason why?
Irregular bleeding
What cancer are you at increased risk at with HRT?
Breast, endometrial
Mother had rupture of membranes at 32 weeks but is not in labour. What do you give her?
Steroids, erythromycin
Pregnant woman with Gram negative bacilli in urine microscopy, what treatment?
Nitrofurantoin unless near term, then amoxicillin or cefalexin
Pregnant woman in early pregnancy with depression and anxiety on sertraline. What do you do?
Continue sertraline
What do you do in a woman in labour after 4 hours of checking, she’s 4cm. Vaginal prostaglandin, Cervical sweep, Oxytocin, Ergometrine, ARM
ARM
Foreign woman has come in and is pregnant. What vaccine should she be offered? Hepatitis A, hepatitis B, whooping cough
Whooping cough
What’s the management for DVT risk in a pregnant woman after an elective Caesarean?
LMWH, LMHW and Ted stockings, Ted stockings, Warfarin, Aspirin, Aspirin and Ted stockings
LMWH and Ted stockings
Down’s syndrome person gets pregnant. Mum wants termination and Down’s person wants to keep it. What should you do?
Assess patient’s mental capacity without mum present
Smear question she is 47 y/o. It was borderline dyskaryosis, HPV negative, what do you do? Repeat in 6w, repeat 6m, repeat 1y, discharge to routine (2y), discharge to routine (3y)
Discharge 3y
What do you measure at booking for hepatitis b?
Surface antigen
Man with azoospermia – what is the most likely cause?
Varicocele
Woman with offensive smelly lochia day 2 post-partum, had had some high vaginal swabs? Reassure and discharge, await swab results, give broad-spectrum antibiotics, abdo USS
Broad spectrum abx
Woman wants to terminate her 8 week pregnancy because she already has 3 children - which clause of the abortion act does this fall under?
D - affects existing children (NEW ANSWER)
45F has a radical hysterectomy (Wertheim’s hysterectomy) for CIN. Last cervical smear 2 years ago. When next smear?
6 months (vaginal vault smear)
Post-LLETZ, when is her next smear?
6 months
Lambda sign on USS – DCDA twin pregnancy. When do you aim to deliver these twins?
37 weeks
Woman in stage 2 of labour, pushing for 30 minutes, head pressing against perineum, when CTG becomes pathological – what do you do next?
Forceps delivery
Woman has come for a sterilisation, has had protected sex since her last menstruation one week ago, just post-ovulation – Immediate tx? Insert IUD, Cancel surgery, Continue with surgery
Cancel surgery
Bloating, raised CA125, next step? (not 2ww)
Pelvic USS
Woman gets headache 24hrs after delivery?
Post-dural puncture headache
Woman who has just given birth to 2 day old baby. Her 2 year old son gets chicken pox, women has antibodies. Goes to GP, what should be done?
Give IVIG to baby
Test for predicting preterm labour
Cervical length or foetal fibronectin
What signifies onset of active/ established labour?
4 cm cervix dilation
Woman has cervical cancer, is a smoker, hasn’t had a smear for 8 years – what is the most likely contributing factor?
HPV infection
Girl with cystic ovaries on USS. What other symptom would be the best indicator of her having polycystic ovaries?
Dysmenorrhoea, Hirsutism, Obesity, Acne
Hirsutism
What is a 21 week USS useful for?
Nuchal thickness for Down’s, congenital heart disease identification, predicting position of placenta at term
congenital heart disease
What causes increased urinary volume and frequency in the first trimester?
Increased GFR, pressure of uterus on bladder, glycosuria
increased GFR
70 year old lady has some spotting and says she uses some steroid cream for a “rash down there
Vulval cancer
Lady is on Tamoxifen, which cancer does this increase the risk of
Endometrial cancer (tamoxifen is a breast cancer drug)
STI: green discharge
Trichomonas vaginalis
Small painful lump inside vagina of sexually active woman
Malignancy
29 y/o woman visits GP with heavy sensation in her vagina when exercising. She is aware of a bulge in her vagina, sometimes associated with a desire to urinate. She had a vaginal delivery 2 years ago. O/E there is some laxity of the anterior vaginal wall but this does not descend to the introitus on straining. Urine culture is negative. What is the most appropriate management plan?
a. Oxybutynin hydrochloride
b. Pelvic floor exercises
c. Refer for urodynamic testing
d. Refer to urogynaecology clinic
e. USS of pelvis
Pelvic floor exercise
42 y/o woman is 34 weeks pregnant and has had repeat admissions for severe abdominal pain. She currently needs opiate analgesia but is still struggling with the pain. USS shows a sub-serosal fibroid measuring 7cm x 9cm. What is the best management option for her pain?
a. Continuous regular opiates
b. Epidural anaesthesia
c. NSAIDs
d. Remifentanyl patient-controlled analgesia
e. Uterine artery embolisation
Opiates
40 y/o woman is successfully treated for ectopic pregnancy with methotrexate. After what interval may she safely conceive again?
a. 1 year
b. 3 months
c. 6 months
d. Her next menses
e. Immediately
3 months
A woman is having a repeat USS at 32 weeks gestation for a previously low-lying placenta. The USS shows the placenta is clear of the cervical os and an additional succenturiate lobe is seen. Which condition needs to be excluded in the USS?
a. Cervical shortening
b. Fetal growth restriction
c. Placenta praevia
d. Vasa praevia
e. Velamentous cord insertion
Vasa praevia - the lobes n stuff
Which of the following is a complication of 3rd trimester Ibuprofen use?
a. Acute kidney injury
b. Closure of ductus arteriosus
c. Liver failure
d. Preterm labour
e. Reye’s syndrome
Closure of ductus arteriosus
32 y/o nulliparous woman is 8 weeks pregnant and experiencing severe nausea and vomiting that makes it impossible for her to work. She is taking 50mg cyclizine OD (once daily) with no effect. What is the best next management option?
a. Admit for I.V. fluids
b. Change to prochlorperazine
c. Increase frequency of cyclizine to TDS (three times daily)
d. Add a PPI
e. Add Prochlorperazine
Change to prochlorperazine
29 y/o woman with past history of cocaine and cannabis use denies using for the past 3 years. Which additional test should be done for this patient at booking?
a. Hair toxicology screen
b. Hepatitis C
c. Hepatitis E
d. Serum toxicology screen
e. Urine toxicology screen
URINE (NEW ANSWER)
33 y/o woman has Ventouse delivery at 39 weeks gestation and requires manual removal of placenta. The removal is uncomplicated with an EBL of 600ml. She plans to mix feed her baby for the first 6 months. When can she expect her menstrual cycle to return?
a. Cannot be predicted
b. When she is more than 50% bottle feeding
c. When she stops breastfeeding
d. Within 6 months
e. Within 6 weeks
Cant be predicted
20 y/o woman attends A&E. She realised 4 days after her menses finished that she had forgotten to remove her tampon. She has now removed it and is asymptomatic but concerned about the possible consequences. What is the most appropriate management?
a. Advise vaginal douching
b. Arrange USS pelvis
c. Perform high vaginal swabs
d. Prescribe prophylactic antibiotics
e. Reassure and discharge
Reassure and discharge
60 y/o woman presents with discomfort during sex and vaginal dryness. What is the best management option?
a. Commence oral HRT
b. Commence SSRI
c. Commence topical vaginal oestrogen
d. Commence transdermal HRT
e. Commence vaginal lubricants
Commence topical vaginal oestrogen - first line
32 y/o woman has diagnostic laparoscopy to investigate pelvic pain, and has a catheter inserted in recovery for urinary retention. The catheter is removed the next morning. When can she be safely discharged home?
a. When she has voided more than 200ml
b. Straight away with advice to return if she has problems voiding
c. When her post-void residual volume is 0ml
d. When her post-void residual volume is 100ml
e. When her post-void residual volume is 300ml
When her post-void residual volume is 100ml - below 150ml
25 y/o woman who is 38 weeks pregnant is seen in triage for irregular painful contractions lasting 6 hours. She took paracetamol 6 hours ago. She is examined and found to be 2cm dilated. Which analgesia is most appropriate?
a. Co-dydramol
b. Epidural analgesia
c. Nitrous oxide
d. NSAID
e. Warm bath
Co-dydramol
41 y/o women attends her dating scan. LMP dates make her 12 weeks pregnant. An intrauterine pregnancy is seen with no fetal heartbeat. CRL is equivalent to a fetus of 9 weeks gestation. What is the best next step?
a. Admit her for laparoscopy
b. Counsel her on management options for miscarriage
c. Offer her a repeat USS in 1 week
d. Offer treatment with methotrexate
e. Serum beta-hCG now and repeat in 48 hours
Counsel her on management options for miscarriage - if no foetal heartbeat and smaller than 7 weeks then ask her to come back because its Pregnancy of unknown viability. More than 7 weeks size is a miscarriage
37 y/o woman has her anomaly scan at 20+3 weeks of pregnancy, and it reveals echogenic bowel. What is the most likely cause?
Trisomy 21
29 y/o woman had had intermittent vaginal bleeding since insertion of the Mirena coil 6 weeks ago. What is the most appropriate investigation?
None required
A woman with sickle cell trait is 8 weeks into an unplanned pregnancy. Which investigation should be offered first?
a. Chorionic villus sampling
b. Free fetal DNA testing
c. Partner FBC
d. Partner haemoglobin electrophoresis
e. Partner karyotyping
Partner haemoglobin electrophoresis
A Rh negative woman has light vaginal bleeding and pain at 9 weeks gestation. USS shows a viable 9 week intrauterine pregnancy. The bleeding resolves 48 hours later. What further treatment does she require?
a. 250IU Anti-D prophylaxis immediately
b. Kleihauer test
c. No further action
d. Progesterone pessaries
e. Repeat scan in 2 weeks
No further action - before 12 weeks, unless its ectopic / medical or surgical termination of pregnancy
19 y/o woman in GP has a 3 week history of post-coital vaginal bleeding. She had a Nexplanon (Progesterone-only subdermal implant) inserted 18 months ago and has been amenorrhoeic for the last 12 months. Vaginal and speculum exams are normal and urine pregnancy test is normal. What is the most appropriate next investigation?
a. Blood test for clotting screen
b. Cervical cytology
c. Endocervical, chlamydial, and high vaginal swabs
d. Transvaginal USS
e. Urine for microscopy, culture, and sensitivities
Endocervical, chlamydial, and high vaginal swabs
19 y/o woman attends GP for contraception review. She started Microgynon-30 14 months ago and reports a recent migraine without aura which lasted 2 days (which she has never experienced before). She is currently a smoker but has no other CVS disease or VTE risk factors. Her temperature is 36.5, HR 70, BP 115/63, RR 14, O2 sats 97% on room air, and her BMI is 21. What is the most appropriate next step in management?
a. Continue Microgynon-30 and offer smoking cessation
b. Continue Microgynon-30 and start Sumitriptan
c. Stop Microgynon-30 and offer Microgynon-20
d. Stop Microgynon-30 and offer progesterone-only contraception
e. Stop Microgynon-30 and start NuvaRing
Stop cocp and offer progesterone only
26 y/o woman has 24 hours of vulval rash and painful urination. What is the most appropriate treatment?
a. Oral aciclovir
b. Oral flucloxacillin
c. Topical aciclovir
d. Topical clotrimazole
e. Topical fusidic acid
Herpes - oral aciclovir
29 y/o seen in GP wanting to conceive. She has epilepsy and her last seizure was 18 months ago. She currently has a copper IUD in situ and is taking sodium valproate 1000mg BD. What is the most appropriate management?
a. Leave IUD in situ, continue sodium valproate, and refer her for specialist advice
b. Remove IUD, continue sodium valproate 1000mg BD and start folic acid 5mg OD
c. Remove IUD, stop sodium valproate 1000mg and start carbamazepine 600mg BD and folic acid 5mg OD
d. Remove ID, stop sodium valproate, and start folic acid 400mcg OD
Leave IUD in situ, continue sodium valproate, and refer her for specialist advice
31 y/o woman in GP is 34 weeks pregnant and presents with dysuria, frequency, and urgency. Temperature 37.2, HR 80, BP 126/78, RR 18, O2 sats 99% on room air. She has mild suprapubic pain with no rebound or tenderness. What is the most appropriate initial management plan?
a. Arrange clinical review in 24 hours
b. No investigation required, treat empirically with antibiotics
c. Reassure, no treatment needed
d. Send urine for MC&S and treat empirically with antibiotics without waiting for results
e. Send urine for MC&S and treat with antibiotics based on the results
Send urine and treat empirically immediately
35 y/o woman has frothy and thin offensive yellow vaginal discharge. She is afebrile and last has sexual intercourse 3 weeks ago. She describes dysuria for the last few days and soreness and itchiness of her vulva. What is the most likely diagnosis?
Trichomonas vaginalis infection
Neisseria gonorrhoeae characteristic discharge
Yellow or greenish discharge
Thick or cloudy consistency
Foul odor
In some cases, the discharge may be accompanied by blood
(from chatgpt)
Chlamydia trachomatis characteristic discharge
Clear or milky white discharge
It may be more watery than usual
In some cases, there may be no noticeable discharge at all
Bacterial vaginosis characteristic discharge
Thin, white or gray discharge
Fishy odor, especially after sexual intercourse
Candida characteristic discharge
Thick, white, and clumpy discharge that resembles cottage cheese
It may be odorless or have a mild yeasty odor
Itchiness and redness in the vaginal area are commonly associated with a yeast infection
80 y/o woman with a BMI of 25, COPD, and angina complains of back pain and a dragging sensation in her vagina. She has a uterine prolapse and a normal pelvic USS. What is the most appropriate treatment option?
Pelvic floor muscle training
80 y/o woman with a BMI of 25, COPD, and angina complains of back pain and a dragging sensation in her vagina. She has a uterine prolapse and a normal pelvic USS. What is the most appropriate treatment option?
Pelvic floor muscle training
8 y/o girl brought to gynaecology clinic with offensive vaginal discharge, but is otherwise well. What is the most likely cause?
Foreign body in the vagina
Stop lactation, which drug
Cabergoline
A low risk woman would like to have epidural anaesthesia but is concerned about the risks. What is the risk of permanent paralysis (give as 1:X)
~1:140,000
Pic of rash that looks like stretch marks on pregnant belly
Pruritic uriticarial papules and plaques of pregnancy
2 antenatal vaccines
Influenza
Whooping cough
A 24 year old woman in her first pregnancy, is in spontaneous labour on the labour ward. She is using Entonox for analgesia and has now been in the second stage for 3 hours. She has been in good descent from pushing for 2 hours. The baby is in the cephalic presentation in an occipito-anterior position, vertex below the ischial spines. The foetal heart rate has been suspicious for 30 minutes. Which is the most appropriate management in this scenario?
a. Caesarean section
b. Epidural analgesia
c. Episiotomy
d. Forceps delivery
e. Ventouse delivery
C-section (foetal heart rate suspicious for 30 mins - cat 1? not entirely sure as usually the answer would be forceps in second stage labour)
A 39 year old woman has a transvaginal ultrasound scan at 6 weeks of pregnancy, in which an intrauterine gestational sac was seen. She attends the Emergency Department 2 weeks later with 2 days of heavy vaginal bleeding. A transvaginal scan shows a normal endometrium. Both ovaries appear normal. There is no adnexal mass but there is a small amount of free fluid in the Pouch of Douglas. Which is the most likely diagnosis?
a. Complete miscarriage
b. Ectopic pregnancy
c. Incomplete miscarriage
d. Molar pregnancy
e. Pregnancy of unknown viability
Complete miscarriage
A 22 year old woman with cystic fibrosis attends the obstetric medicine clinic for preconception counselling. Development of which obstetric complication is she at greatest risk, given her pre-existing disease?
a. Foetal congenital malformation
b. Gestational diabetes
c. Obstetric cholestasis
d. Pregnancy induced hypertension
e. Spontaneous miscarriage
Gestational diabetes
A 48 year old woman has a progesterone IUS in place. She complains of a 1 year history of palpitations, night sweats, fatigue, irritability and vaginal dryness. What is the most appropriate treatment?
a. Oral oestrogen
b. SSRIs
c. Tibolone
d. Transdermal oestrogen
e. Vaginal oestrogen
Transdermal oestrogen - Vaginal oestrogen if there are only urogenital symptoms, oral increases VTE and stroke risk while transdermal does not
A 40 year old woman with uterine fibroids require the active management of the third stage of labour. At which point in labour should IM syntocinon (oxytocin) be administered?
a. When the anterior shoulder has been delivered
b. When the head has been delivered
c. When the neonate has been delivered
d. When the trunk has been delivered
e. When the vertex is crowning
Anterior shoulder delivered
A 55 year old woman in gynaecology outpatients has a BMI of 23.5 kg/m2 and a history of stress incontinence. Pelvic floor exercises have not improved her symptoms. Which is the most appropriate next step in management?
a. Hysterectomy
b. Intra urethral bulking
c. Ring pessary
d. Surgical repair
e. Weight loss
Surgical repair - pessary is for prolapse not incontinence
A 23 year old woman has superficial dyspareunia and type 3 female genital mutilation. Which is the most appropriate next step in management?
a. Make a safeguarding risk assessment
b. Offer reversal surgery
c. Refer for psychosexual counselling
d. Refer to police
e. Refer to social services
Psychosexual counselling - above 18 so not for safeguarding/ police, wouldnt do surgery without counselling first
A 57 year old woman in General Practice has vulval itching and passes urine more frequently. She denies any vaginal discharge. The vulval area looks dry with evidence of excoriation marks. There is an area of paler skin near the introitus. Urinalysis showed 1+ leukocytes only. Which is the most likely diagnosis?
a. Atrophic vaginitis
b. Lichen sclerosus
c. Urinary tract infection
d. Vaginal candida
e. Vaginal malignancy
Lichen sclerosus - paler skin = white plaques?
A 34 year old woman attends her GP for her 32 week antenatal appointment. She feels well in herself and has regular foetal movements. She has had normal scans to date and an uncomplicated pregnancy. Her temperature is 36.8C, pulse 93 bpm, blood pressure 113/72 mmHg, and oxygen saturation 98% breathing air. Her booking blood pressure was 110/68 mmHg.
Urinalysis - negative Ketones - negative Blood - negative Protein - 2+
Nitrites - negative
Leukocytes - negative
Which is the most appropriate next step in management?
a. Ask midwife to review in 2 weeks
b. Reassure and review at 36 week antenatal appointment
c. Refer for antenatal same day assessment
d. Send a mid-stream urine for microscopy, culture and sensitivity
e. Send a protein creatinine ratio
Protein creatinine ratio - exclude other causes of proteinuria
A woman is due to have an elective caesarean section for breech presentation at 39 weeks’ gestation. For how many hours should she be fasted for solids prior to the operation? Your answer should be expressed numerically in the form: X hours
6 hours (2 for fluids)
A woman is admitted at 12 weeks with severe nausea and vomiting. She requires three different anti-emetic treatments and IV fluids. What supplement must also be prescribed in this scenario?
Pabrinex
A 27 year old woman has a non-viable pregnancy at 6 weeks with a beta-HCG of 28,000 IU/L. What malignancy is she at greatest risk of developing?
Choriocarcinoma
A 19 year old woman complains of irritability, aggression and low mood every month. She has no other medical conditions, takes no regular medication and is sexually active. The symptom diary shows that her work and social life are being affected in a cyclical way. What, specifically, is the aim of the hormonal management in this scenario?
Surpress cyclical change of oestrogen and progesterone
A 27 year old woman has a complete molar pregnancy and only receives surgical management. She subsequently has regular serum beta-HCG monitoring. For how long should she be told to avoid pregnancy after the beta-HCG has returned to normal? (Your answer should be expressed numerically in the form: X months)
6 months
A 30 year old woman in the third trimester of her first pregnancy develops an itchy, bumpy rash on her abdomen, with sparing of the periumbilical area. She is usually fit and well and has had an uneventful pregnancy so far. What is the most likely diagnosis?
Polymorphic eruption of pregnancy - spares periumbilical area
DIC blood test results after induction of labour with misoprostol. What is the most likely causative obstetric event?
Uterine rupture - increased chances with induction due to overstimulation?
Woman in labour can feel cord protruding, emergency buzzer pulled - before experienced staff arrive what is best action?
knee chest, replace presenting structure, consent for CS, IM terbutaline
knee chest - alternative to all fours
63 yo lady just had a vaginal hysterectomy, she works as a carer in a care home. How long does she have to take off work assuming she has no complications?
6 weeks i think
Percentage increase chance of developing T2DM after having GDM:
5, 30, 50, 80, none
50 (40-60)
Women recently underwent LLETZ for CIN, when should next smear be?
6 months
Pregnant woman with swelling in lower leg. Wait for scans or give LMWH immediately?
LMWH, discontinue after if excluded
Incomplete miscarriage, what management?
Manual vacuum aspiration
After how many completed weeks of pregnancy do you offer induction of labour?
40 completed weeks
HPV vaccine strains
6, 11 - warts
16, 18 - cancer
Pureperal sepsis common organism
group A strep (pyogenes)
DVT/PE in pregnancy- scan?
Duplex ultrasound
Urge incontinence drug for old people
Tolterodine/Mirabegron, NOT oxybutynin
